Pancoast tumor (superior pulmonary sulcus tumor)
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Pathology
- tumor, originating from the superior sulcus of the lung
- invades all or a portion of the brachial plexus
- most frequently adenocarcinoma of the lung or squamous cell carcinoma of the lung[1][2]
Clinical manifestations
- Horner's syndrome*
- shoulder pain, shoulder & arm weakness (brachial plexopathy)*
Radiology
- chest X-ray
- CT of chest
- positron emission tomography (PET) to assess metastases[4]
- CT-guided biopsy after CT +/- PET[6]
Management
- operable
- pre-operative chemotherapy & radiation therapy
- radiation dose: 45 Gy/25 fractions
- chemotherapy: cisplatin-etoposide
- surgery 3-7 weeks after completion of chemotherapy & radiation therapy
- for patients in whom surgery is no longer an option after completing pre-operative chemotherapy & radiation therapy or in the case of positive margins, boost radiation is recommended
- inoperable - intent to cure
- chemotherapy & radiation therapy
- chemotherapy: cisplatin-based chemotherapy with either etoposide or vinorelbine
- thoracic radiation of 55 Gy/25 fractions to 66 Gy/33 fractions
- inoperable, palliative treatment
- in patients where lung reserve or effusion precludes standard radiation therapy, palliative chemotherapy &/or palliative radiotherapy recommended.
- palliative chemotherapy
- platinum-based combinations (first line)
- docetaxel, erlotinib or pemetrexed
- palliative radiation therapy
- 20 Gy/5 fractions & 30 Gy/10 fractions
More general terms
Additional terms
References
- ↑ 1.0 1.1 Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ 2.0 2.1 Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998
- ↑ Vallieres E et al. Pancoast tumors. Curr Probl Surg 2001 May 3; 38:293 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11332249
- ↑ 4.0 4.1 Arcasoy SM, Jett JR Superior Pulmonary Sulcus Tumors and Pancoast's Syndrome. N Engl J Med 1997; 337:1370-1376. November 6, 1997 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/9358132 <Internet> http://www.nejm.org/doi/full/10.1056/NEJM199711063371907
- ↑ Popat R, Derodra J, Vig S, Lim E. A sinister cause of shoulder pain, with numbness and weakness in the ipsilateral hand. BMJ 2012 Oct 26; 345:e6948 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2309755
- ↑ 6.0 6.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022