Pancoast Tumor

Pancoast Tumor

    * Introduction
    * Diagnosis
    * Treatment
Pancoast tumor or tumor of the upper groove tip is a type of lung cancer, especially lung defined by its location in the top right or left lung. Progressively growing tumor can cause compression brahiocefalice vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve or sympathetic ganglion resulting in a variety of symptoms known as Pancoast syndrome, named after the man who discovered it first.
In addition to general cancer symptoms such as malaise, fever, weight loss and fatigue, Pancoast tumor may also include complete Horner syndrome in severe cases: miosis, anhidrosis, ptosis and endophthalmitis. In progressive cases, the brachial plexus is also affected cauzaind pain and weakness in the muscles of the arm and hand. The tumor may compress laryngeal nerve caused by a voice hoarse and coughing cow. The superior vena cava syndrome, superior vena cava obstruction by a tumor result in facial swelling, cyanosis, and other head and neck veins.
A Pancoast tumor is found associated with smoking. Clinical signs can be confused with pulmonary neurovascular damage. Patient's smoking history, rapid onset of signs and symptoms and pleuritic pain suggests apical tumor. A Pancoast tumor Pancoast's syndrome may also cause Horner syndrome. When the roots of the brachial plexus is involved Pancoast syndrome, damage to the sympathetic fibers entering the cervical ganglion will produce Horner's syndrome.
The tumor is much less common than other types of lung cancer. This shows the percentages of 3%. A major problem is their late detection. Apical lung cancer can not be viewed from an initial chest radiograph, and at the time of patient presentation to the doctor, the tumor has already invaded nearby structures. In addition to the symptoms produced by the tumor can be mimicked by numerous neurological or musculoskeletal disorders, late for diagnosis.
Treatment of Pancoast lung tumor may be different from that of other types of lung cancer. Its position and proximity to vital structures (nerves and spinal cord) surgery is difficult. As a result, and depending on the stage of cancer treatment may involve surgery, radiotherapy and chemotherapy, neoadjuvant treatment previously. Surgery consists of removing the upper lobe of the lung-associated structures with subclavian artery, vein, branches of the brachial plexus, ribs and vertebral corpus, and mediastinal lymphadenectomy. Surgical approach is by thoracotomy.
Pathogenesis Lung tumor mass in the upper groove is an extension of lung cancer. Most tumors are extrapulmonary and involves the chest wall, nerve roots, trunk of brachial plexus, sympathetic chain, stellate ganglion, ribs and bones. Most Pancoast tumors are squamous cell carcinomas or adenocarcinomas. Only 3-5% are small cell carcinomas. Squamous cell carcinomas occur more frequently, although undifferentiated tumor types are also common. Adenocarcinoma is sometimes found in this location and can be metastatic. Phrenic or recurrent laryngeal nerve damage or superior vena cava are not representative of the classic Pancoast tumor.
Signs and symptoms Pancoast tumor is a subset of lung cancer that invades the apical chest wall. Due to its location on the apex of the pleural invade neighboring tissues. Although many other tumors can produce similar clinical pictures by locating their chest, the most common cause is believed to be from the ditch bronhogenic carcinoma invading the upper and extratoracice structures by direct extension. Tumor location, pathology or histology only to determine the characteristic clinical picture.
Typical symptoms are localized lung tumor in the upper groove of the chest adjacent cervical nerve roots, the second thoracic trunk distribution, the sympathetic chain and stellate ganglion. Initially the pain is localized in the shoulder and spine edge of the scapula. Pain can then extend the distribution of the ulnar nerve in the arm and hands. If the tumor extends to the sympathetic chain and stellate ganglion, Horner syndrome and anhidrosis develop on the face and ipsilateral upper extremity. Pain is usually relentless and not remitted, requiring administration of narcotics. The patient said his elbow hit his hand into the palm of the hand opposite to remove blood and relieve pain.
The hand muscles may become weak and atrophic, and the triceps reflex may be absent. First or second rib or vertebrae may be affected by the extension of the tumor and the intensity of pain. Spinal canal and spinal cord may be invaded or compressed, with symptoms secondary spinal tumor or cervical disc disease. Confusion with degenerative disc disease is common in early clinical course.
Rarely a patient with Pancoast tumor may also present features paraneoplazic syndrome. Most events are the result of metabolic substances secreted by endocrine tumor. Manifestations include sidnrom Cushing, excessive secretion of antidiuretic hormone, hypercalcemia, myopathies, and hematologic problems osteoartropatie hypertrophic. This does not cause nerezecabilitate paraneoplazice syndromes, but most are associated with small cell cancer. Brain metastases are common at diagnosis.