Understanding Pancoast Tumor and Its Effects on the Body

Written by Medicover Team and Medically Reviewed by Dr Kovvuru Bhaskar Reddy , Oncologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

A Pancoast tumor is a rare type of lung cancer that begins in the upper part of the lung, near the shoulder and the base of the neck. Most Pancoast tumors are non-small cell lung cancers (NSCLC) and can grow into nearby structures such as the chest wall, ribs, nerves, blood vessels, or vertebrae.

Because of its location, a Pancoast tumor may initially cause shoulder, upper back, or arm symptoms rather than typical lung cancer symptoms such as persistent cough or shortness of breath. Early evaluation of persistent or unexplained symptoms is important for diagnosis and treatment planning.

Key points to remember:

It develops in the upper part of the lung, also called the lung apex or superior sulcus.
Shoulder, upper back, or arm pain may be among the first symptoms.
It may cause weakness, tingling, or numbness in the arm or hand when nearby nerves are affected.
It can affect the sympathetic nerves and cause Horner's syndrome, which may include a drooping eyelid and a smaller pupil on one side.
Diagnosis and treatment require assessment of the tumor's type, stage, and involvement of nearby structures.

What Are the Stages of a Pancoast Tumor?

Pancoast tumors are staged using the same lung cancer staging principles as other non-small cell lung cancers. Staging considers the size and local extension of the tumor, involvement of nearby lymph nodes, and whether the cancer has spread to distant organs.

The exact stage depends on the tumor's TNM classification rather than simply whether it has reached a particular nearby structure. Understanding the stage helps doctors determine whether the tumor can be treated with surgery and which combination of treatments may be appropriate.

Early-Stage Disease

The tumor is confined to the lung or has limited local involvement.
There is no evidence of spread to distant organs.
Treatment may include surgery as part of a combined treatment plan when the tumor is considered resectable.

Locally Advanced Disease

The tumor may extend into nearby structures such as the chest wall, ribs, nerves, blood vessels, or vertebrae.
Nearby lymph nodes may also be involved.
Treatment commonly requires a combination of chemotherapy, radiation therapy, and surgery when appropriate.

Metastatic Disease

The cancer has spread to distant parts of the body.
Treatment generally focuses on controlling the cancer, relieving symptoms, and maintaining quality of life.
Systemic treatments such as chemotherapy, immunotherapy, or targeted therapy may be considered depending on the tumor's characteristics.

What Are the Types of Pancoast Tumor?

Pancoast tumor describes the location of a lung cancer rather than a separate cancer type. Most Pancoast tumors are non-small cell lung cancers, although other histological types can rarely occur.

Identifying the type of cancer cells is important because it helps doctors determine the most appropriate treatment and whether molecular or biomarker testing is needed.

Non-Small Cell Lung Cancer (NSCLC)

NSCLC is the most common type of cancer found in Pancoast tumors. It includes several subtypes with different cellular characteristics.

Squamous cell carcinoma: A common NSCLC subtype that can occur in Pancoast tumors.
Adenocarcinoma: A type of NSCLC that develops from glandular cells and may occur in the upper lung.

Small Cell Lung Cancer (SCLC)

Small cell lung cancer can rarely occur in the superior sulcus region. It tends to grow and spread more quickly than NSCLC and is treated differently.

It represents a small proportion of Pancoast tumor cases.
It can spread early to lymph nodes and distant organs.
Treatment usually relies on systemic therapy and radiation rather than the treatment approach commonly used for resectable NSCLC.

What Are the Symptoms of Pancoast Tumors?

Pancoast tumors grow in the upper part of the lung and can press on nearby nerves, blood vessels, ribs, and other tissues. As a result, the symptoms may differ from those of other lung cancers.

Shoulder or upper back pain and nerve-related symptoms may appear before common respiratory symptoms. The symptoms depend on which nearby structures are affected by the tumor.

Common symptoms include:

Shoulder pain, which may extend toward the arm or upper back
Arm pain or weakness
Neck pain
Weakness of the hand or arm muscles
Tingling or numbness in the hand or fingers

These symptoms may occur when the tumor affects the nerves of the brachial plexus or other nearby structures. This group of symptoms is often referred to as Pancoast syndrome or superior sulcus syndrome.

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

Chest pain
Swelling of the arm or hand when blood vessels are affected
Fatigue
Unexplained weight loss
Shortness of breath

Some people develop Horner's syndrome when the tumor affects the sympathetic nerves. Its features may include:

Drooping eyelid on one side of the face (ptosis)
Smaller pupil in one eye (miosis)
Reduced or absent sweating on one side of the face (anhidrosis)

Persistent shoulder or arm pain, particularly when accompanied by weakness, numbness, or other neurological symptoms, should be evaluated by a doctor.

