Pancoast Tumor: Symptoms, Causes and Treatment

Written by Medicover Team and Medically Reviewed by Dr Jeepalem Sai Moulika , Oncologists

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A Pancoast tumor is a rare type of lung cancer that begins at the very top part of the lung, near the shoulder. Because of where it's located, it often doesn't cause the usual lung cancer symptoms like a cough or shortness of breath. Instead, it can affect nearby nerves, ribs, and bones, leading to pain and weakness in the shoulder and arm.

This tumor can press on important nerves and blood vessels, which makes early diagnosis very important.

Key points to remember:

If you or someone you know has ongoing shoulder pain or nerve symptoms, it's important to speak with a doctor.

What Are the Stages of the Pancoast Tumor?

Pancoast tumors, a rare type of lung cancer found at the top of the lung, go through stages like other cancers. These stages describe how far the tumor has grown and if it has spread to other parts of the body.

Understanding the Pancoast tumor staging helps doctors plan the right treatment.

Stage I: Localised

Stage II: Spread to Nearby Areas

Stage III: Advanced Local Spread

Stage IV: Distant Spread (Metastasis)

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What Are the Types of Pancoast Tumor?

Pancoast tumors are a rare form of lung cancer that start at the top part of the lung. Even though they all grow in the same area, not all Pancoast tumors are the same.

There are mainly two types based on the kind of cancer cells involved. Knowing the type helps doctors decide on the best treatment plan.

Non-Small Cell Lung Cancer (NSCLC)

This is the more common type of Pancoast tumor and tends to grow more slowly than the other type.

Small Cell Lung Cancer (SCLC)

This type of tumor is faster-growing and more serious but also responds better to chemotherapy in some cases.

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What Are the Symptoms of Pancoast Tumors?

Pancoast tumors are a rare type of lung cancer that grows at the top part of the lung, near the shoulder and spine. Because of their location, they often press against nearby nerves and tissues.

This leads to symptoms that are quite different from typical lung cancer, and many people don't even notice breathing problems at first.

Instead, the earliest signs are often related to pain and nerve-related issues. Knowing what to look for can help with early diagnosis and better treatment outcomes.

Here are the most common symptoms:

The early symptoms of a Pancoast tumor can often be mistaken for other conditions, which can delay diagnosis.

These symptoms occur because the tumor can press on nerves in the area. Healthcare providers refer to this condition as Pancoast syndrome.

As the tumor grows, other symptoms may develop, including:

In some cases, half of the people who have Pancoast tumors may develop a condition known as Horner's syndrome, which includes:

If you or someone you know has ongoing shoulder pain, especially along with these other symptoms, it's important to consult a doctor. Pancoast tumors are serious but treatable when caught early. Don't ignore persistent pain, early care can make a big difference.

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What Are the Causes of Pancoast Tumors?

Pancoast tumors are a rare type of lung cancer that form at the very top part of the lung, near the shoulder. Unlike other lung tumors that grow deeper inside the chest, these grow outward and often press on nearby nerves, blood vessels, and bones.

The exact cause of Pancoast tumors, like many cancers, isn't always clear. However, doctors believe that certain habits and exposures increase the chance of developing this condition over time. For Pancoast tumors, many of the risks are similar to those for other types of lung cancer, especially those linked to lifestyle and environment.

Common causes and contributing factors include:

While these causes don't guarantee someone will get a Pancoast tumor, being aware of them can help with prevention and early detection.

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How Is Pancoast Tumor Diagnosed?

Pancoast tumors can be tricky to diagnose because their symptoms often look like other common problems such as shoulder pain, neck pain, or nerve issues. That's why doctors use a mix of your medical history, physical check-ups, and several tests to find out what's really going on.

At first, your doctor will ask about symptoms like shoulder pain, arm weakness, or tingling. These signs can often point to problems with the top part of your lungs, where Pancoast tumors grow.

After the initial exam, imaging tests are done to see inside your chest and spot anything unusual. These pictures help doctors understand if there's a mass, where it's located, and how it's affecting nearby areas like bones, nerves, or blood vessels.

Once a tumor is suspected, doctors need to confirm if it's cancer and what type. That's when they collect a small sample of the tumor tissue, called a biopsy. This sample is tested in a lab to give a clear diagnosis.

Important Tests & Additional Imaging

Because Pancoast tumors grow at the top of the lung and near important structures like the spine and nerves, detailed imaging is a must. These tests don't just find the tumor, they also help the doctor decide the best treatment plan.

Here are the key imaging tests used:

Needle Biopsy

A needle biopsy is one of the most common ways doctors confirm if a Pancoast tumor is cancer. It's a simple procedure where a small sample of tissue is taken from the tumor using a thin needle.

This test is usually done after imaging scans show a suspicious mass. The doctor uses either a CT scan or ultrasound to guide the needle to the exact spot, so they can take the right tissue sample.

