What is Pancoast Tumor?
Pancoast tumors are a form of non-small cell lung cancers. They form at the top of either lung and due to their location they invade the adjoining tissues as well. The affected structures are the lymph vessels, adjacent ribs, nerves, the small bones of the spine and the region located between the lungs. American radiologist Dr. Henry Pancoast discovered them in 1932 and therefore they are named after him.
Symptoms of Pancoast Tumor
The Pancoast tumor symptoms are different from the cancers that affect the other parts of the lung. Patients rarely face coughing or shortness of breath that are connected to lung cancer. Along with the general symptoms of cancer like fatigue and weight loss, this tumor causes nerve pressure in the neck, face, arms and upper chest. This pressure leads to specific symptoms such as the following:
- Arm, elbow and armpit pain
- Weakness of hand
- Pain in the hand and fingers
- Shoulder and shoulder blade pain
- Shrinking of the arm and hand
The pain is constant and severe. Horner’s syndrome is another symptom that is associated with this tumor. The Horner’s syndrome affects one side of the face and may cause drooping of the upper eyelid, a small pupil, elevation of the lower eyelid, and no sweat on one side of the face.
Causes of Pancoast Tumor
The causes of Pancoast tumors are the following:
- Exposure to prolonged asbestos
- Secondary smoke exposure
- Exposure to industrial elements like chromium and nickel.
Diagnosis of Pancoast Tumor
The diagnosis of Pancoast tumors is delayed as these are not typical lung cancers. People usually consult a neurologist or an orthopedic surgeon before seeing an oncologist. The tumors are diagnosed through the following ways:
X-rays to Diagnose Pancoast Tumor: It can reveal an abnormal tissue at the top of the lung and also whether the tumor has penetrated the ribs and vertebrate.
CT Scan for Diagnosing Pancoast Tumor: CT scan can reveal whether the tumor has invaded the spine, blood vessels, windpipe, food pipe or the chest wall.
MRI: An MRI is more accurate compared to a CT scan. It is more effective and can examine the region between the lungs.
Bronchoscopy: This checks the airways of the lungs.
Tissue Biopsy: Tissue biopsy is done by removing the tumor cells for examination. This procedure may be an open chest biopsy or can be done by using a needle.
Other Tests to Diagnose Pancoast Tumor: These are conducted to check if cancer has spread to other areas of the body like the bones and brain. Some examples are MRI of the brain, PET scans, bone scans and mediastinoscopy.
Treatment of Pancoast Tumor
Treatment depends on the overall health condition of the patient and the Pancoast tumor size. Treatment can reduce the symptoms and remove cancer. The treatments offered for Pancoast Tumor are chemotherapy, surgery and radiation therapy. The most effective approach to treat Pancoast tumor is the one that combines the three treatments. Patients who are healthy and have little tumor growth can receive radiation and chemotherapy in combination followed by surgery and chemotherapy post-operation. Other treatments include the targeted therapies and symptom relief.
Prevention of Pancoast Tumor
The most significant preventive measure that can reduce the risk of Pancoast tumor is to quit smoking. Avoiding exposure to asbestos and radon can also reduce its risk. Screening is another preventive measure that can detect cancer in the early stages and reduce its progression.
Pancoast Tumor Survival Period
The survival rates for Pancoast tumor are rising in the last few decades and they have a better chance than the cancerous tumors located at the down of the lungs. The survival rate after treating pancoast tumor with chemotherapy, surgery, and radiation during 2 years is 55-70%. The 5 years survival rate is the range of 55-74%. T3 and T4 have the better chance of survival.