What Are the Causes of Pancoast Tumors?

Pancoast tumors are caused by cancerous changes in cells in the upper part of the lung. The exact reason why these changes occur is not always known, but the risk factors are generally similar to those for other lung cancers.

Smoking is the most important preventable risk factor for lung cancer. Exposure to certain occupational or environmental carcinogens can also increase the risk.

Common risk factors include:

Smoking: Cigarette smoking significantly increases the risk of lung cancer and is associated with many Pancoast tumors.
Exposure to harmful substances: Long-term exposure to substances such as asbestos, certain industrial chemicals, and other occupational carcinogens can increase lung cancer risk.
Secondhand smoke: Regular exposure to tobacco smoke can also increase the risk of lung cancer.
Previous radiation exposure: Radiation therapy to the chest for another cancer can increase the risk of developing a later lung cancer.
Genetic changes: Acquired changes in lung cells can cause uncontrolled cell growth and cancer development.

When to See a Doctor for Pancoast Tumor?

Consult a doctor if you have persistent or unexplained shoulder, upper back, neck, or arm pain, especially when it is accompanied by weakness, numbness, or other neurological symptoms. A pulmonologist or medical oncologist may evaluate suspected lung cancer, while a thoracic surgeon may assess whether surgery is appropriate.

Persistent pain in the shoulder, upper back, neck, or arm
Weakness, tingling, or numbness in one arm or hand
Drooping eyelid or a smaller pupil on one side of the face
Unexplained weight loss or persistent fatigue
A persistent cough, chest discomfort, or breathing difficulty

Get medical help immediately if:

Severe breathing difficulty or rapidly worsening respiratory symptoms
Sudden severe weakness or neurological symptoms
Severe chest pain or coughing up significant amounts of blood

Prompt medical evaluation is important because Pancoast tumors can involve nerves, blood vessels, bones, and other structures near the upper lung.

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How Is Pancoast Tumor Diagnosed?

Pancoast tumors can be difficult to diagnose because early symptoms may resemble shoulder, neck, or nerve problems. Doctors consider the symptoms, medical history, physical examination, imaging findings, and biopsy results when evaluating a suspected tumor.

Imaging tests help determine the location and extent of the tumor and whether nearby structures or distant organs are involved. A biopsy is generally needed to confirm cancer and identify its histological type.

What Imaging Tests Are Used?

Chest X-ray: May detect an abnormality or mass in the upper part of the lung.
CT scan: Provides detailed images of the chest and helps assess the tumor, lymph nodes, ribs, and other nearby structures.
MRI: Provides detailed information about soft tissues and is particularly useful for assessing involvement of the brachial plexus, spine, blood vessels, and other structures.
PET-CT: Helps evaluate metabolic activity and identify possible spread to lymph nodes or distant parts of the body.

How Is a Biopsy Performed?

A biopsy involves removing a small sample of tissue from the suspected tumor so that it can be examined under a microscope. The sample may also undergo molecular or biomarker testing when appropriate to help guide treatment.

What Is VATS?

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure that can be used to examine the chest and obtain tissue samples in selected cases. It uses small incisions and a thoracoscope to provide a view inside the chest.

What Is a Thoracotomy?

A thoracotomy is an open surgical procedure that provides direct access to the chest. It may be considered when a tumor requires extensive surgical access or when the treatment plan involves removal of the tumor and affected lung or chest-wall structures.

How Are Pancoast Tumors Treated?

Treatment for a Pancoast tumor depends on the cancer type, stage, whether the tumor can be completely removed, its molecular characteristics, and the patient's overall health. Because these tumors are close to important nerves, blood vessels, ribs, and the spine, treatment is usually planned by a multidisciplinary cancer team.

For resectable NSCLC Pancoast tumors, treatment commonly involves chemotherapy and radiation therapy followed by surgery. Other treatments, including immunotherapy or targeted therapy, may be considered depending on the stage and tumor biomarkers.

For tumors that cannot be removed surgically or have spread to distant organs, treatment is generally based on the stage and tumor type and may include systemic therapy, radiation therapy, or supportive treatment.

Chemoradiation followed by surgery for selected resectable tumors
Chemotherapy combined with immunotherapy in appropriate advanced NSCLC cases
Radiation therapy to control the tumor or relieve symptoms when indicated
Targeted therapy when specific actionable molecular changes are identified
Immunotherapy when the tumor and clinical situation make it appropriate

What Is Chemoradiation Followed by Surgery?

