Is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (stellate ganglion).
This is accompanied by: 1) severe pain in the shoulder region radiating toward the axilla and scapula along the ulnar aspect of the muscles of the hand; 2) atrophy of hand and arm muscles; 3) Horner syndrome (ptosis, miosis, hemianhidrosis, enophthalmos); and 4) compression of the blood vessels with edema.
Non-small-cell lung cancer is the most common etiology of Pancoast syndrome; adenocarcinoma, squamous cell carcinoma, and large cell carcinoma have all been observed. Overall, Pancoast tumors are uncommon and comprise fewer than 5% of all lung cancers.
Although superior sulcus tumors were considered categorically unresectable and resistant to radiotherapy (RT), multimodality therapy has been shown to be the optimal approach for the treatment of these tumors.
- For tumors that invade the brachial plexus, the spine, or both, a combined thoracic-neurosurgical approach is warranted.
- Radiation and chemotherapy may benefit local and systemic control by addressing individual adverse findings. Neoadjuvant or induction chemoradiotherapy can be administered to patients with potentially resectable tumors.
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Adapted from Medscape Drugs & Diseases. Pancoast Syndrome. Available at http://emedicine.medscape.com/article/284011-overview. Accessed on February 15, 2016. To view the entire article and all other content on the Medscape Drugs & Diseases site, a free, one-time registration is required