Pancoast Tumor

Pancoast tumors are tumors that form at the extreme apex 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.

They principally involve the chest wall structures rather than the underlying lung tissue.

They typically invade the following structures:

  • lymphatic system
  • lower brachial plexus root  (network of nerves that is formed chiefly by the lower 4 cervicalvertebrae nerves and the first thoracic nerve of the chest)
  • Intercostal nerves
  • 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
Symptoms: “Pancoast syndrome”
  1.  Shoulder pain
  2. Pain along the medial aspects of the arm and hand
Pancoast tumors tend to spread to the tissue surrounding them in the early stage.
As nerves are affected, 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).
As nerves of the face are affected, Horner (sign) syndrome is characterized by drooping eyelids (ptosis), absence of sweating (anhidrosis), sinking of the eyeball (enophthamos), and excessive smallness or contraction of the pupil of the eye.
10-25% of persons with Pancoast tumor may develop spinal cord compression and paraplegia  when the tumor extends into the intervertebral foramina.
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