For selected resectable Pancoast tumors, chemotherapy and radiation therapy may be given before surgery. This approach can shrink or control the tumor and treat microscopic cancer cells before the operation.

Chemotherapy: Uses medicines that travel through the body to destroy or control cancer cells.
Radiation therapy: Uses high-energy radiation to target the tumor and nearby cancer cells.
Surgery: May be performed after initial treatment when the tumor can be safely and completely removed.

When Is Immunotherapy Used?

Immunotherapy helps the immune system recognize and attack cancer cells. It may be used in certain stages of NSCLC based on the treatment plan, tumor characteristics, and biomarker results.

When Is Radiation Therapy Used?

Radiation therapy may be used as part of treatment before surgery, when surgery is not possible, or to control symptoms caused by the tumor or its spread.

When Is Targeted Therapy Used?

Targeted therapy is used when testing identifies specific molecular changes that can be treated with an approved targeted medicine. Unlike conventional chemotherapy, these medicines are designed to act on particular molecular features of cancer cells.

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What Is the Recovery Process After Pancoast Tumor Treatment?

Recovery after Pancoast tumor treatment varies according to the stage of cancer and the treatments received. Recovery may involve healing after surgery, managing the effects of chemotherapy or radiation therapy, and gradually returning to daily activities.

Recovery may include:

Regular follow-up visits and imaging as recommended by the cancer care team
Physical therapy to improve shoulder, arm, and chest movement after treatment
Pain management for postoperative or nerve-related pain
Breathing exercises and pulmonary rehabilitation when appropriate
A balanced diet, adequate rest, and gradual physical activity to rebuild strength

Patients should report new or worsening symptoms to their cancer care team during recovery and follow the recommended follow-up schedule.

What Precautions Can Help Reduce the Risk of Pancoast Tumors?

There is no guaranteed way to prevent Pancoast tumors, but reducing exposure to known lung cancer risk factors can lower the overall risk of lung cancer.

Helpful measures include:

Avoid smoking and seek support to quit if you currently smoke.
Avoid or minimize exposure to secondhand smoke.
Follow appropriate workplace safety measures when exposed to asbestos or other occupational carcinogens.
Maintain a healthy lifestyle with regular physical activity and a balanced diet.
Discuss lung cancer screening with a healthcare provider if you meet recommended high-risk criteria.

What Are the Possible Complications of Pancoast Tumors?

Pancoast tumors can cause complications when they grow into or compress nearby nerves, blood vessels, bones, or other structures. The complications depend on the location and extent of the tumor.

Possible complications include:

Persistent or severe shoulder and arm pain
Weakness, numbness, or loss of function in the arm or hand
Breathing difficulties
Horner's syndrome
Involvement of the ribs, spine, blood vessels, or chest wall
Spread of cancer to lymph nodes or distant organs

What Is Our Approach to Treating Pancoast Tumors?

If you or a loved one has been diagnosed with a Pancoast tumor, treatment requires careful assessment because of the tumor's location near important nerves, blood vessels, and bones. A multidisciplinary team can evaluate the cancer type, stage, resectability, and available treatment options.

Care may involve oncologists, thoracic surgeons, pulmonologists, radiation oncologists, and radiologists.
Treatment options may include chemotherapy, radiation therapy, surgery, immunotherapy, or targeted therapy when appropriate.
The treatment plan is tailored according to the tumor stage, pathology, molecular findings, and overall health.
Supportive care can help manage pain, breathing problems, treatment side effects, and recovery needs.

Frequently Asked Questions

1. What does a Pancoast tumor feel like?

Pancoast tumors often cause severe, persistent shoulder or arm pain, which may radiate to the chest, upper back, or neck. Patients may also experience numbness, tingling, or weakness in the arm or hand, particularly in the ring and pinky fingers, due to nerve compression.

2. What does a Pancoast tumor look like?

On imaging (X-ray, CT, or MRI), Pancoast tumors appear as a mass or density at the lung's apex, often invading nearby ribs or vertebrae. They may be hard to detect early on X-rays due to their location.

3. How do Pancoast tumors spread?

Pancoast tumors typically spread locally to nearby structures like ribs, vertebrae, nerves, or blood vessels. They can also metastasize to lymph nodes, bones, liver, or brain via lymphatic or hematogenous routes.

4. What is the life expectancy with a Pancoast tumor?

Life expectancy varies by stage. Early-stage, surgically treatable tumors have a 5-year survival rate of 30-50%, up to 90% in favorable cases. Late-stage, inoperable tumors have lower survival rates.