Video-Assisted Thoracoscopic Surgery (VATS)

VATS is a minimally invasive procedure that helps doctors see inside your chest and take a biopsy or even remove part of a tumor. It's often used when needle biopsy doesn't provide enough information or when a closer look is needed.

Instead of one large cut, VATS uses small incisions and a tiny camera called a thoracoscope. The doctor inserts tools through these openings and watches everything on a video screen. This allows for precise and careful movement without the need for open surgery.

Thoracotomy

A thoracotomy is a more traditional and open surgical procedure that allows the surgeon to access the lungs and chest area directly. It's usually done when the tumor is large, hard to reach, or involves critical structures like nerves or bones.

While this procedure is more invasive, it gives doctors the most access and visibility. It's sometimes used for both diagnosing and treating Pancoast tumors, mainly when the plan includes removing part of the lung or affected tissues.

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How Are Pancoast Tumors Treated?

Treating Pancoast tumors located at the top of the lung can be a bit different from treating other lung cancers. That's because these tumors are close to important structures like the spine, nerves, and blood vessels. Treatment often requires a combination of therapies to get the best results.

Doctors usually use a team approach that involves lung specialists, cancer doctors, surgeons, and radiologists. The goal is to shrink the tumor, stop it from spreading, and relieve symptoms like shoulder or arm pain.

Most treatment plans include:

Chemoradiation and Surgery

This is one of the most common treatment combinations for Pancoast tumors. It begins with chemoradiation, followed by surgery to remove the tumor.

Chemoradiation means you get chemotherapy and radiation therapy at the same time. This combination works better than either treatment alone because:

Chemoimmunotherapy and Surgery

In some cases, chemoimmunotherapy is given before surgery to improve the chances of removing the tumor fully and stopping it from returning.

Chemoimmunotherapy combines:

Side effects are usually manageable and may include tiredness, low blood counts, or skin rashes. Immunotherapy side effects may take longer to appear but can be treated with medication.

This approach is promising, especially for people whose tumors respond well to immune-based treatment. Your cancer care team will guide you through each step and adjust the plan as needed.

Chemoradiation and Immunotherapy

This treatment plan starts with chemoradiation, followed by immunotherapy. It's used when surgery isn't possible or when doctors want to give the immune system a boost after shrinking the tumor.

Step 1 - Chemoradiation:

After this step, the tumor is reassessed. If it's not safe to remove it surgically, or if surgery isn't an option, doctors move to immunotherapy.

Step 2 - Immunotherapy:

Radiation Therapy

Radiation therapy uses powerful energy beams to kill cancer cells. For Pancoast tumors, it's often used when surgery isn't possible or as part of a larger treatment plan.

It's typically given 5 days a week for several weeks, in short, painless sessions. The goal is to shrink the tumor, ease pain, and prevent the cancer from spreading further.

Targeted Treatment

Targeted therapy is a newer treatment option that focuses on the specific features of cancer cells, such as gene mutations or proteins that help the cancer grow.

Unlike traditional chemotherapy, which affects all rapidly dividing cells, targeted therapy goes after only the cancer cells, making it more precise and often with fewer side effects.

Before starting, your doctor will test your tumor to check if targeted therapy is a good fit. If it is, this treatment can be an effective and gentle option for managing your Pancoast tumor.

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When to See a Doctor for Pancoast Tumor?

Pancoast tumors are a rare type of lung cancer that can press on nearby nerves and tissues, causing symptoms that are sometimes mistaken for other problems like shoulder or arm pain. It's important to know when these signs could be something more serious.

See a doctor if you experience:

Early attention can lead to better outcomes, so don't ignore these signs.

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What Is the Recovery Process After Pancoast Tumor Treatment?

Recovery from a Pancoast tumor takes time and varies for each person, depending on the stage of the tumor and the treatment received (surgery, radiation, or chemotherapy). The focus is on healing, managing side effects, and slowly getting back to daily life.

Recovery may include:

Staying in touch with your doctor and reporting any new symptoms helps you heal better and avoid complications.

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What Precautions Can Help Prevent Pancoast Tumors?

While not all tumors can be prevented, some lifestyle changes can reduce your overall cancer risk.

Helpful prevention tips:

Taking care of your lungs and overall health can go a long way in lowering your chances.

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What Are the Possible Complications of Pancoast Tumors?

If not treated early, Pancoast tumors can affect nearby nerves and tissues, causing serious health problems.

Possible complications include:

Timely diagnosis and treatment are the best ways to reduce the risk of these complications.

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Our Experience Treating Pancoast Tumor

If you or a loved one has been diagnosed with a Pancoast tumor, don't panic. We understand this can be overwhelming, but you're not alone. At Medicover, we combine care, expertise, and the latest medical technology to give you the best chance at recovery.

We're here for you, every step of the way. Stay strong, and trust that you're in safe hands.

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