Pathophysiology of Pancoast Tumor
Pancoast tumor is:
1) caused by growth of tumor in lung apex
2) extends into eighth cervical and first and second thoracic nerves
3) can also selectively affect the cervical sympathethic nerves
Signs and Symptoms
1) shoulder pain radiating down the arm
2) numbness in fourth and fifth fingers
3) weakness of intrinsic muscles of the hand
4) Horner’s syndrome on affected side
5) cough
6) hemoptysis
7) dyspnea
8) chest pain
Characteristic Test Findings
Radiology – chest radiograph shows mass in apex of lung, pleural effusion, destruction of first and second ribs
Histology/Gross Pathology
Pancoast tumor is usually squamous cell carcinoma
Associated Conditions
obstructive pneumonia
Treatment
1) preoperative radation (30 Gy in 10 treatments) followed by en bloc resection of tumor and chest wall
2) higher doses of radiation as single modality
Tips for USMLE
1) Horner’s syndrome – ptosis (drooping) of upper eyelid, miosis (constriction of pupil), anhidrosis (lack of sweating), and sometimes enophthalmos (depression of eyeball)
2) Pancoast tumor has a 10% cure rate with aggressive surgical resection
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