Pancoast tumours are cancers that start in the top part of the lung (the apex).
These cancers were named after an American doctor called Professor Henry Pancoast in 1932. They are also called superior pulmonary sulcus tumours.
Cancers in the top part of the lung are rare. Fewer than 5 in every 100 cases of lung cancer (5%) are Pancoast tumours.
A Pancoast tumour can spread into one or more structures in the top part of the chest, which include:
- the first ribs in the chest (thoracic ribs)
- upper part of the back
- the bundle of nerves that sends signals from the spinal cord to the shoulder, arm and hand (the brachial plexus)
- blood vessels that supply blood to the arms
Types of Pancoast tumour
Most Pancoast tumours are a type called non small cell cancer and most commonly adenocarcinomas. These are cancers that start in the mucus making gland cells in the lining of your airways.
Because the cancer is at the top of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms. The group of nerves is called the brachial plexus.
Pressure on the brachial plexus can cause several very specific symptoms:
- severe pain in the shoulder or the shoulder blade (scapula)
- pain in the arm and weakness of the hand on the affected side
- Horner syndrome
Horner syndrome is the medical name for a group of symptoms. They include:
- flushing on one side of the face
- not sweating in the face
- the eye on the same side has a smaller (constricted) pupil with a drooping or weak eyelid
Diagnosing Pancoast tumours
Pancoast tumours can be difficult to diagnose. This is because, in the early stages, they often don’t show up easily on x-ray. To help diagnose a Pancoast tumour, you might have a:
- needle biopsy
- biopsy through a video assisted thoracoscopy surgery (VATS)
- biopsy through a small cut in the chest wall (small thoracotomy)
- scans such as a CT, MRI or PET-CT
The symptoms are unusual, and this might lead your doctor to suspect other conditions before lung cancer.
Treatment for a Pancoast tumour depends on the stage of the cancer, it's exact position in the lung and your general health. The stage means the size of the cancer and whether it has spread to other areas of the body.
Chemoradiotherapy and surgery
If you are fit enough to have surgery, you usually have a combination of chemotherapy and radiotherapy (chemoradiotherapy) first. This helps to shrink the cancer.
Surgery for Pancoast tumours is often difficult. It needs to be carried out by a team of specialist surgeons at a specialist cancer hospital. The surgery involves removing the top two ribs or sometimes more.
Sometimes the surgeon also needs to remove a major artery behind the collar bone. They replace it with an artificial tube (graft). This keeps a good blood supply to the arm on the affected side. They might carry out the surgery through a cut in the back or the front of the chest.
Chemoradiotherapy and immunotherapy
If you can’t have surgery, you might have chemoradiotherapy (chemotherapy with radiotherapy).
You might then have immunotherapy after chemoradiotherapy. Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
Radiotherapy or supportive care
You usually have radiotherapy if:
- the cancer can't be removed with surgery
- has spread to other areas of the body
This treatment shrinks the cancer and reduces symptoms. You can also have other medicines or treatments to control symptoms.
Your doctor will test your cancer cells for certain receptors of particular proteins. The receptors make them sensitive to targeted cancer drugs. If these receptors are present, your doctor might offer you treatment with a targeted cancer drug.