Superior Sulcus (Pancoast) Tumor

A relatively uncommon type of non-small cell lung cancer, a superior sulcus (Pancoast) tumor can develop in the upper portion (superior sulcus) of a lung, which is located in the pulmonary apex of the chest. This area is surrounded by vital bodily structures, including blood vessels, the brachial plexus and other nerves, as well as the spine, ribs and chest cavity lining. For this reason, a superior sulcus tumor can be challenging to treat. However, groundbreaking advances in surgical techniques and radiation therapy continue to improve patient outcomes and quality of life.

Why Do Superior Sulcus Tumors Develop?

Exposure to tobacco smoke is the No. 1 risk factor for superior sulcus tumors as well as all other forms of lung cancer. When inhaled, tobacco smoke introduces a dangerous cocktail of chemicals and carcinogens into the lungs. These harmful substances can trigger cellular DNA mutations that cause healthy cells to grow and divide uncontrollably. Clusters of abnormal cells can then accumulate in the lungs and form a Pancoast tumor.

What Are the Symptoms of a Superior Sulcus Tumor?

In many cases, early-stage superior sulcus tumors do not produce noticeable symptoms. As the cancer progresses, however, it may begin to interfere with nearby structures and cause symptoms such as:

• Chest or shoulder pain
• Numbness or muscle weakness in an arm or hand
• A droopy eyelid or small pupil (Horner’s syndrome)
• Facial flushing
• Excessive sweating

How Are Superior Sulcus Tumors Diagnosed?

Usually, the diagnostic process for superior sulcus tumors involves several steps. If a physician suspects a Pancoast tumor based on a review of an initial chest X-ray or computed tomography (CT) scan, the physician will likely order further imaging tests, such as a magnetic resonance imaging (MRI) scan, which can be used to assess the vascular and neurological structures around a suspicious mass.

The next step is a biopsy. To obtain a tissue sample, the physician may perform a percutaneous (through-the-skin) CT-guided needle biopsy (PCNB) or a flexible bronchoscopy, which involves inserting a special instrument (bronchoscope) through the airways.

How Are Superior Sulcus Tumors Treated?

Pancoast tumor treatment is complex and often involves a combination of surgery, chemotherapy and/or radiation therapy. Thus, it requires the coordinated expertise of multiple specialists in thoracic surgery, medical oncology and radiation medicine. Tampa General Hospital is proud to excel in the multidisciplinary approach necessary for treating superior sulcus tumors, and the very latest options are available through our nationally recognized pulmonary and lung cancer program.