Pancoast tumor was first described by American Physician Henry Pancoast first third of 20th century. It is characterized by its own location, where it affects the upper part of the lung (lung peak), and may invade surrounding tissues / organs of the ribs and nerves and vertebral column adjacent to it. The main treatment for this tumor is usually surgical intervention to eradicate it with the removal of the affected part of the lung, in addition to the parts affected around him from ribs, vertebrae, blood vessels and nerves. In some cases, the patient may need chemotherapy and radiotherapy sessions to prevent the spread of cancerous cells through blood or lymphatic fluid to other parts of the body, thus improving the success rate of the treatment plan for the tumor, thus saving the patient from complications.
Most of the pancoast tumors are lung cancer with non-small cells, and the symptoms that the patient complains vary according to the part of the tumor that causes the occurrence of two famous medical syndromes. The first is called the superior vena cava syndrome, which causes a blockage of the superior vena cava and structures that are above the level of the heart (arms, neck, head) because of the pressure of the tumor, the patient comes swelling in the veins of the face and neck with swollen hands. The second syndrome, which is often caused by a pancoast tumor, is called the Horner syndrome, which results from the pressure on the sympathetic nerve chain. The patient has an indication of the upper eyelid on the affected side with an interruption in sweating and narrowing of the pupil. The patient may complain only of weakness of the hand with shoulder pain on the side where the tumor is just without anything else.
Diagnosis is usually confirmed by a CT guided core needle biopsy or VATS ( Video Assisted Thoracoscopic Surgery) in most of the surgical settings. Sputum cytology has very minimal sensitivity. In contrast to conventional cancer treatment, the removal of a pancoast tumor usually takes place after chemotherapy and radiotherapy, not before, because the tumor is located in a confined space surrounded by a group of blood vessels and nerve bundles, making it difficult to remove it before chemotherapy and radiation. The surgeon may have to remove the entire upper lobe of the lung during surgery according to the spread of the tumor.
If parts of the affected vertebrae are to be removed, stainless steel reinforcement brackets are placed to maintain the backbone of the spinal cord in the neural tube. If the surgeon is forced to remove major blood vessels during the operation, special tubes must be placed to deliver blood instead. Currently, different surgical procedures have been developed to remove pancost tumor, all of which aim to remove the tumor and its surrounding accessories in the surrounding tissues with minimal losses to protect the body and preserve the patient’s life without complications, and also to reduce the chances of recurrence of cancer cells.
As mentioned before, surgery in the case of Pancost tumor is followed by radiotherapy and chemotherapy and does not precede them, in order to ensure that the size of the tumor is reduced as much as possible before surgery. It is only performed by a team of skilled surgeons in order to remove the tumor with higher degree of accuracy. Make an early appointment to your doctor if you suspect to have a Pancoast tumor.