Description

• Pancoast tumors, or superior sulcus tumors, refer to a unique subset of lung carcinomas.
• These bronchogenic carcinomas are characteristically located in the apex of the lung and invade through contiguous chest wall structure; invasion and classic symptoms are required for definitive diagnosis (1).
• They demonstrate primarily extrathoracic extension. Invasion may include nearby lymphatics, ribs or periosteum, vertebral bodies, brachial plexus nerve roots, upper sympathetic chain, and stellate ganglion as well as the subclavian artery and vein. Extent of invasion classifies them as either T3 or T4 tumors (2).

Epidemiology

These tumors represent 3–5% of all lung cancers. The tumor demonstrates a male preponderance and an average age of presentation during the 6th decade of life. The strongest risk factor associated with development is cigarette smoking (3).

Etiology and Pathophysiology

They most frequently present as non–small cell lung cancer (NSCLC). The most common histologic subtype is adenocarcinoma (50–66% of cases), followed by squamous cell and large cell carcinomas. Infrequently, small cell carcinomas may be present in up to 5% of cases (2).

Risk Factors

• Tobacco use
• Secondhand smoke
• Radiation exposure
• Occupational exposures including asbestos, chromium, nickel, beryllium, arsenic, soot, or tar
• Industrial air pollution
• Family history of lung cancer
• HIV infection

General Prevention

Avoidance of risk factors