Pancoast tells you where the cancer is, rather than what type it is. These cancers were named after an American doctor called Professor Henry Pancoast in 1932. Pancoast tumours grow right at the top of the lung (the apex). This position makes them rare because most lung cancers develop lower down in the lungs. Fewer than 5 in every 100 cases of lung cancer (5%) are pancoast tumours.
Most pancoast tumours are non small cell cancers and most commonly squamous cell cancers. Between 35 and 40 out of every 100 lung cancers diagnosed (35 to 40%) are squamous cell cancers. These cancers develop from the cells that line the airways.
Pancoast tumours can be difficult to diagnose. This is because
- They often don’t show up easily on X-ray – you may need an MRI scan to help diagnose the cancer
- The symptoms are unusual and this may lead your doctor to suspect other conditions before lung cancer
Because the cancer is at the top of the lungs, it may put pressure on or damage a group of nerves (the brachial plexus) that runs from the upper chest into your neck, face and arms. This 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's syndrome.
Horner’s syndrome is the medical name for a group of symptoms. You get flushing on one side of the face and that side doesn’t sweat. The eye on the same side has a smaller (constricted) pupil with a drooping or weak eyelid.
As with other types of lung cancer, treatment will depend on the stage of the cancer and your general health. By stage we mean the size of the cancer and whether it has spread to other areas of the body.
If your tumour has not spread, radiotherapy is likely to be the recommended treatment. Doctors are doing clinical trials to see if chemotherapy and radiotherapy together (chemoradiation) is useful for shrinking the tumour before surgery. This is early stage research but it looks promising. The results of 2 trials have confirmed that chemoradiation and surgery works better than radiotherapy and surgery for stages T3 or 4 with no spread to other parts of the body.
Surgery for pancoast tumours is difficult and needs to be carried out by a specialist surgeon at a specialist cancer hospital. The surgery involves removing the top 2 ribs or sometimes more. Sometimes the surgeon also needs to removes a major artery behind the collar bone and replace it with an artificial tube (graft) to keep a good blood supply to the arm on the affected side. The surgery may be done through a cut in the back or the front of the chest.
If surgery is not possible then you may have radiotherapy alone. This is very useful for controlling the tumour and any symptoms, such as pain. Or your doctor may decide to offer you a course of chemotherapy. If your cancer cells have receptors for particular proteins that make them sensitive to biological therapies your doctor may offer you this treatment.
Pancoast tumours are uncommon so it can be difficult to find much information about them. Do ask your own doctors and nurses all the questions you need. This is often the best place to start when trying to find information about a rare cancer.
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