What Are the Symptoms of a Pancoast Tumor?

Medically Reviewed on 2/13/2023
Symptoms of a Pancoast Tumor
The life expectancy for Pancoast tumors is lower than that for individuals with other types of lung cancer.

Pancoast tumors, also known as superior sulcus tumors, are a type of lung cancer that invades the top of the lung and can affect the nerves in the chest, leading to various symptoms.

The most common signs and symptoms of a Pancoast tumor include:

  • Pain in the shoulder or upper arm: This is often the first symptom of a Pancoast tumor. The pain can be constant and severe, and it can worsen when you raise your arm or move your neck.
  • Weakness or numbness in the arm or hand: The tumor can affect the nerves that control the muscles in the arm and hand, leading to weakness or numbness.
  • Difficulty moving the arm or shoulder: The weakness or numbness in the arm may make it difficult to move the shoulder or lift the arm.
  • Loss of grip strength: The weakness in the muscles of the hand and arm may affect the ability to grip objects.
  • Changes in sensation in the arm or hand: The tumor can affect the nerves that carry sensations, leading to changes in the arm or hand.
  • Changes in skin color and temperature: The skin of the arm or hand may become pale, blue, or red due to changes in blood flow. The arm or hand may feel cold to the touch.
  • Swelling in the arm: The tumor can cause fluid to build up in the arm, leading to swelling.
  • Horner syndrome: This is a group of symptoms that occur when the tumor affects the nerves that control the eyes and face. Symptoms include drooping eyelids, small pupils, and decreased sweating on the affected side of the face.
  • Chest pain: The tumor can cause pain in the chest, especially when taking a deep breath or coughing.
  • Shortness of breath: The tumor may cause difficulty breathing due to pressure on the airways or fluid accumulation in the lungs.
  • Hoarseness: The tumor may affect the nerves that control the vocal cords, leading to hoarseness or a change in the voice.
  • Cough: A Pancoast tumor may cause a persistent cough.
  • Weight loss: The tumor may cause unintentional weight loss.
  • Fatigue: Many people with a Pancoast tumor experience fatigue.

Other conditions can also cause these symptoms, so it's important to see a doctor if you are experiencing any of these symptoms.

What are the causes of and risk factors for Pancoast tumors?

The exact cause of Pancoast tumors is unknown, but several factors may increase a person's risk of developing this type of cancer. Pancoast tumors affect the upper part of the lung and can invade nearby structures such as the ribs, spine, and brachial plexus (a network of nerves in the shoulder).

These tumors are relatively rare and occur more frequently in men than in women. They are often found in people who smoke tobacco, and the risk of developing a Pancoast tumor increases with the number of cigarettes smoked and the duration of smoking. People with a history of heavy tobacco use are at the highest risk of developing this type of cancer.

There may also be a genetic component to the development of Pancoast tumors as some families have a higher incidence of this type of cancer.

Potential risk factors for Pancoast tumors

  • Smoking: The most significant risk factor for Pancoast tumors and all types of lung cancer. The chemicals in tobacco smoke can damage the DNA in lung cells, leading to cancerous changes.
  • Exposure to harmful substances: People who work in certain industries, such as mining or construction, may be exposed to dust and chemicals that can increase the risk of developing a Pancoast tumor.
  • Age: The risk of developing a Pancoast tumor increases with age, and most people diagnosed with this type of cancer are older than 50 years.
  • Gender: Men are more likely to develop a Pancoast tumor than women.
  • Family history: People with a family history of lung cancer may be at increased risk for developing a Pancoast tumor.
  • Environmental factors: Exposure to certain environmental toxins, such as air pollution, may increase a person's risk of Pancoast tumors.
  • Genetics: Some studies have suggested that certain genetic mutations may increase a person's risk of developing Pancoast tumors.

Having one or more of these risk factors does not guarantee that a person will develop a Pancoast tumor. However, it is important to be aware of these factors and to take steps to reduce the risk, such as quitting smoking and avoiding exposure to harmful substances.

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How are Pancoast tumors diagnosed?

These tumors can be challenging to diagnose because they often do not cause symptoms until they are advanced.

Several tests can be used to diagnose a Pancoast tumor:

  • Physical examination: A doctor may suspect a Pancoast tumor based on specific physical symptoms, such as shoulder or arm pain, numbness or weakness in the arm, or difficulty moving the arm.
  • X-ray: An X-ray of the chest can help visualize the tumor and assess its size and location. However, X-rays are not always able to accurately detect Pancoast tumors because they are located in a part of the lung that is not always visible on an X-ray.
  • CT scan: A more detailed imaging test that can provide a better view of the tumor and the surrounding tissues. A CT scan can help confirm the presence of a Pancoast tumor and determine its size and location.
  • Positron emission tomography (PET) scan: A specialized imaging test that uses a small amount of a radioactive substance to create detailed images of the body's cells. A PET scan can help detect Pancoast tumors because they tend to be more active and take up more of the radioactive substance than normal cells.
  • Biopsy: A procedure in which a small sample of tissue is removed and examined under a microscope. A biopsy can be performed to confirm the diagnosis of a Pancoast tumor and to determine the type of cancer cells present. This information can help guide treatment decisions.
  • Other tests: Other tests, such as blood tests or imaging tests of the brain, may be performed to evaluate the extent of the cancer and determine the best course of treatment.

How are Pancoast tumors classified?

Pancoast tumors are classified based on the location and type of cancer cells present. 

