Pancoast Tumor

Overview

• Carcinoma that occurs in apex of lung  
  • also known as a superior sulcus tumor
  • defined by location
  • bronchogenic adenocarcinoma most common histologic type
    • historically, squamous cell carcinoma was most common
• Associated conditions
  • Horner syndrome  
    • proximity of the tumor to the superior cervical sympathetic ganglion chain can result in destruction/compression of the chain yielding characteristic
      • ptosis
      • miosis
      • anhidrosis
  • thoracic outlet syndrome 
    • proximity of the tumor to the thoracic outlet of the brachiplexus can result in compression of the C8, T1, and T2 nerve roots yielding characteristic:
      • axillary pain
      • shoulder pain especially along the cervical border of the scapula
      • pain along the ulnar nerve distribution
• fourth and fifth digit pain, numbness, and muscle atrophy

Presentation

• Symptoms
• most common presenting symptom is shoulder pain that radiates to the axilla and scapula 

Evaluation

• Imaging
  • cancer staging studies
    • CT chest, abdomen, and pelvis
    • MRI
• PET scan

Treatment

• Determined by type of tumor and extent of disease