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Pancoast tumours

Pancoast tumours are cancers that start in the top part of the lung (the apex). 

Diagram showing the lungs including the apex

These cancers were named after an American doctor called Professor Henry Pancoast in 1932. They are also called superior pulmonary sulcus tumours.

Cancers in the top part of the lung are rare. Fewer than 5 in every 100 cases of lung cancer (5%) are Pancoast tumours.

A Pancoast tumour can spread into one or more structures in the top part of the chest, which include:

  • the top ribs in the chest (the thoracic ribs)
  • nerves in the top of the chest
  • bundles of nerves close to the spinal cord that supply the arm and hand (the brachial plexus)
  • blood vessels that supply blood to the arms

Types of Pancoast tumour

Most Pancoast tumours are a type called non small cell cancer and most commonly squamous cell cancer. Squamous cell cancers develop in the flat cells that cover the surface of your airways.

Symptoms

Because the cancer is at the top of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms. The group of nerves is called the brachial plexus.

Pressure on the brachial plexus 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.

Diagnosing Pancoast tumours

Pancoast tumours can be difficult to diagnose. This is because, in the early stages, they often don’t show up easily on x-ray. You might need a CT scan or MRI scan to help diagnose it.

The symptoms are unusual and this might lead your doctor to suspect other conditions before lung cancer.

Treatment

Treatment for a Pancoast tumour depends on the stage of the cancer, it's exact position in the lung and your general health. The stage means the size of the cancer and whether it has spread to other areas of the body.

Chemotherapy, radiotherapy and surgery

If you are fit enough to have surgery, you usually have a combination of chemotherapy and radiotherapy (chemoradiotherapy) first to shrink the cancer. This is called trimodality or combination treatment.

Surgery for Pancoast tumours is often difficult and needs to be carried out by a team of specialist surgeons at a specialist cancer hospital. The surgery involves removing the top two ribs or sometimes more.

Sometimes the surgeon also needs to remove 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. They might carry out the surgery through a cut in the back or the front of the chest.

Chemotherapy, radiotherapy and immunotherapy

If you can’t have surgery, you might have chemoradiotherapy (chemotherapy with radiotherapy).

You might then have immunotherapy after chemoradiotherapy. Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

Radiotherapy or supportive care

If the cancer can't be removed with surgery or has spread to other areas of the body, you usually have radiotherapy. This treatment shrinks the cancer and reduces symptoms. You can also have other medicines or treatments to control symptoms.

After the radiotherapy your doctor might offer you a course of chemotherapy. If your cancer cells have receptors for particular proteins that make them sensitive to targeted cancer drugs your doctor might offer you treatment with a targeted cancer drug.

For more information and support

You can phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They will be happy to help.
Last reviewed: 
23 Oct 2019
Next review due: 
23 Oct 2022
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    National Institute for Health and Care Excellence (NICE), 2019

  • Management of lung cancer
    Scottish Intercollegiate Guideline Network, February 2014

  • Diagnosing and treating pancoast tumors
    K Zarogoulidis and others
    Expert Review of Respiratory Medicine, 2016

    Volume 10, Issue 12

  • Superior sulcus tumors: a mini-review

    V. C. Archie and C. R. Thomas Jr

    The Oncologist, 2004

    Volume 9, Number 5

  • Pancoast tumour: current therapeutic options

    VD Palumbo and others

    Clinica Terapeutica, 2019

    Volume 170, Issue 4

  • Superior pulmonary sulcus (Pancoast) tumors

    UpToDate 2019

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