Different types of Pancoast tumors may include:

  • Squamous cell carcinoma: The most common type of Pancoast tumor, which accounts for about 70 percent of cases. It arises from flat squamous cells scale-like cells that line the surfaces of the body.
  • Adenocarcinoma: This type of Pancoast tumor arises from glandular cells, which are cells that produce and secrete mucus or other substances. Adenocarcinomas can occur in various organs, including the lungs, breasts, and colon.
  • Small cell carcinoma: Fast-growing cancer that tends to spread quickly to other parts of the body. It is often found in the lungs but can also occur in the superior sulcus region.
  • Large cell carcinoma: A less common type of lung cancer that grows and spreads more slowly than small cell carcinoma. It is characterized by large, abnormal cells that do not look like normal lung tissue.
  • Mixed histology: This Pancoast tumor combines two or more types of cancer cells, such as squamous and adenocarcinoma cells.
  • Other types: There are other rare types of Pancoast tumors, including sarcomas, which are cancerous tumors that arise from connective tissue, and lymphomas (cancerous tumors that arise from immune cells).

A diagnosis and treatment plan will be developed based on these factors and the overall health of the affected person.

What are the stages of Pancoast tumors?

There are several stages of Pancoast tumors, which are used to describe the severity of cancer and help guide treatment.

The following are the five stages of Pancoast tumors:

  1. Stage 0: The earliest stage of a Pancoast tumor, where the cancer is contained within the lining of the bronchus (the airways in the lung). At this stage, the cancer is considered noninvasive and has not spread to other parts of the body.
  2. Stage I: At this stage, cancer has grown through the bronchus and into the surrounding tissue but has not spread to lymph nodes or other organs.
  3. Stage II: By this stage, cancer has spread to nearby lymph nodes but has not reached other organs.
  4. Stage III: Cancer has spread to nearby organs or lymph nodes or may have even caused the collapse of the lung.
  5. Stage IV: The most advanced stage of a Pancoast tumor, where cancer has spread to distant organs or tissues.

The stages of Pancoast tumors are based on the size of the tumor and how far it has spread. The treatment options and prognosis vary depending on the stage of cancer.

How are Pancoast tumors graded?

Pancoast tumors are classified into the following three grades based on how aggressive they are:

  • Grade I: These tumors are the least aggressive and tend to grow slowly. They are often small in size and have not spread beyond the area where they originated.
  • Grade II: These tumors are more aggressive than grade I tumors and tend to grow faster. They may have spread beyond their original location and invaded nearby tissues or organs.
  • Grade III: These tumors are the most aggressive and proliferate rapidly. They often spread to other parts of the body and can be difficult to treat.

The grade of a Pancoast tumor can affect treatment options and the outlook for the affected person. A higher-grade tumor is generally considered more serious and may require more aggressive treatment.

What are the treatment options for Pancoast tumors?

Pancoast tumors can be challenging to treat, however, several different treatment options are available. 

Treatment options for Pancoast tumors include:

  • Surgery: This is typically the first line of treatment for Pancoast tumors. The goal of surgery is to remove as many cancerous cells as possible. This may involve the removal of a portion of the lung, the nearby lymph nodes, and other tissues that may be affected by cancer.
  • Radiotherapy: Involves the use of high-energy radiation to kill cancer cells. It can be used before or after surgery to help reduce the risk of cancer relapse.
  • Chemotherapy: Involves the use of drugs to kill cancer cells. It is often used in combination with surgery or radiotherapy to help improve the chances of a successful outcome.
  • Photodynamic therapy: Involves the use of a photosensitizing agent and a special light source to kill cancer cells. It is typically used in conjunction with other treatments, such as surgery or chemotherapy.
  • Targeted therapy: Uses drugs that target specific proteins or other substances within cancer cells. It may be used in combination with other treatments to help improve the chances of a successful outcome.
  • Immunotherapy: Uses medications that help boost the body's immune system to fight cancer. It is often used in combination with other treatments to help improve the chances of a successful outcome.
  • Clinical trials: Some people with Pancoast tumors may be eligible for participation in clinical trials, which are research studies that test new or experimental treatments.

The specific treatment plan for a Pancoast tumor will depend on several factors, including the stage and grade of cancer, the person’s overall health, and personal preferences. It is important to discuss all of the available treatment options with a healthcare provider to determine the best course of action.

What is the life expectancy of people with Pancoast tumors?

In general, the life expectancy for individuals with Pancoast tumors is lower than that for individuals with other types of lung cancer due to the location of the tumor. These tumors can be particularly aggressive and difficult to treat because they often grow into surrounding tissues and nerves, which can lead to significant symptoms and complications.

  • On average, the five-year survival rate for people with Pancoast tumors is about 30 to 50 percent but may be as high as 90 percent if detected very early.
  • If surgery allows the complete removal of cancerous cells, the five-year survival rate is 54 to 77 percent.
  • The outlook is better for people with stage III tumors than for those with stage IV tumors.

Advances in treatment and the development of new therapies have improved the outlook for many individuals with Pancoast tumors in recent years, and some may experience long-term survival.

These survival rates are only estimates and do not guarantee how long an individual with a Pancoast tumor will live. Every person's situation is unique, and it's important to discuss prognosis and treatment options with a medical professional.

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Medically Reviewed on 2/13/2023
References
Image Source: iStock image

Pancoast Cancer https://utswmed.org/conditions-treatments/pancoast-cancer/

Pancoast Tumors https://www.roswellpark.org/cancer/lung/what-lung-cancer/pancoast-tumors

Superior Sulcus (Pancoast) Tumor https://www.tgh.org/institutes-and-services/conditions/superior-sulcus-tumor-pancoast

The Favorable Prognostic Factors for Superior Sulcus Tumor: A Systematic Review and Meta-Analysis https://www.frontiersin.org/articles/10.3389/fonc.2020.561935/full

What is the optimal management of Pancoast tumours? https://wiki.cancer.org.au/australia/Clinical_question:What_is_the_optimal_management_of_Pancoast_tumours%3F