Pancoast tumor overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
Historical Perspective
Pancoast tumor was first described by Hare in 1838. In 1924, Henry K. Pancoast discovered the association between apical chest tumors, characteristic pain distribution, and Horner’s syndrome. In 1954, external beam radiation was used for the treatment of associated pain by Haas and colleagues. In 1990’s a combination of chemotherapy and radiotherapy was found to be associated with better prognosis and treatment outcome.
Classification
The staging of the pancoast tumor is based on the TNM system. Pancoast tumors staging starts at T3 always, as there is an invasion of the chest wall. Invasion of the vertebral body or the subclavian vessels is regarded as T4.
Pathophysiology
Pancoast tumor is the type of lung cancer that is associated with invasion of the apical chest wall. The location of Pancoast tumor in the superior sulcus results in an invasion of adjacent structures and in its characteristic clinical presentation. The progression of Pancoast tumor usually involves spread across the pleural apex to invade the following structures by direct extension into lymphatic vessels in the endothoracic fascia, intercoastal nerves, lower roots of brachial plexus, stellate ganglion, sympathetic chain, adjacent ribs, adjacent vertebra bodies, extension to the spinal cord can result in cord compression, subclavian artery or subclavian vein. The development of Pancoast syndrome is the result of tumors in the superior pulmonary sulcus is characterized by pain along ulnar nerve distribution and Horner syndrome.
Causes
Most common cause of Pancoast tumor is non–small cell lung carcinoma (NSCLC).Common types of non-small cell lung carcinoma (NSCLC) presenting as Pancoast tumor are squamous cell cancer, adenocarcinoma and large cell carcinoma. Less common causes of Pancoast tumor includes small cell cancer as it rarely presents as a peripheral tumor. Pancoast syndrome is classically associated with Pancoast tumor. Rare causes of Pancoast syndrome include desmoid tumor, metastasis, hematologic neoplasms, and infections that may present as a tumor localized to the lung apex.