Have you heard about Pancoast tumors, a rare type of lung cancer that can cause shoulder or arm pain? Learn the early signs, how it’s diagnosed, and the best treatment options.
What is a Pancost Tumor?
A Pancoast tumor is a rare form of lung cancer that grows at the apex (top) of the lungs and often spreads to nearby tissues such as ribs, spine, or nerves. Due to its unusual location, it usually starts with shoulder pain, arm weakness, or neck discomfort. It may not show typical lung cancer symptoms like a persistent cough or breathlessness.
Types of Pancost tumor
Pancost tumor, also known as superior sulcus tumor, can be defined by its histology (types of cells); types are
1. Non-Small Cell Lung Cancer (NSCLC): Most common, accounting for over 95% of cases. NSCLC is a broad category that includes several subtypes:
Adenocarcinoma: It originates from the glandular cells that produce mucus in the lungs. Currently, it is the most frequently diagnosed histological type of Pancoast tumor.
Squamous Cell Carcinoma: arises from the flat, scale-like cells lining the airways and is strongly associated with smoking.
2. Small Cell Lung Cancer (SCLC): A rare, aggressive, fast-growing cancer makes up a small percentage of cases, often indicating a more advanced stage of disease.
Other Rare Malignant Causes
A tumor at the lung apex might originate from other tissues or be a spread from another cancer. These are
- Metastatic Cancer: Cancer that has spread (metastasized) to the top of the lung from a primary tumor located elsewhere in the body (e.g., breast cancer, kidney cancer, thyroid cancer, sarcoma).
- Primary Chest Wall Tumors: Originating directly from the bones (ribs, vertebrae) or soft tissues of the chest wall (e.g., sarcomas like osteosarcoma or chondrosarcoma).
- Lymphoma: A cancer of the lymphatic system that can sometimes appear as a mass in the superior sulcus.
- Mesothelioma: A rare cancer of the lining of the lung (pleura), associated with asbestos exposure, occasionally involves the lung apex.
What are the Pancost Tumor Symptoms?
A Pancost tumor may place pressure on the brachial plexus; when this happens, it is these collective symptoms that can lead to pancost syndrome. Some of the common symptoms include:
- Persistent shoulder pain or pain in the shoulder blade (scapula)
- Pain that spreads to the arm, neck, or upper back
- Fatigueless
- Hand and arm weakness.
- discomfort in the neck.
- upper rib pain.
- swelling in the upper arms.
- Loss of hand and finger coordination.
- Tingling or numbness in your hand.
- chest tightness.
- Unexplained weight loss.
Some people with a Pancoast tumor may develop Horner’s syndrome ( a Neurological condition) affecting eyelids and one side of the face. The symptoms are:
- Redness or flushing on one side of the face
- Drooping eyelid (ptosis)
- Sunken or displaced eyeball (enophthalmos)
- Reduced sweating (anhidrosis)
Note- If these symptoms don’t go away, it’s essential to see a doctor because they can be confused with nerve or muscle issues, particularly if you smoke or have a history of lung disease.
What are the causes of a Pancoast tumor?
Its symptoms are the same as those of lung cancer. The causes include:
- Smoking
- asbestos exposure
- contact with industrial chemicals (such as diesel fumes and arsenic)
- chest radiation exposure to the chest
- chronic lung conditions (like COPD)
- genetic mutations
- air pollution
- family history of lung cancer
Which Areas Can a Pancoast Tumor Spread To?
A Pancoast tumor may spread to nearby areas of the upper chest, such as:
- First ribs (upper portion of the rib cage)
- The back or upper spine.
- Brachial plexus—A network of nerves that regulates the hand, arm, and shoulder.
- The blood vessels that carry blood to the arms.
How to diagnose a Pancoast tumor?
Symptoms of a Pancoast tumor often resemble those of other conditions, such as nerve or shoulder issues. Here’s how doctors usually identify it:
- Medical history & physical exam –Examine symptoms like shoulder pain, arm weakness, or nerve involvement.
