- Pancoast tumor - causes
- Pancoast tumor - symptoms
- Pancoast tumor - diagnosis
- Pancoast tumor - treatment
Pancoast tumor is a special form of lung cancer located at the apex of the lung and can infiltrate other structures of the chest outside the pleura, including vertebrae or ribs. This cancer belongs to malignant neoplasms. Pancoast tumor is a relatively rare lesion, accounting for only 1-3% of all lung cancers. It is characterized by the occurrence of the so-called The "trinity of symptoms", that is, chest pain, pain in the upper limbs and visual symptoms. What are the causes of a Pancoast tumor and how is it treated?
Pancoast tumoris located in the upper opening of the chest. It was first described in the 1930s by an American radiologist, Henry Pancoast. Although medicine has made tremendous progress since then, the biggest problem with lung cancers remains their late diagnosis. Rapid tumor growth and involvement of adjacent lymphatic vessels, fascia, intercostal nerves and a number of nerve ganglia (including the brachial plexus and the stellate ganglion) will cause the occurrence of the characteristic trinity of symptoms :
- chest pains,
- radiating upper limb pain
- and ophthalmic symptoms, e.g. eyeball collapse and pupil constriction.
When diagnosing this type of ailments, it is said about the so-calledPancoast team .
Pancoast tumor - causes
The risk factors for most types of lung cancer, including Pancoast tumor, are very similar. The main one is, first of all,smoking , both active and passive (e.g. when staying in smoky rooms).
There are even several hundred carcinogens in cigarette smoke, including aromatic hydrocarbons, phenols, benzopyrene or nitrosamines, which can induce the formation of gene mutations related to the cancer process.
Another dangerous factor, unfortunately more and more difficult to avoid by residents of large cities, arepollution of the air we breathe , and the smog it creates.
Exposure to heavy metals- nickel, radon, chromium or asbestos canalso determine a higher probability of neoplastic changes.
Genetic factors , incl. the presence of mutations in certain genes (e.g. KRAS, BRAF, EGFR) and diagnosed lung tumors in close family members may also increase the individual's predisposition to develop a Pancoast tumor.
Pancoast tumor - symptoms
The initial symptoms of a Pancoast tumor may be non-specific, difficult to distinguish from a chronic shoulder injury or back pain.
Point pain will appear around the shoulder blade, upper ribs and upper arm. With time, however, it may "extend" throughout the entire hand, elbow joint, and even fingers.
The neurological symptoms you experience usually depend on what nerves the tumor invades. The frequently developing disease can damage the brachial plexus and the stellate ganglion, one of the main ganglia in the chest.
If the stellate ganglion is involved, and with it a sympathetic trunk (i.e. a complex series of nerves running along the spine to the base of the skull), neurological symptoms may show up on the face, especially on the side affected by the neoplastic tumor.
These ailments, also known asHorner's syndrome , characteristic for the diagnosis of a Pancoast tumor, include :
- narrowing of the eye (eyelid fissure) caused by paralysis of the muscles supporting the eyelid,
- constriction of the pupil of the eye on one side, damaged dilator muscles also prevent it from expanding in the dark,
- collapse of the entire eyeball into the eye socket, caused by paralysis of the orbital muscle,
- lighter color of the iris of the eye on the side of the damaged nerve.
On the tumor side, the hand muscles will become weaker and weaker, so sometimes patients involuntarily support the drooping, atrophic arm and elbow.
As the cancer progresses, the pains can become very strong and only go away after the strongest opioids are given.
Pancoast tumor - diagnosis
Due to complex neurological symptoms that may indicate, among others, a hernia of the spine (colloquially known as "disc prolapse") and other diseases.
In order to make a diagnosis of a Pancoast tumor, a thorough diagnosis must be made. It consists, depending on the doctor's recommendations, mainly a series ofimaging tests :
- RTG,
- MRI
- and PET-TK.
It is especially considered the gold standard in the diagnosis of lung cancer computed tomography (CT) of the chest and abdomen .
An in-depth assessment based on the photos and sections received allows for:
- verification of the cancer stage,
- presence of metastases,
- determining the proportion and location of the lesion to other organs, e.g. heart, diaphragm, etc.
In all patients suspected of lung cancer,bronchoscopyis also performed, i.e. a tumor specimen is collected using special specula with forceps.
In situations where the histopathological diagnosis of the tumor is not established, afine needle aspiration biopsy (FNAB) is performedintroduced through the chest wall.
In patients with suspected lymph node metastases (detected in previous CT or PET examinations),mediastinoscopyis also performed. It is the collection of tissue fragments of mediastinal lymph nodes through the speculum.
Blood laboratory tests(e.g. for tumor markers or the presence of oncogenic mutations) usually do not have much diagnostic significance in the diagnosis of lung cancer and are performed only as an aid.
Pancoast tumor - treatment
Until 50 years ago, a Pancoast tumor was considered incurable. Thanks to the progress of medicine and the advancement of surgical procedures, currentlyit is possible to cure this type of cancer in approximately 35 to 45% of patients .
The main therapeutic strategy is combination therapy: surgical resection preceded by local irradiation (radiotherapy).
The operation may be complex, involving the simultaneous removal of the affected lobe of the lung along with the chest wall, ribs, intercostal nerves and the lower roots of the brachial plexus.
Therefore, in patients diagnosed with a Pancoast tumor, a very careful assessment of the general he alth condition, efficiency, risk of complications, and quality of life of the patient after the end of therapy should be performed.
- The first symptoms of lung cancer. How to recognize the onset of lung cancer?
- Lung cancer - causes, symptoms, diagnosis