Definition

What is Pancoast syndrome?

Pancoast syndrome is the term given to the unique set of symptoms that accompany a Pancoast tumor – a type of lung cancer.

Pancoast tumors are a type of non-small cell cancer that account for less than 5 percent of all lung cancers.

How common is Pancoast syndrome?

Pancoast syndrome is not common. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Pancoast syndrome?

The symptoms of Pancoast syndrome differ from the symptoms that accompany cancer in other parts of the lung. In fact, Pancoast tumors rarely cause the coughing or shortness of breath that are typically associated with lung cancer.

Instead, in addition to general cancer symptoms, such as fatigue and weight loss, the Pancoast tumor may cause pressure on nerves in the upper chest, neck, face, and arms. This pressure can lead to specific symptoms such as:

  • Pain in the shoulder and shoulder blade
  • Pain in the arm, elbow, or armpit
  • Weakness of the hand
  • Pain or tingling in the hand and fingers

The associated pain is severe and constant. Wasting away or shrinking of the hand and arm may also occur.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Pancoast syndrome?

Pancoast’s syndrome is usually caused by an apical (superior pulmonary sulcus) malignant neoplasm of the lung. They are rare, accounting for fewer than 5% of all lung cancers. The neoplasm is usually bronchogenic in origin (about half are squamous cell carcinomas, half adenocarcinomas).

Malignancies other than lung cancer can result in Pancoast’s syndrome. Primary cancers have been reported, such as breast cancer, mesothelioma, plasmacytoma or lymphoma; or metastatic carcinoma from the larynx, cervix, bladder, thyroid or colon.

Non-neoplastic causes of Pancoast’s syndrome are rare; however, there have been reported cases due to bacterial pneumonia (staphylococcal or pseudomonas), tuberculosis, hydatid disease, mycotic aneurysm, disseminated nocardiosis (a rare Gram-positive bacterial infection), plasma-cell granulomas, a cervical rib and pulmonary amyloidosis.

Risk factors

What increases my risk for Pancoast syndrome?

There are many risk factors for Pancoast syndrome, such as:

  • Smoking tobacco
  • Being exposed to secondhand tobacco smoke
  • Being in long-term contact with asbestos and radon
  • Being exposed to industrial elements, such as gold and nickel

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Pancoast syndrome diagnosed?

Diagnosis of Pancoast syndrome and Pancoast tumors can be delayed because symptoms are not typical of lung cancer. Frequently, people see a neurologist or orthopedic surgeon before consulting an oncologist.

Pancoast tumors are diagnosed using:

  • X-rays: This may reveal abnormal tissue at the top of the lung, and can show if the tumor has invaded the ribs or vertebrae. However, in the early stages Pancoast tumors are difficult to see on an X-ray film due to shadowing.
  • CT scan: This can indicate if the tumor has entered the chest wall, spine, blood vessels, nerves, windpipe, food pipe, or region between the lungs.
  • MRI: An MRI is generally more accurate than a CT scan at uncovering the extent to which a tumor has invaded other structures. It is often used alongside a CT scan, as the CT may be more effective at examining the region between the lungs.
  • Bronchoscopy: This test checks the airways of the lung.
  • Tissue biopsy: This involves removing some of the tumor cells for examination. The procedure may be an open chest biopsy, or done using a needle through the skin.
  • Other tests: These may be required to check for spread of the cancer to other areas of the body, such as the brain or bones. Examples include an MRI of the brain, bone scans, PET scans, and a mediastinoscopy to check the area between the lungs.

Some combination of X-ray, scan, and biopsy is usually carried out to confirm tumor diagnosis and to accurately assess the stage of the Pancoast tumor.

How is Pancoast syndrome treated?

Treatment of a Pancoast tumor depends on the overall health of the person who has it, the size of the tumor, and the areas it affects. Treatment can aim to reduce symptoms or to remove the cancer.

The main treatments offered are:

  • Chemotherapy
  • Radiation therapy
  • Surgery

The most effective approach is usually one that combines these three treatments. For example, people with early Pancoast syndrome who are in general good health and have limited tumor growth, may receive a combination of radiation and chemotherapy, followed by surgery and post-operative chemotherapy.

Other treatments that may be offered include:

  • Targeted therapies: In some cases treatments are available that selectively target cancer cell activity. This causes less damage to healthy cells, and people who have this type of therapy usually experience fewer side effects.
  • Symptom relief: Pain medications may help manage symptoms, while steroids can be prescribed to reduce nerve pressure.

Surgery

Surgery on Pancoast tumors should always be carried out by a specialist surgeon due to the difficulties that can be encountered. Such surgery may involve removal of the entire lung, affected nearby tissues, or the top ribs.

In some situations, removal of a major artery may be required. If so, it will be replaced by an artificial tube to maintain blood supply.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Pancoast syndrome?

The following lifestyles and home remedies might help you prevent Pancoast syndrome:

  • To reduce the risk of developing any lung cancer, quit smoking.
  • Avoid exposure to secondhand smoke and materials, such as asbestos and radon.
  • Screening is another step that can be taken to catch cancer in its early stages and prevent its progression.
  • People with a family history of lung cancer, people over 55, smokers, and former smokers may wish to discuss lung cancer screening options with their doctor.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: May 22, 2018 | Last Modified: May 22, 2018

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