Pancoast Tumor (cont.)
In the past, Pancoast tumors were considered inoperable and incurable because of their relative inaccessibility and extensive invasion of nearby tissues and structures. However, recent studies have shown that, in some persons, the tumor completely stops growing and the pain is gone. In addition, survival rates have improved.
Clinical studies demonstrate that preoperative irradiation in doses not strong enough to shrink the tumor (1) decreases the chance that the tumor will grow back, (2) prevents tumor cells from growing elsewhere in the body, and (3) increases the chance of survival compared with irradiation or surgery alone.
By surgically removing the lower trunk of the brachial plexus, the distribution of the ulnar nerve (nerve that runs along the inside of the arm and hand) is permanently damaged, but the person is not incapacitated. After surgery, Horner syndrome and anhidrosis (inability to sweat) develop following the removal of parts of the sympathetic nervous system. However, these do not disable the person. This type of surgery should be performed in a tertiary referral center.
The 5-year survival rate after surgery is approximately 30%.
In the presence of involvement of the mediastinal lymph nodes, the median expected survival period is less than 9 months.
Factors that are associated with a poor prognosis include Horner syndrome, mediastinal adenopathy, and an incomplete surgical removal of the tumor. To date, no patient with any of the above factors has survived for 5 years.
Factors that have a negative effect on outlook can be summarized as follows:
- Presence of Horner syndrome
- Involvement of mediastinal lymph nodes
- Involvement of supraclavicular lymph nodes
- Invasion of the tumor into areas of the vertebrae
Shreekanth V Karwande, MBBS
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