What is the relationship between Horner's syndrome and bronchogenic (lung) carcinoma?

From the Guidelines

The management of Horner's syndrome in bronchogenic carcinoma should prioritize a multidisciplinary approach, including concurrent chemoradiation followed by surgery, to optimize local control and improve overall survival, as demonstrated in the Intergroup 0160-SWOG 9416 study 1. This approach is crucial in patients with superior sulcus tumors, who often present with brachial plexus invasion and Horner's syndrome, in addition to generalized edema, chest wall invasion, and shortness of breath. The use of concurrent chemoradiation followed by surgery has been shown to achieve excellent local control and prolonged overall survival in this patient population, with a 5-year overall survival rate of 54% after complete resection 1. Key considerations in the management of these patients include:

• Comprehensive staging with CT, PET scan, and possibly MRI of the thoracic inlet to assess the extent of invasion
• Pain management to address significant shoulder and arm pain caused by the tumor
• Immediate investigation for an underlying malignancy in patients presenting with Horner's syndrome, particularly in individuals with risk factors for lung cancer such as smoking history The presence of Horner's syndrome often indicates involvement of the T1 nerve root and sympathetic chain, suggesting a more aggressive tumor that has extended beyond the lung parenchyma, and therefore requires prompt and aggressive treatment, as outlined in the American College of Chest Physicians evidence-based clinical practice guidelines 1.

From the Research

Horner's Syndrome and Bronchogenic Carcinoma

• Horner's syndrome is a characteristic clinical syndrome associated with Pancoast tumors, a type of bronchogenic carcinoma located in the apex of the lung 2, 3.
• The syndrome is caused by the invasion of the tumor into the thoracic inlet and the structures of the sympathetic nervous system, resulting in symptoms such as Claude-Bernard-Horner syndrome, severe pain in the shoulder and arm, and atrophy of hand and arm muscles 3.
• Bronchogenic carcinoma is a type of lung cancer that can cause Horner's syndrome, especially in cases where the tumor is located in the apex of the lung and invades the thoracic inlet 2, 3.

Diagnosis and Treatment

• The diagnosis of Pancoast tumors and Horner's syndrome is made by a combination of clinical symptoms, radiographic findings, and tissue diagnosis via CT-guided FNA/B or other methods 3.
• The treatment of Pancoast tumors involves induction chemo-radiotherapy followed by surgical resection, which can be performed through various approaches to the thoracic inlet 2, 3.
• The prognosis of Pancoast tumors depends on the T stage of the tumor, response to preoperative chemo-radiotherapy, and completeness of resection 3.

Causes of Horner's Syndrome

• Horner's syndrome can be caused by various conditions, including tumors, surgical procedures, and carotid dissection 4.
• In cases where the cause of Horner's syndrome is unknown, the identification of the syndrome can be valuable in leading to important diagnoses such as carotid dissection and tumor 4.
• The prevalence of causes of Horner's syndrome depends on the accrual method, with procedures in the neck, chest, skull base, and paraspinal region accounting for most of the identified causes in some studies 4.