From the Guidelines
A Pancoast tumor is a rare type of lung cancer that develops at the apex (top) of the lung and invades surrounding structures including the chest wall, brachial plexus, and sometimes vertebrae. These tumors typically cause a distinctive set of symptoms known as Pancoast syndrome, which includes shoulder pain radiating down the arm, weakness and atrophy of hand muscles, and Horner's syndrome (ptosis, miosis, and anhidrosis) 1.
Key Characteristics
- Develops at the apex of the lung
- Invades surrounding structures such as the chest wall, brachial plexus, and vertebrae
- Causes Pancoast syndrome, characterized by shoulder pain, arm weakness, and Horner's syndrome
Diagnosis and Treatment
Diagnosis requires imaging studies such as CT scans and MRI, along with tissue biopsy for confirmation 1. Treatment generally involves a multimodal approach with preoperative radiation therapy and chemotherapy followed by surgical resection when possible 1. The prognosis depends on the extent of invasion and whether complete surgical removal can be achieved. Early detection is crucial as these tumors can become inoperable if they extensively invade critical structures 1. Patients with symptoms of upper chest pain, shoulder pain, or arm weakness, especially smokers, should be evaluated promptly as Pancoast tumors can be challenging to diagnose in early stages due to their location and nonspecific initial symptoms.
Important Considerations
- Involvement of mediastinal nodes and/or metastatic disease represents a contraindication to resection 1
- A complete resection with negative margins (R0) and a pulmonary resection involving at least a lobectomy are major factors associated with better survival 1
- Referral to a specialized center with experience in performing this type of resection is recommended for patients with vertebral body or subclavian vessel involvement 1
From the Research
Definition of Pancoast Tumor
- A Pancoast tumor, also known as a superior sulcus tumor, is a malignant neoplasm of the superior sulcus of the lung that produces destructive lesions of the thoracic inlet and involves the brachial plexus and stellate ganglion 2.
- It is a complex and challenging condition that requires a multidisciplinary approach for treatment 3, 4.
Characteristics of Pancoast Tumor
- Pancoast tumors are rare and often present with severe pain and other symptoms due to the involvement of the brachial plexus and stellate ganglion 2.
- The tumors can be diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI) scans, which can detect early lesions and define the local extent or metastatic progression of the disease 2.
- The treatment of Pancoast tumors has evolved over the years, and a trimodality approach combining chemotherapy, radiation, and surgery is currently the standard of care 4, 5.
Treatment Options for Pancoast Tumor
- Surgical resection is a crucial part of the treatment, and various surgical approaches are available, including anterior and posterior approaches 3.
- Induction chemoradiation followed by surgery is a common treatment strategy, and it has been shown to improve outcomes in patients with Pancoast tumors 5, 6.
- A multidisciplinary approach involving medical and radiation oncology, as well as spine neurosurgery, is essential for optimizing outcomes in patients with Pancoast tumors 6.
Outcomes and Prognosis
- The outcomes and prognosis of Pancoast tumors have improved significantly in recent years, with a 5-year survival rate of around 38% 5.
- Complete resection and pathologic response are significant predictors of better prognosis, and novel therapies are needed to improve complete response rates 5, 6.
- Local-regional and distant recurrence are common causes of death in patients with Pancoast tumors, and further research is needed to improve systemic control of the disease 6.