What is a Pancoast tumor? How does it differ from other lung cancers? What are the symptoms and treatment options? Get answers to your questions about this rare but serious condition.

Understanding Pancoast Tumors

Pancoast tumors are a unique type of lung cancer that originate in the upper portion of the lung, also known as the lung apex. These cancers were first described by American physician Henry Pancoast in 1932, and are therefore often referred to as “Pancoast tumors” or “superior pulmonary sulcus tumors.” Pancoast tumors account for less than 5% of all lung cancer cases, making them a relatively rare form of this disease.

Anatomy and Spread of Pancoast Tumors

Pancoast tumors are characterized by their location at the top of the lung. Due to this positioning, these cancers can spread and invade surrounding structures, including the:

• First ribs in the chest (thoracic ribs)
• Upper part of the back
• Bundle of nerves that send signals from the spinal cord to the shoulder, arm, and hand (brachial plexus)
• Blood vessels supplying the arms

This ability to infiltrate nearby anatomical structures sets Pancoast tumors apart from other lung cancers, which typically grow and spread within the lung tissue itself.

Histological Subtypes of Pancoast Tumors

The majority of Pancoast tumors are a type of non-small cell lung cancer, most commonly adenocarcinomas. Adenocarcinomas originate from the mucus-producing gland cells lining the airways. Other less common subtypes include squamous cell carcinoma and small cell lung cancer.

Symptoms of Pancoast Tumors

What are the typical symptoms associated with Pancoast tumors? Due to their location at the lung apex, these cancers can put pressure on or damage the brachial plexus – the bundle of nerves running from the upper chest into the neck and arms. This can lead to a characteristic set of symptoms, including:

• Severe shoulder or arm pain
• Muscle weakness or atrophy in the hand and arm
• Numbness or tingling sensations in the hand and arm
• Drooping eyelid and constricted pupil on the affected side (Horner’s syndrome)

In addition, Pancoast tumor patients may also experience more general lung cancer symptoms such as cough, shortness of breath, and weight loss.

Diagnosis and Imaging of Pancoast Tumors

How are Pancoast tumors detected and diagnosed? Initial imaging with a chest X-ray may show subtle changes, such as a non-homogenous opacity in the upper lung zone or tracheal deviation. However, in up to 1.7% of cases, the chest X-ray may appear normal despite the presence of a Pancoast tumor. Therefore, if there is a high clinical suspicion, further imaging with a CT scan of the chest is warranted. CT scans can clearly demonstrate the soft tissue mass in the lung apex and assess for invasion of surrounding structures.

Treatment Approaches for Pancoast Tumors

The treatment of Pancoast tumors typically involves a multimodal approach, often combining surgery, radiation therapy, and chemotherapy. The specific treatment plan depends on the stage and extent of the tumor, as well as the patient’s overall health and preferences. In early-stage Pancoast tumors, surgical resection may be the primary treatment, potentially followed by adjuvant (additional) therapies. For more advanced or inoperable tumors, neoadjuvant (pre-surgical) chemotherapy and radiation therapy may be used to try to shrink the tumor prior to surgery. In some cases, definitive chemoradiation therapy without surgery may be the most appropriate approach.

Prognosis and Outcomes

The prognosis for patients with Pancoast tumors can vary widely, depending on factors such as the stage at diagnosis, the tumor’s resectability, and the patient’s response to treatment. In general, early-stage Pancoast tumors that are surgically resectable tend to have a better prognosis, with 5-year survival rates around 30-40%. However, more advanced or inoperable Pancoast tumors have a poorer prognosis, with 5-year survival rates often less than 10%. Continuous advancements in treatment approaches and the use of multimodal therapy have helped to improve outcomes for some patients with Pancoast tumors in recent years.