- Chest X-ray – to check for a mass at the top of the lung.
- CT Scan (Computed Tomography) – Provides a detailed image of the tumor and nearby structures.
- MRI (Magnetic Resonance Imaging) – checks for the tumor spread to nerves, spine, or blood vessels.
- PET Scan – Shows whether the tumor has spread to other body parts in case of advanced cancer.
Biopsy Methods for Diagnosing Pancoast Tumor
- Needle Biopsy
Uses a thin needle to extract tissue, fluid, or cells from the tumor. The sample is sent to a pathology lab to detect cancer cells. - VATS (Video-Assisted Thoracoscopic Surgery)
A minimally invasive procedure includes a small incision made in the chest. followed by a thoracoscope (camera tube) is inserted to view the lungs. If a tumor is found, a biopsy sample is taken for further testing. - Thoracotomy
This is an open-chest surgery where a larger incision is made between the ribs. Provides a clear view of the lungs and nearby tissues, allowing for a direct and reliable biopsy
Note- A biopsy confirms if the tumor is cancerous and helps decide the best treatment plan.
How is Pancoast Tumor Treated?
Depending upon the location and cancer spread, the Pancoast tumor treatment options are:-
- Chemoradiotherapy with Surgery- A combination of chemotherapy and radiotherapy helps shrink the tumor and makes it easier to remove surgically. It can be given post-surgery to kill any leftover cells for effective treatment.
- Chemoradiotherapy with Immunotherapy (Non-surgical Option)- If surgery isn’t possible, you may receive chemoradiotherapy (chemotherapy + Radiotherapy) as the primary treatment, followed by immunotherapy, which enhances the immune system to destroy cancer cells more effectively.
- Radiotherapy- If the cancer cannot be removed or the tumor has spread to other parts of the body, radiotherapy is used to help shrink the tumor, relieve symptoms, and improve quality of life.
- Supportive Care- Supportive treatments like pain management or medications may also be given to control symptoms.
- Targeted Therapy-. These drugs block cancer growth by acting directly on the molecular pathway involved in tumor development.
What questions do I ask my doctor?
- In what part of my body is the tumor located?
- Has the tumor spread to bones, nerves, or other nearby tissues?
- Has the cancer spread to other locations or other organs?
- What stage is my cancer at right now?
- What options do I have for treating my condition?
- Can I keep working while I’m receiving treatment?
- What is the average duration of the treatment process?
A final thought
A Pancoast tumor is an uncommon but aggressive form of lung cancer that often appears with mild symptoms like arm weakness or shoulder pain. Effective outcomes depend on early detection, as timely diagnosis enables more efficient treatment planning, including surgery, immunotherapy, chemoradiotherapy, and targeted therapies. If you or a loved one is experiencing unexplained upper-body symptoms, don’t ignore them. Consult a medical professional right away. With the right care and expert guidance, treatment is possible.
Frequently Asked Questions (FAQs)
What are the early signs of a Pancoast tumor?
Shoulder pain, arm weakness, tingling in the fingers, or chest discomfort are early signs, mistaken for muscle or nerve issues.
How is a Pancoast tumor diagnosed?
Diagnosis typically involves a chest X-ray, CT scan, MRI, PET scan, and a biopsy to confirm the presence and type of cancer.
Can a Pancoast tumor be treated successfully?
Yes. If detected early, it can be treated through chemoradiotherapy followed by surgery, immunotherapy, or targeted therapy, depending on the condition.
Is surgery always required for a Pancoast tumor?
Not always. Surgery is recommended if the patient’s health is good and fit for the tumor surgery. If not, treatment may involve chemoradiotherapy and immunotherapy.
What is the survival rate for Pancoast tumor?
Survival depends on diagnostic stage and treatment response; early-stage cases have a 5-year survival rate of around 30–50%.
