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Pancoast Tumor (cont.)

Outlook

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. Chemotherapy and radiation can result in no evidence of viable cancer in the surgical specimen.

Clinical studies demonstrate that even preoperative irradiation alone 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.

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
Medically Reviewed by a Doctor on 6/10/2014
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Read What Your Physician is Reading on Medscape

Pancoast Tumor »

In 1932, Pancoast defined a superior pulmonary sulcus tumor as a mass growing at the thoracic inlet that produces a constant and characteristic clinical presentation of pain in an eighth cervical or first and second thoracic trunk distribution.

Read More on Medscape Reference »


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