A relatively uncommon type of non-small cell lung cancer, Pancoast tumors usually develop in the upper portion (superior sulcus) of a lung. Due to their location in the pulmonary apex of the chest - which is surrounded by critical structures such as blood vessels, the brachial plexus and other nerves, the spine, the ribs and the lining of the chest cavity - Pancoast tumors can be challenging to treat. However, through advances in surgical techniques and radiation therapy, patient outcomes and quality of life are continually improving.
Why do Pancoast tumors develop?
Like other types of lung cancer, most Pancoast tumors are caused by smoking or exposure to secondhand smoke. When inhaled, tobacco smoke introduces carcinogens into the lungs. These harmful substances can trigger cellular mutations that cause healthy cells to grow and divide very rapidly. Clusters of abnormal cells can then accumulate in the lungs and form Pancoast tumors.
What are the signs of a Pancoast tumor?
Early-stage Pancoast tumors are usually asymptomatic. However, as a tumor grows, it may begin to interfere with nearby structures and cause symptoms such as:
- Pain in the neck or chest, or in a shoulder, armpit, arm or wrist
- Muscle weakness, numbness or tingling sensations in an arm, hand or finger
- A droopy eyelid and pupil constriction (Horner’s syndrome)
- Facial flushing or sweating
How are Pancoast tumors diagnosed?
The diagnostic process for a Pancoast tumor involves several steps. If a Pancoast tumor is suspected based on an initial chest X-ray or computed tomography (CT) scan, further imaging tests may be ordered. For instance, magnetic resonance imaging (MRI) may be used to assess the neurological and vascular structures surrounding the tumor.
After the imaging scans are evaluated, an interventional radiologist may perform a percutaneous (through the skin) CT-guided needle biopsy (PCNB). After precisely guiding the biopsy needle into the tumor, the physician will remove a small tissue sample for evaluation by a pathologist. Alternatively, a physician may obtain tissue samples from the tumor and surrounding lymph nodes by performing a flexible bronchoscopy, which involves inserting a special instrument (bronchoscope) through the airways.
Moffitt’s approach to Pancoast tumor treatment
Pancoast tumor treatment is complex and requires the coordinated expertise of various physicians specializing in thoracic surgery, medical oncology and radiation medicine. Moffitt Cancer Center is proud to excel in the multispecialty approach necessary for treating Pancoast tumors.
As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt performs extensive research and is continually evaluating novel cancer treatments. Our Thoracic Oncology Program offers an extensive range of treatment options for Pancoast tumors, including:
Chemotherapy and radiation therapy
In many cases, Pancoast tumor treatment begins with a combination of chemotherapy and radiation therapy, which may be administered before surgery to shrink a tumor and make it easier to remove. Typically, a patient receives two or three cycles of chemotherapy and approximately six weeks of external beam radiation therapy.
At Moffitt, we offer single chemo agents and multi-agent combinations, as well as a unique three-cycle, platinum-based chemotherapy regimen that can alleviate pain associated with Pancoast tumors. We also offer several highly targeted radiation delivery methods.
Surgical treatment for a Pancoast tumor typically involves the removal of the entire tumor, the affected lung’s upper lobe and possibly a portion of the chest wall. Moffitt has a high-volume thoracic surgery center and our surgeons have extensive experience in the complex surgical management of Pancoast tumors, including combined thoracic-neurosurgical-vascular procedures and minimally invasive techniques. Oftentimes, surgeons from multiple specialties are involved.
Through our robust clinical trials program, our patients have access to groundbreaking new therapies that are not yet available in other settings, such as novel radiation delivery techniques combined with immunomodulatory drugs and targeted therapies.
Moffitt is proud to offer a comprehensive range of Pancoast tumor diagnostic and treatment options in a single location, making the process as streamlined as possible for our patients. Whether you require an initial diagnosis, a second opinion or a first, second or third line of treatment, we’re here for you at every step of your journey.
For more information about Pancoast tumors, you are welcome to talk with a specialist in the Thoracic Oncology Program at Moffitt Cancer Center. To request an appointment, please call 1-888-663-3488 or complete our new patient registration form online.