Pancoast tumor

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Pancoast tumor

A pancoast tumor or superior sulcus tumor, is a tumor of the pulmonary apex i.e. a type of lung cancer defined primarily by its location situated at the top end of either the right or left lung.

The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner's syndrome.

Pancoast tumors are named for Henry Pancoast, a US radiologist, who described them in 1924 and 1932.

Symptoms

Symptoms can include miosis (constriction of the pupils), anhidrosis (lack of sweating), ptosis (drooping of the eyelid), and in severe cases, a complete Horner's syndrome. In progressive cases, the brachial plexus is also affected, causing pain and weakness in the muscles of the arm and hand. The tumour can also compress the right recurrent laryngeal nerve, a hoarse voice and bovine cough may also occur.

In superior vena cava syndrome, obstruction of the superior vena cava by a tumor (mass effect) causes facial swelling, cyanosis and dilatation of the veins of the head and neck.

A pancoast tumor is an apical tumor that is typically found in conjunction with a smoking history. The clinical signs and symptoms can be confused with neurovascular compromise at the level of the thoracic outlet. The patient's smoking history, rapid onset of clinical signs and symptoms, and pleuritic pain can suggest an apical tumor.

Treatment

The treatment of a Pancoast lung cancer may differ from that of other types of non-small cell lung cancer. Its position and close proximity to vital structures (such as nerves and spine) may make surgery difficult. As a result, and depending on the stage of the cancer, treatment may involve radiation and chemotherapy given prior to surgery (neoadjuvant treatment). Surgery may consist of the removal of the upper lobe of a lung together with its associated structures (subclavian artery, vein, branches of the brachial plexus, ribs and vertebral bodies), as well as mediastinal lymphadenectomy. Surgical access may be via thoracotomy from the back (Paulson) or the front of the chest (Dartevelle and modifications )