Pancoast tumor is a cancer of the upper lung that manifests itself with specific neurological symptoms. Morphologically, it is a non-small cell carcinoma – often, histology reveals adenocarcinoma or squamous cell carcinoma. A growing tumor can compress or grow into the brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, and vagus nerve. A compression or germination of the stellate ganglion is also typical for Pancoast tumor. When sympathetic fibers are involved in the pathological process from the level of the superior cervical ganglion to the Th1 segment, the patient develops Horner’s syndrome. The pathognomonic symptoms of Pancoast tumor are due to the apical localization of the tumor, destruction of the upper chest aperture, tumor infiltration of the brachial plexus and stellate ganglion. Specific signs of Pancoast tumor occur against the background of cancer intoxication (malaise, weight loss, fever) and paraneoplastic disorders. X-ray of the lungs helps to reveal darkening in the area of ​​​​the upper groove, thickening of the pleura at the top of the lung. Moreover, X-rays often found destruction of I-III ribs, lower cervical and upper thoracic vertebrae. With the help of CT or MRI of the lungs, the degree of tumor invasion into the vessels, lymph nodes, ribs, vertebrae, and chest wall tissues is determined (Feneis and Stark, 2017). To assess the involvement of blood vessels, it is possible to perform arterio- or phlebography, or contrast computed tomography. Finally, histological verification of the diagnosis is carried out after transthoracic fine-needle puncture biopsy of the tumor or open biopsy of the lymph nodes. Most often, Pancoast tumor is diagnosed at stage III, which imposes its own specifics on the treatment process. Immediately after the diagnosis is established, it is important to prescribe adequate pain relief to the patient, up to narcotic analgesics. A good analgesic effect comes from a blockade of the scalene muscle. In the practice of oncology, a three-component approach is considered the most acceptable, which includes radiation therapy, chemotherapeutic, and surgical treatment. Neoadjuvant therapy is prescribed to reduce the extent of the tumor and improve operability. Pancoast tumor usually affects men more often than women, and the people in the age between 50 and 60 are the most at risk, especially if they have a long history of smoking (Leonard, 2019).
References
Feneis, J., & Stark, P. (2017). Pancoast tumors.Contemporary Diagnostic Radiology, 40(18), 1–5. Web.
Leonard, J. (2019). Pancoast syndrome: Risk factors, symptoms, and more. Medical News Today. Web.