Pancoast cancer is an oncological disease that is localized in the upper sulcus of the lung. In its symptoms, it is similar to tuberculosis, abscess, echinococcus, pneumonia, benign tumors and other pathologies.
Pancoast's tumor got its name from the radiologist Henry C. Pancoast. He was the first of his colleagues to describe this disease in detail. This happened in 1924.
In addition to malignant pathology, some inflammatory and oncological diseases, also localized in the upper part of the lung, can cause similar symptoms. This phenomenon is called the Pancoast syndrome.
The urgency of the problem of Pancoast cancer lies in the difficulty of its early diagnosis due to the specific location of the tumor, closed by the bone structure. Even with the help of fluorography, carried out in the most modern oncological clinics, it is far from always possible to quickly identify the disease in the early stages.
Causes of upper lung cancer
In general, the causes of Pancoast cancer are influenced by the same causes as other types of lung cancer. What is this? The main reason for its manifestation is smoking: active or passive. An important role is played by the number of cigarettes smoked inday, quality of tobacco used, and total smoking history. It is worth noting that when giving up an addiction, a person leaves the risk zone only after ten years.
People who do not suffer from a passion for smoking can also be exposed to this disease. The percentage of Pancoast cancer in passive smokers increases by 1.7-2 times. Children and adolescents whose parents regularly smoke in their presence also fall into the risk group. Tobacco smoking in 85% of cases causes cancer of the apex of the lung.
In addition to smoking, environmental and industrial factors can cause Pancoast cancer. Contact with substances such as pesticides, asbestos, heavy metals, arsenic, nickel or chromium also increases the incidence of Pancoast cancer.
The role of various pulmonary diseases in history is also great: tuberculosis, previous pneumonia and bronchiectasis - all this increases the chance of a person developing a Pancoast tumor.
This disease affects men five times more often than women, and it manifests itself after the age of 50. It has been proven that the predisposition to Pancoast cancer is also transmitted at the gene level.
In general, there are several key factors affecting the occurrence of Pancoast cancer:
- age;
- smoking;
- environmental situation in the area;
- professional activity in the construction or chemical industry;
- heredity.
Cancer Symptoms
Often the patient seeks help already withadvanced stage of the disease. This problem is associated with the absence of symptoms in the early stages: the patient does not have cough, hemoptysis and, most importantly, visible physical defects in the form of bumps on the body. Pain in oncology of the early stages, as a rule, does not appear.
The only warning symptoms in the 1st and 2nd stages of cancer are general weakness, constant fatigue, weight loss.
Pancoast and Horner syndromes
With the further course of the disease, there is a manifestation of Pancoast and Horner syndromes, both individually and in combination with each other. You need to know about this.
Pancoast Syndrome is manifested by several of the following symptoms:
- severe debilitating pain on the side of the tumor localization - in the shoulder area, along the ulnar nerve and under the scapula;
- weakness of the muscles of the arm on the affected side of the body, paresthesia, numbness of the fingers, atrophy of the muscles of the limb;
- voice change - hoarseness, coughing.
When a tumor affects the sympathetic fibers, Horner's syndrome appears:
- drooping of the upper eyelid (ptosis);
- anhidrosis of the upper limb and part of the face with the affected side of the tumor;
- pupil constriction (miosis) and retraction of the eyeball (ethnophthalmos).
Quite often, Pancoast cancer is accompanied by superior vena cava syndrome with tumor pressure on it. This syndrome is accompanied by the following symptoms:
- chest pain;
- cough;
- difficulty breathing;
- headache and increased sleepiness;
- whistling when breathing.
Diagnosis of apical lung cancer
As mentioned above, the diagnosis of the disease is quite difficult, because in the early stages of Pancoast cancer, even an X-ray examination can not always be detected due to the fact that the tumor is not visible at the site of its localization.
As a rule, patients first of all turn to a neurologist or surgeon with complaints of pain in the upper limbs, and only after that they get an appointment with oncologists.
Given that Pancoast's tumor is similar in its symptoms to other diseases of the bronchopulmonary system, its diagnosis should be comprehensive and include the following types of examinations:
- X-ray - determines the presence of a tumor in later stages due to the thickening of the pleura and the appearance of blackouts.
- Computed tomography and MRI - determine the degree of involvement of blood vessels, ribs, lymph nodes, vertebrae in the process. The results of these studies are among the most important. They show the possibility of the operation.
- Biopsy of lymph nodes - allows you to determine the stage of development of the pathology.
- Blood test - determines the state of the body as a whole.
Also, as additional examinations, bronchoscopy is performed (determines the condition of the bronchi and trachea close to the affected area), arteriogram and phlebogram (assess the condition of the veins and arteries in the clavicle area).
Lung cancer treatment
Treatment of Pancoast cancer occurs only in specialized oncological clinics, while the fundamental factor is the complexity of the therapy. As statistics show, Pancoast cancer is most often detected at the 3rd stage, when the pain in oncology of this type becomes unbearable. Treatment in this case must begin with taking painkillers, up to narcotic analgesics.
The main treatments for Pancoast tumor are:
- chemotherapy;
- radiotherapy;
- surgical intervention.
Preoperative Therapy
Therapy of the disease takes place in several stages: preoperative and postoperative treatment, surgery.
Preoperative therapy is a combination of chemotherapy and radiation necessary to shrink the tumor and prevent the spread of metastases to the lymph nodes. This allows you to perform an operation that was impossible before such treatment.
Radiotherapy can also be used as an independent method of treatment when surgery is not possible. Irradiation in this case reduces pain in the patient, but does not affect life expectancy.
Both radiation and chemotherapy are carried out in courses in several stages, with breaks between them of 2-3 weeks. After radiotherapy and chemotherapy, the patient is scheduled for a second examination, the results of which make a conclusion about the possibility of surgicalintervention.
Relevance of surgery in the treatment of lung cancer
Surgical treatment is far from being carried out in all cases: if there is no full guarantee that the patient's capabilities will allow him to undergo surgery, or if numerous parts of the body, remote from the lesion, are already affected, intervention is pointless. The percentage of survival in such a neglected condition of the patient is minimal.
In other cases, when the operation is possible, there are several options for its implementation:
- Pneumoectomy - removal of the entire volume of the affected lung.
- Resection of part of the lung.
With a significant growth of the tumor, it is possible to remove several ribs and vertebrae, vessels, chest wall, brachial plexus. In rare cases, the patient needs to have an upper limb amputation.
After the operation, radiation and chemotherapy are also carried out to “finish off” tumor cells in order to avoid recurrences.
Prognosis for upper lung cancer
Survival of patients who have had Pancoast cancer directly depends on the stage at which the disease was detected.
In patients diagnosed at the 1st stage of the disease, the survival threshold is about 60%, at the 2nd stage - no more than 40%, and when diagnosed at the 3rd stage of cancer, the five-year milestone is overcome only 20% of patients.
At the 4th stage, Pancoast cancer is practically incurable: in 98% of cases, death occurs within 6-7 months after thetreatment.
