Pancoast tumor (patient information)

Pancoast tumor
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Pancoast tumor?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

A Pancoast tumor, also known as superior sulcus tumor, defined primarily by its location at the pulmonary apex. The tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, or, compression of a sympathetic ganglion.

What are the Symptoms of Pancoast tumor?

• Common symptoms of Pancoast tumor include

• A cough that doesn't go away and gets worse over time
• Constant chest pain
• Coughing up blood
• Shortness of breath, wheezing, or hoarseness
• Repeated problems with pneumonia or bronchitis
• Swelling of the neck and face
• Loss of appetite or weight loss
• Fatigue

Who is at Highest Risk?

• People with constant exposure to high levels of air pollution and drinking water that has a high level of arsenic can increase your risk of lung cancer that can present as Pancoast tumor. A history of radiation therapy to the lungs can also increase risk.
• Working with or near cancer-causing chemicals or materials can also increase the risk of developing lung cancer. Such chemicals include:

• Asbestos
• Chemicals such as uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust
• Certain alloys, paints, pigments, and preservatives
• Products using chloride and formaldehyde

Diagnosis

• The doctor will perform a physical exam and ask about your medical history. You will be asked if you smoke, and if so, how much you smoke and for how long you have smoked. You will also be asked about other things that may have put you at risk of lung cancer, such as exposure to certain chemicals. When listening to your chest with a stethoscope, the doctor may hear fluid around the lungs or areas where the lung has partially collapsed. This may suggest cancer.
• Tests that may be done to diagnose lung cancer or see if it has spread include:

• Bone scan
• Chest x-ray
• Complete blood count (CBC)
• CT scan of the chest
• MRI of the chest
• Positron emission tomography (PET) scan
• Sputum test to look for cancer cells
• Thoracentesis (sampling of fluid buildup around the lung)

• In most cases, a piece of tissue is removed from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

• Bronchoscopy combined with biopsy
• CT-scan-directed needle biopsy
• Endoscopic esophageal ultrasound (EUS) with biopsy
• Mediastinoscopy with biopsy
• Open lung biopsy
• Pleural biopsy

• If the biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread.

Treatment Options

There are many different types of treatment for Pancoast tumor:

• Treatment depends on the stage of the cancer
• Surgery is the common treatment for Pancoast tumor that has not spread beyond nearby lymph nodes. The surgeon may remove:

• One of the lobes of the lung (lobectomy)
• Only a small part of the lung (wedge or segment removal)
• The entire lung (pneumonectomy)

• Some patients need chemotherapy
• Chemotherapy uses drugs to kill cancer cells and stop new cells from growing. Treatment may be done in the following ways:
• Chemotherapy alone is often used when the cancer has spread outside the lung (stage IV).
• It may also be given before surgery or radiation to make those treatments more effective. This is called neoadjuvant therapy.
• It may be given after surgery to kill any remaining cancer. This is called adjuvant therapy.
• Chemotherapy is usually given through a vein (by IV). Or, it may be given by pills.
• Controlling symptoms and preventing complications during and after chemotherapy is an important part of care.
• Radiation therapy can be used with chemotherapy if surgery is not possible. Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells. Radiation may be used to:
• Treat the cancer, along with chemotherapy, if surgery is not possible
• Help relieve symptoms caused by the cancer, such as breathing problems and swelling
• Help relieve cancer pain when the cancer has spread to the bones

• The following treatments are mostly used to relieve symptoms caused by Pancoast tumorr:

• Laser therapy - a small beam of light burns and kills cancer cells
• Photodynamic therapy - uses a light to activate a drug in the body, which kills cancer cells

Where to find Medical Care for Pancoast tumor ?

Medical care for (disease name) can be found here.

Prevention

• If you smoke, now is the time to quit. If you are having trouble quitting, talk with your doctor.
• There are many methods to help you quit, from support groups to prescription medicines. Also, try to avoid secondhand smoke.
• If you smoke or used to smoke, talk with your doctor about getting screened for lung cancer. To get screened, you need to have a CT scan of the chest.

What to Expect (Outlook/Prognosis)?

• The outlook varies. Most often, Pancoast tumor grows slowly. In some cases, it can grow and spread quickly and cause rapid death. The cancer may spread to other parts of the body, including the bone, liver, small intestine, and brain.
• Chemotherapy has been shown to prolong life and improve the quality of life in some patients with stage IV non small cell lung cancer.
• Cure rates are related to the stage of disease and whether you are able to have surgery.

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000434.htm