A Pancoast tumor develops in the top portion of the lung—known as the apex—and can trigger several uncomfortable and painful symptoms when it invades the chest wall or spine. These symptoms rarely involve the coughing and shortness of breath that are common with other respiratory malignancies, even though a Pancoast tumor is a type of non-small cell lung cancer. Instead, many patients experience sharp shoulder pain, arm pain and muscle weakness as a result of a tumor placing pressure on a nearby nerve. Patients may also experience other neurological symptoms like tingling sensations, impaired hand function and sensation loss.
Is shoulder pain a sign of lung cancer?
Sharp shoulder or scapula (shoulder blade) pain are some of the most common symptoms of a Pancoast tumor, particularly in its early stages. The pain typically develops as the tumor impacts one or more of the nearby structures, such as the:
- Ulnar nerve, which runs from the side of the arm to the wrist
- Branchial plexus, the nerve fibers that run downward from the spine and into the shoulder and arm
- Parietal pleura, the highly sensitive outer layer of the membrane that lines the chest cavity.
- Endothoracic fascia, the fibrous tissue that separates the chest wall from the diaphragm and the pleura
Shoulder pain can be a symptom of other lung cancers besides Pancoast tumors, typically if a lung tumor presses against a particular nerve or if the cancer travels to the tissues or bones near the shoulder joint.
It’s important to note that shoulder pain is far more likely to be caused by an orthopedic condition, such as osteoarthritis or a rotator cuff injury, than lung cancer. Nevertheless, shoulder pain that persists for more than a few days should be evaluated by a medical professional. Shoulder discomfort that is related to lung cancer may worsen at night, be present while resting or occur without impacting range of motion. Lung cancer that is not classified as a Pancoast tumor may also cause a hacking cough, shortness of breath and wheezing, among other respiratory symptoms.
Other Pancoast tumor symptoms
As a Pancoast tumor continues to spread, so can the pain. Patients with an advanced Pancoast tumor may feel intense, constant or radiating pain in their arms, around their chest wall, between their shoulder blades or traveling into their upper back. Patients whose tumor has spread into the scalene muscles may also feel pain in their armpit.
In addition to disruptive pain in various areas of the upper body, a Pancoast tumor may cause the following symptoms to develop:
- Swelling in the upper arm
- Chest tightness
- Weakness or loss of coordination in the hand muscles
- Numbness or tingling sensations in the hand
- Loss of muscle tissue in the arm or hand
- Unexplained weight loss
If a Pancoast tumor compresses or irritates a nerve in the sympathetic nervous system, which regulates many of the body’s involuntary actions, a patient may experience flushing and/or excessive facial sweating. Physicians occasionally refer to these complications as Pancoast syndrome. These symptoms typically only affect one side of the face—the same side where the tumor is causing the compression—and can develop long before cancerous cells invade nearby tissues.
Some patients also experience a tingling or prickly feeling in their hands. This symptom, sometimes referred to as paresthesias, is also a result of nerve compression. In advanced cases, this compression can lead to permanent sensation loss.
Pancoast tumors and Horner’s syndrome
Horner’s syndrome is a rare nerve condition that is characterized by decreased pupil size (miosis), drooping eyelids (ptosis) and an inability to sweat (anhidrosis)—all on one side of the face. Also known as oculosympathetic palsy, Horner’s syndrome affects up to 50% of people with a Pancoast tumor. The condition occurs when the tumor invades the sympathetic nervous system, which is the nerve pathway between the brain and the face that controls the body’s “flight or fight” response. Horner’s syndrome generally isn’t a serious condition and will go away when the cancer is treated.
Pancoast tumor risk factors
A risk factor is a characteristic or behavior that may increase the likelihood of developing a certain condition. The most common risk factor for Pancoast tumors is similar to that of other lung cancers: smoking or being exposed to secondhand smoke. That’s because tobacco smoke enables carcinogens to enter the lungs, which can trigger cells to grow and divide rapidly. When a cluster of abnormal cells gathers in the lungs, a Pancoast tumor can form.
Pancoast tumors are also more commonly diagnosed in men and in people in their 50s. In the general medical community, research is still being conducted on why this is so.
Pancoast tumors can affect anyone, including individuals who do not have any known risk factors for this cancer. Still, people with one or more risk factors should be particularly mindful to seek care for symptoms and receive appropriate treatment.
How common are Pancoast tumors?
Pancoast tumors are rare, making up fewer than 3% to 5% of all lung cancers. This means they can be more challenging to diagnose and treat, as not many doctors have experience with this complex disease.
When should I see a specialist about a Pancoast tumor?
If you are concerned that the shoulder pain you’re experiencing may be related to a Pancoast tumor, it’s a good idea to consult with an oncologist who specializes in this type of cancer. As discussed, this type of cancer is incredibly uncommon and it’s crucial to work with a specialist who understands and regularly treats Pancoast tumors. That’s why you should visit a high-volume cancer center, such as Moffitt Cancer Center, for advanced diagnosis and treatment of Pancoast tumors. Our experts possess a unique level of experience with uncommon lung malignancies such as these, and we have several oncologists who specialize in Pancoast tumor treatment.
Consider seeking out the Pancoast tumor specialists at Moffitt if you have been diagnosed with this type of tumor, your physician believes you might have this malignancy and has ordered additional testing or you’re experiencing unusual symptoms in addition to shoulder pain (such as chest tightness, shortness of breath and numbness and tingling) that haven’t gone away on their own after several days.
Moffitt Cancer Center’s approach to Pancoast tumors
The multispecialty team in Moffitt Cancer Center’s Thoracic Oncology Program leverages leading-edge technologies and focused expertise to efficiently identify Pancoast tumors and create refined treatment plans. As a high-volume cancer center with specialists who focus solely on lung cancers, our team routinely treats Pancoast tumors and spearheads an ambitious clinical trial program to facilitate treatment breakthroughs. A testament to our commitment to research, Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center—the only such cancer center based in Florida.
If you’ve been experiencing possible symptoms of a Pancoast tumor, Moffitt can work with your primary care provider to help you find answers and specialized lung care. Contact us at 1-888-663-3488 or complete a new patient registration form to consult with a Moffitt physician. We provide every patient with rapid access to our cancer experts within a day, which is faster than any other cancer hospital in the nation.
Medically reviewed by Dr. Lary Robinson, Pancoast Tumor Program director