A rare type of lung cancer that begins to develop in the top part of the lung is called a Pancoast tumor. The most common symptoms are shoulder pain and arm weakness. However, this type of cancer cannot be cured. That’s why the treatment focuses on relieving the symptoms and improving the quality of life. Usually, doctors recommend chemotherapy, radiation therapy, and surgery.
In most cases, this tumor is detected in advanced stages because it does not cause symptoms similar to classic lung cancer. People often get the diagnosis when it spreads to nearby tissues (including nerves and blood vessels). The name of this tumor comes from the radiologist who first identified it in the early 20th century. Sometimes, it is called a superior sulcus tumor.
Generally, it occurs very rarely and accounts for 5% of all lung tumors.
Types of Pancoast Tumor
Healthcare professionals have categorized this condition into 2 subtypes. For example:
- Non-small cell lung cancers (including adenocarcinomas and squamous cell carcinomas)
- Small cell lung cancers
Generally, most Pancoast tumors are adenocarcinomas. These tumors begin to develop in the lining of the alveoli and airways.
Symptoms
When the tumor becomes large, it may put pressure on the brachial plexus (a group of nerves that go from the upper chest into the neck and arms). As a result, you may experience symptoms. This collection of symptoms is often called Pancoast syndrome, or Pancoast-Tobias syndrome.
In most cases, this tumor develops on the affected side of the body. For instance, if the tumor affects the right part of the body, the symptoms will occur in the same part. Check below some symptoms that people with Pancoast tumors often experience:
- Severe shoulder pain (sometimes may include the shoulder blade)
- Arm and hand weakness
- Neck pain
- Upper arm swelling
- Numbness or tingling in the hand
- Loss of dexterity in the hands and fingers
- Fatigue (extreme tiredness)
- Tightness in the chest
- Unexplained weight loss
- Pain in the upper ribs
- In some cases, pain may spread to the arm, wrist, and fingers
Furthermore, about 50% of people who develop a Pancoast tumor may also have Horner’s syndrome. This condition may also cause symptoms. For example:
- Facial flushing
- Ptosis (drooping eyelid)
- Enophthalmos (displaced eyeball)
- Anhidrosis (lack of sweat)
In any case, if any of the previous symptoms occur, immediately contact your healthcare professional.
Causes and Risk Factors
The causes and risk factors are similar to other types of lung cancer. Check below the most common risk factors:
- Prolonged exposure to some chemicals (including Asbestos, Radon gas, heavy metals, and others)
- Smoking (including secondhand smoke exposure)
- Cancer treatments (such as radiation therapy)
- Industrial elements
Additionally, this cancer may spread to other structures and organs of the body. In most cases, it spreads from the affected lung to the upper chest or back, thoracic ribs, and nearby blood vessels.
What Are The Potential Complications of Pancoast Tumor?
People with a Pancoast tumor may also experience some complications, especially if cancer is found in advanced stages. Check below some examples:
- Pancoast syndrome – it often causes severe shoulder and arm pain that radiates into the hand.
- Horner’s syndrome
- Damage to the brachial plexus
- Vascular compression
- Spinal canal compression that may lead to paralysis
- Metastasis
- Treatment complications – These include skin irritation, myelitis, brachial neuritis, esophagitis, lung fibrosis, and others
This document does not contain a complete list of Pancoast tumor complications. However, you can consult with your healthcare professional about ways to reduce the risk or even prevent previous complications.
How to Prevent Pancoast Tumor?
Generally, it is not always possible to prevent this type of lung cancer. However, the following tips may significantly reduce the risk. Examples include:
- Quit smoking – If you face problems with smoking cessation, it is advised to discuss it with your physician. You should also avoid secondhand smoke when possible.
- Clean environment – It is very important to make sure your environment is free from dangerous chemicals or substances, especially Asbestos.
Additionally, if you have a family history of lung cancer, your risk of developing a Pancoast tumor significantly increases. That’s why it is usually recommended to have regular cancer screenings.
Diagnosis
Commonly, in the early stages, this tumor cannot be seen on a two-dimensional chest X-ray. That’s why doctors often suspect a Pancoast tumor based on the symptoms. Therefore, they may perform the following tests to confirm the condition. Examples include:
- Imaging tests – The following tests are often performed to get detailed images of the lung and nearby structures. They may also determine the extent (stage) of the cancer. Doctors often perform CT (computed tomography) scans, PET (positron emission tomography) scans, or MRI (magnetic resonance imaging) scans.
- Needle biopsy – This procedure involves the removal of a small sample of tumor to test it under a microscope for cancerous cells.
- VATS (video-assisted thoracoscopy surgery) – During this procedure, doctors make a cut (incision) in the chest and then insert a thoracoscope to examine the chest cavity and detect any tumors. Doctors may also get a sample of the tumor for testing during VATS.
- Thoracotomy – This test also involves an incision on the right or left side of the chest (between the ribs). Hence, it helps doctors clearly see the affected lung and take a sample for biopsy. Sometimes, physicians may remove the tumor during this procedure to avoid multiple surgical procedures.
Treatment
The treatments are often different among people with Pancoast tumors. It depends on the severity, type, and exact location of the tumor, existing health problems, age, and preferences. Check below for the most common treatments recommended for people with this type of lung cancer:
Chemoradiation and Surgery
While surgery is the primary treatment, doctors may also recommend chemotherapy along with radiation therapy before surgery to shrink a large tumor. Sometimes, surgery to remove a Pancoast tumor can be difficult. Sometimes, surgeons may need to remove the top two ribs.
Chemoimmunotherapy and Surgery
In some cases, doctors may recommend a combination of surgery and chemoimmunotherapy (chemotherapy and immunotherapy). While chemotherapy destroys cancerous cells throughout the body, immunotherapy boosts the immune system to fight against these abnormal cells.
Chemoradiation and Immunotherapy
This combination of treatments is mostly recommended when surgery is not an option.
Radiation Therapy
This therapy is commonly recommended to slow cancer growth and ease the symptoms. When the tumor is found in the early stages and surgery is not an option, radiation therapy may be the only treatment needed.
Targeted Therapy
This option involves specific medicines that block certain proteins in the cancerous cells, causing them to die. It is often prescribed by doctors in advanced stages of the cancer and when surgery is not an option.
Frequently Asked Questions
Are Pancoast tumors fatal?
In general, this type of cancer is considered very aggressive. However, today these tumors can be managed. If you suspect you may have this tumor, do not hesitate to see a doctor.
What can be mistaken for a Pancoast tumor?
Sometimes, the following conditions can be mistaken for a Pancoast tumor. Examples include:
- Primary tumors of the thyroid, larynx, or pleura
- Infectious disorders of the lungs
- Aneurysm of the subclavian vessels
- Amyloid of the pleura
- Multiple myeloma
This article does not contain a full list of disorders that could be mistaken for Pancoast tumors. For more details, discuss it with your doctor.
What are the symptoms of a Pancoast tumor?
These include:
- Severe shoulder pain
- Weakness in the arm and hand
- Upper arm swelling
- Pain in the neck or upper ribs
Ask your healthcare provider if you have any other questions.
