Pancoast tumor natural history

The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention. Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast’s syndrome. The symptoms of Pancoast’s syndrome start as referred pain to the shoulder. Without treatment, the tumor may invade surrounding tissues to cause pain along the ulnar nerve distribution, atrophy of hand muscles and spinal cord compression. The complications associated with Pancoast tumor are breathing difficulties, pneumonia, hemoptysis, pain, pleural effusion,metastasis, Horner’s syndrome, superior vena cava syndrome, compression of the spinal cord, and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between two vertebrae). The prognosis of Pancoast tumor depends on the stage of the tumor at diagnosis. The factors associated with a poor prognosis among patients with Pancoast tumor include Horner’s syndrome, spread to the mediastinal lymph nodes, incomplete resection of tumor, involvement of supraclavicular lymph node, vertebral body invasion, metastasis to the brain.

• The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention.^[1][2][3]
• Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast’s syndrome.
• The symptoms of Pancoast’s syndrome start as referred pain to the shoulder. Without treatment, the tumor may invade surrounding tissues to cause pain along the ulnar nerve distribution, atrophy of hand muscles, and spinal cord compression.

Pancoast tumor is a subtype of lung cancer that is located at the apex of the lung.The complications associated with Pancoast tumor are:^{[1][2][3][4][5]}

• Breathing difficulties

• Lung cancer patients can experience trouble breathing especially when tumors grow and block the airways. Also, it is possible for fluid to build up in the lungs of the patients which makes it difficult for the lungs to fully expand when inhaling.

• Pneumonia

• If cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.

• Hemoptysis (coughing up blood)

• Occasionally lung cancer can cause bleeding in the airways which results in the patient coughing up blood.

• Pain

• It is possible that Pancoast tumor will cause shoulder pain as well, especially if it spreads to the surrounding tissue resulting in Pancoast’s syndrome.

• Pleural effusion

• Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties.

• Metastasis

• In many cases, lung cancer will spread out to other parts of the body. Some of the more common places lung cancer metastasizes to are the bones, liver, brain, and adrenal glands.

• Horner’s syndrome

• Tumors in the apex of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner’s syndrome).

• Superior vena cava syndrome
  • SVCS is a group of symptoms caused by obstruction of the superior vena cava. More than 60% of cases of superior vena cava obstruction are caused by malignant causes, typically a tumor outside the vessel compressing the vessel wall.
• Compression of the spinal cord
  • Spinal cord compression and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between two vertebrae).

Surgical Complications

• Bronchopleural fistula

• It is when air leaks from a pneumonectomy bronchial stump.
• Experienced in approximately 2% of patients that undergo a pneumonectomy.
• It commonly occurs approximately 7 to 10 days after surgery.

• Hemothorax

• In majority of cases, it occurs from bronchial vessels or lung parenchyma.
• It may have the symptoms of hypovolemia.
• Usually, it can be treated by transfusion.

• Atelectasis
• Sputum retention
• Wound infection
• Wound dehiscence
• Air embolism
• Respiratory failure associated with or without ARDS

Vascular complications

• Subclavian artery injury
• Subclavian vein thrombosis
• Forearm edema
• Chylothorax

Neurological complications

• Klumpke-Déjérine syndrome
• Horner’s syndrome (miosis, ptosis, and enophthalmos)

Chemo-radiotherapy complications

• Pneumonitis
• Peripheral neurologic dysfunctions
• Esophagitis
• Infection
• Hematologic toxicity
• Stomatitis

• The prognosis of Pancoast tumor depends on the stage of the tumor at diagnosis.^[6][7][8]
• The presence of the following is associated with a poor prognosis among patients with Pancoast tumor:
  • Horner’s syndrome
  • Spread to the mediastinal lymph nodes
  • Incomplete resection of tumor
  • Involvement of supraclavicular lymph node
  • Vertebral body invasion
  • Metastasis to the brain
• Pancoast tumor is associated with a 5 year survival rate as follows depending on the stage of disease:

Template:WH Template:WS