Pancoast tumor natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
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 syndrome. The symptoms of Pancoast 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 presence of the following is associated with a poor prognosis among patients with Pancoast tumor Horner syndrome, spread to the mediastinal lymph nodes, incomplete resection of tumor, involvement of supraclavicular lymph node, vertebral body invasion, metastasis to the brain.
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.[1][2][3]
- Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast syndrome.
- The symptoms of Pancoast 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.
Complications
Pancoast tumor is a subtype of lung cancer that is located at the apex of the lung. The complications associated with Pancoast tumor are:[4][5][1][2][3]
- 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.
- It is possible that Pancoast tumor will cause shoulder pain as well, especially if it spreads to the surrounding tissue resulting in Pancoast syndrome.
- Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties.
- There are treatments available to help drain the excess fluid
- 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.
- Tumors in the top (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
- It is when air leaks from a pneumonectomy bronchial stump
- Approximately 2% of patients that undergo a pneumonectomy experience this
- It will most commonly occur approximately 7 to 10 days after surgery
- In most 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
Prognosis
- 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 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 survival rate as follows depending on the stage of disease:
| Stage Of Pancoast Tumor | 5 year survival rate |
|---|---|
| IIB | 47% |
| IIIA | 14% |
| IIIB | 16% |
References
- ↑ 1.0 1.1 Glassman LR, Hyman K (July 2013). "Pancoast tumor: a modern perspective on an old problem". Curr Opin Pulm Med. 19 (4): 340–3. doi:10.1097/MCP.0b013e3283621b31. PMID 23702478.
- ↑ 2.0 2.1 Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D (March 2014). "Pancoast tumors: characteristics and preoperative assessment". J Thorac Dis. 6 Suppl 1: S108–15. doi:10.3978/j.issn.2072-1439.2013.12.29. PMC 3966151. PMID 24672686.
- ↑ 3.0 3.1 Jones DR, Detterbeck FC (July 1998). "Pancoast tumors of the lung". Curr Opin Pulm Med. 4 (4): 191–7. PMID 10813231.
- ↑ Jones, DR (Jul 1998). "Pancoast tumors of the lung". Current Opinion in Pulmonary Medicine. 4 (4): 191–197. PMID 10813231. Unknown parameter
|coauthors=ignored (help) - ↑ Eren S, Karaman A, Okur A (2006). "The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT". Eur J Radiol. 59 (1): 93–103. doi:10.1016/j.ejrad.2006.01.003. PMID 16476534.
- ↑ Komaki R, Roth JA, Walsh GL, Putnam JB, Vaporciyan A, Lee JS, Fossella FV, Chasen M, Delclos ME, Cox JD (September 2000). "Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center". Int. J. Radiat. Oncol. Biol. Phys. 48 (2): 347–54. PMID 10974447.
- ↑ Ginsberg RJ, Martini N, Zaman M, Armstrong JG, Bains MS, Burt ME, McCormack PM, Rusch VW, Harrison LB (June 1994). "Influence of surgical resection and brachytherapy in the management of superior sulcus tumor". Ann. Thorac. Surg. 57 (6): 1440–5. PMID 8010786.
- ↑ Johnson DE, Goldberg M (June 1997). "Management of carcinoma of the superior pulmonary sulcus". Oncology (Williston Park, N.Y.). 11 (6): 781–5, discussion 785–6. PMID 9189936.