Pancoast Tumor

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Pancoast tumors are tumors that form at the extreme apex (very top) of either the right or left lung in the superior sulcus (a shallow furrow on the surface of the lung). Pancoast tumors are a subset of lung cancers that invade the top of the chest wall. Because of their location in the apex of the lung, they invade adjoining tissue.

Pancoast tumors originate at the top margin of the lung. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures: 

• Lymphatics (small, thin vessels that carry lymph fluid through the body)



• Lower roots of the brachial plexus (a complex network of nerves that is formed chiefly by the lower 4 cervical [neck] nerves and the first thoracic [chest] nerve)



• Intercostal nerves (nerves that lie between a pair of adjacent ribs)



• Stellate ganglion (a mass of nerve tissue containing nerve cells that form an enlargement on a nerve or on 2 or more nerves at their point of junction or separation)



• Sympathetic chain (either of the pair of ganglionated lengthwise cords of the sympathetic nervous system that are situated on each side of the spinal column)



• Adjacent ribs



• Vertebrae

Carcinomas (cancerous tumors) in the superior pulmonary sulcus produce the Pancoast syndrome, which is characterized by pain in the shoulder and along the inner side of the arm and hand. Pancoast tumors tend to spread to the tissue surrounding them in the early stage of the disease. As long as the cancer has not metastasized (spread) and involved the regional lymph nodes (small, bean-shaped structures found throughout the body), these tumors can be successfully treated.