A Pancoast tumor is a lung cancer located in the apex of the lung. Pancoast tumors are classically associated with ipsilateral Horner's syndrome: ptosis (eyelid droop), miosis (pinpoint pupil), and anhydrosis (lack of sweating).
Characteristic symptoms associated with Pancoast tumors occur as a result of compression/destruction of neighboring anatomic structures. Their proximity to the sympathetic trunk can result in compression of the paravertebral sympathetic chain, causing Horner's syndrome, as described above. Proximity of tumors to the brachial plexus may result in arm and shoulder pain or paresthesias. Vocal cord paralysis may occur if the tumor compresses the recurrent laryngeal nerve. Most commonly, these tumors are non-small cell lung carcinomas.
Collins et al. review the diagnosis and management of lung cancer. Lung cancer is the leading cause of cancer-related death in the United States. While the most common presenting symptoms of lung cancer include cough and hemoptysis, Pancoast tumors more typically present with symptoms related to intrathoracic spread.
Tumura et al. review the current treatment options for Pancoast tumors. Treatment of these tumors has remained a challenge because of their invasive nature into adjacent structures. The most common approach today is induction chemoradiation with the hope of shrinking the tumor size before proceeding with surgical resection.
Figure A is a chest x-ray showing a Pancoast tumor in its typical location at the apex of the lung.
Illustration A depicts the structures that may be injured as a result of their proximity to a Pancoast tumor. Illustration B shows a patient suffering from Horner's syndrome with characteristic miosis and ptosis of the left eye.
Answer 1: Polydipsia is not associated with Pancoast tumors.
Answer 2: Digital clubbing is associated with chronic hypoxia and may be seen in patients with lung pathologies; however, it is not specifically associated with Pancoast tumors.
Answer 3: Superior vena cava syndrome results from direct compression of the SVC. While it can be seen with Pancoast tumors, it is most commonly caused by centrally-located lung or mediastinal malignancies.
Answer 5: Lateral gaze palsy is not associated with Pancoast tumors.
Collins LG, Haines C, Perkel R, Enck RE. Lung cancer: diagnosis and management. Am Fam Physician. 2007 Jan 1;75(1):56-63. Review
PMID:17225705 (Link to Abstract)
Tamura M, Hoda MA, Klepetko W. Current treatment paradigms of superior sulcus tumours. Eur J Cardiothorac Surg. 2009 Oct;36(4):747-53. Review
PMID:19699106 (Link to Abstract)