Pancoast Tumor - Pancoast Tumor

Pancoast Tumor
Pancoast Tumor Overview
Pancoast tumors are tumors that form at the extreme apex (very top) of either the right or left lung in the superior sulcus (a shallow furrow on the surface of the lung). Pancoast tumors are a subset of lung cancers that invade the top of the chest wall. Because of their location in the apex of the lung, they invade adjoining tissue.

Pancoast tumors originate at the top margin of the lung. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures:

Lymphatics (small, thin vessels that carry lymph fluid through the body)

Lower roots of the brachial plexus (a complex network of nerves that is formed chiefly by the lower 4 cervical [neck] nerves and the first thoracic [chest] nerve)

Intercostal nerves (nerves that lie between a pair of adjacent ribs)

Stellate ganglion (a mass of nerve tissue containing nerve cells that form an enlargement on a nerve or on 2 or more nerves at their point of junction or separation)

Sympathetic chain (either of the pair of ganglionated lengthwise cords of the sympathetic nervous system that are situated on each side of the spinal column)

Adjacent ribs

Vertebrae
Carcinomas (cancerous tumors) in the superior pulmonary sulcus produce the Pancoast syndrome, which is characterized by pain in the shoulder and along the inner side of the arm and hand. Pancoast tumors tend to spread to the tissue surrounding them in the early stage of the disease. As long as the cancer has not metastasized (spread) and involved the regional lymph nodes (small, bean-shaped structures found throughout the body), these tumors can be successfully treated.

Pancoast Tumor Causes
The risk factors for almost all lung cancers are similar. These include the following:

Smoking

Secondary smoke exposure

Prolonged asbestos exposure

Exposure to industrial elements (eg, gold, nickel)
Pancoast Tumor Symptoms
Although a Pancoast tumor is a lung tumor, it rarely causes symptoms that are typically related to the lungs (eg, cough, chest pain).

The initial symptom is pain in the shoulder, inner part of the scapula (large, triangular, flattened bone that lies over the ribs on the back), or both.

The pain may later extend to the inner side of the arm, elbow, and the pinky and ring fingers.

The associated pain is severe and constant, often requiring narcotic pain medications for relief. The affected person usually needs to support the elbow of the affected arm in the opposite hand to ease the tension on the shoulder and upper arm.

The hand, arm, and forearm may weaken, atrophy (degenerate or shrink from disuse), or develop paresthesia (a sensation of pricking, tingling, or creeping on the skin).

If the tumor extends to the sympathetic chain (a series of ganglia [masses of nerve cells] that run parallel to the vertebrae) and stellate ganglion, Horner syndrome may develop on the face and hand of one side of the body. Horner syndrome is characterized by drooping eyelids (ptosis), absence of sweating (anhidrosis), sinking of the eyeball (enophthalmos), and excessive smallness or contraction of the pupil of the eye (miosis).

In as many as 10-25% of persons with Pancoast tumor, compression of the spinal cord and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between 2 vertebrae).