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Pancoast Tumor

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Pancoast Tumor

A Pancoast tumor is an apical lung carcinoma located in the superior sulcus of the lung.
It is most commonly a non-small cell lung cancer (NSCLC) and causes symptoms
primarily through invasion of nearby neurovascular structures

Also called

Superior Sulcus Tumor

ICD-10

C34

Specialty

Pulmonology

Onset

Chronic

Reviewed

July 2026

On This Page

Overview

SCC is a centrally located epithelial lung cancer characterized by
keratin production, intercellular bridges, cavitary lesions, and frequent association with
paraneoplastic hypercalcemia due to Parathyroid Hormone Related Protein (PTHrP).

Etiology & Risk Factors

-Main Cause :

  • Cigarette smoking — the most important cause
  • Other Causes / Carcinogenic Exposures
  • Secondhand smoke
  • Radon exposure
  • Asbestos exposure
  • Arsenic exposure
  • Chromium exposure
  • Nickel exposure
  • Air pollution
  • Previous chest radiation
  • Risk Factors
  • Cigarette smoking — most important risk factor
  • Long smoking duration
  • Secondhand smoke exposure

Increasing age

-Occupational exposure to:

  • Asbestos
  • Radon
  • Arsenic
  • Chromium
  • Nickel
  • Air pollution
  • Previous chest radiation

Pathophysiology

An apical lung tumor invades adjacent structures, causing mass effect on :
• Cervical sympathetic ganglion (stellate ganglion)
• Brachial plexus
• Recurrent laryngeal nerve
• Brachiocephalic vein
• Phrenic nerve

Clinical Presentation

-Cervical sympathetic ganglion involvement :
• Horner syndrome:
• Ipsilateral ptosis
• Miosis
• Anhidrosis


-Brachial plexus involvement :
• Shoulder pain
• Axillary pain (plexus neuralgia)
• Upper limb weakness
• Hand muscle weakness and atrophy
• Upper limb sensory deficits
Recurrent laryngeal nerve involvement
• Hoarseness


-Brachiocephalic vein involvement :
• Unilateral arm edema
• Facial swelling
Phrenic nerve involvement
• Paralysis of the hemidiaphragm

History Taking

-Assess for:
• Shoulder pain
• Axillary pain
• Upper limb weakness
• Upper limb sensory symptoms
• Hoarseness
• Facial swelling
• Arm swelling
• Symptoms of Horner syndrome
• Smoking history
• Constitutional symptoms

Physical Examination

-Assess for :
• Horner syndrome
• Upper limb motor deficits
• Hand muscle atrophy
• Sensory deficits
• Hoarseness
• Facial edema
• Unilateral arm edema
• Signs of diaphragmatic paralysis

Investigations of Pancoast Tumor

-Laboratory studies :
• CBC
• Comprehensive metabolic panel
• LDH


-Imaging :
• Chest X-ray
• CT chest
Staging investigations
• CT thorax and abdomen
• Brain MRI (preferred) or CT
• PET-CT


-Tissue diagnosis :
• Histopathological confirmation by biopsy
Biopsy methods
• Bronchoscopy with transbronchial biopsy (if accessible)
• CT-guided biopsy
• Other biopsy techniques as indicated

Diagnosis of Pancoast Tumor

-Diagnosis is based on:
• Clinical features of Pancoast syndrome
• Chest imaging
• Histopathological confirmation by biopsy
• Complete staging evaluation

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Management of Pancoast Tumor

-Management depends on disease stage and should involve a multidisciplinary tumor board whenever available.


Early-stage NSCLC
• Preferred: Surgical resection with or without chemotherapy
• If inoperable: Radiotherapy (e.g., stereotactic radiotherapy)


Locally advanced NSCLC
• Surgical resection plus chemotherapy when appropriate
• Chemotherapy plus radiotherapy for nonsurgical candidates
• Consider adjuvant immunotherapy


Metastatic disease
• Palliative treatment
• Targeted therapy if actionable mutations are present
• Chemotherapy and/or immunotherapy when appropriate


General principle
• Early palliative care improves quality of life and may prolong survival.

Complications of Pancoast Tumor

-Prognosis depends on:
• Histologic subtype
• Tumor stage
• Presence of metastases
• Response to treatment

Prognosis of Pancoast Tumor

  • Prognosis depends on the stage at diagnosis.
  • As with other lung cancers, many patients present with advanced disease, resulting in an overall poor prognosis.

Key Points / Clinical Pearls of Pancoast Tumor

• Pancoast tumor = apical (superior sulcus) lung carcinoma.
• Usually an NSCLC.
• Commonly squamous cell carcinoma, though adenocarcinoma may also occur.
• Horner syndrome is a classic feature.
• Shoulder pain and upper limb neurological deficits are common.
• Hoarseness may occur from recurrent laryngeal nerve involvement.
• Diagnosis requires imaging and biopsy

  • Gundepalli SG, Tadi P. National Center for Biotechnology Information (NIH). Lung Pancoast Tumor, StatPearls.
  • Villgran VD, Chakraborty RK, Cherian SV. National Center for Biotechnology Information (NIH). Pancoast Syndrome, StatPearls.
  • Marulli G, Battistella L, Mammana M, et al. Superior Sulcus Tumors (Pancoast Tumors). Ann Transl Med. 2016. PMC4930518.
  • Munir M, Jamil SB, Rehmani S, Borz-Baba C. Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer. Cureus. 2021. PMID: 33728131.
  • Pancoast HK. Superior Pulmonary Sulcus Tumor: Tumor Characterized by Pain, Horner's Syndrome, Destruction of Bone and Atrophy of Hand Muscles. JAMA. 1932;99:1391-1396.