Although a Pan Coast tumor is a lung tumor, it rarely causes symptoms that are typically related to the lungs (e.g., cough, chest pain).
The initial symptom is pain in the shoulder, inner part of the scapula (large, triangular, flattened bone that lies over the ribs on the back), or both.
The pain may later extend to the inner side of the arm, elbow, and the pinky and ring fingers.
The associated pain is severe and constant, often requiring narcotic pain medications for relief. The affected person usually needs to support the elbow of the affected arm in the opposite hand to ease the tension on the shoulder and upper arm.
The hand, arm, and forearm may weaken, atrophy (degenerate or shrink from disuse), or develop parenthesis (a sensation of pricking, tingling, or creeping on the skin).
If the tumor extends to the sympathetic chain (a series of ganglia [masses of nerve cells] that run parallel to the vertebrae) and satellite ganglion, Horner syndrome may develop on the face and hand of one side of the body. Horner syndrome is characterized by drooping eyelids (posies), absence of sweating (anhidrosis), sinking of the eyeball (exophthalmoses), and excessive smallness or contraction of the pupil of the eye (mitosis).
In as many as 10-25% of persons with Pan Coast tumor, compression of the spinal cord and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between 2 vertebrae).
Preoperative radiotherapy
The standard of care for persons with a Pan coast tumor is radiation followed by removal of the tumor and chest wall, when possible. Some health care centers offer a combination of chemotherapy and radiation followed by surgery. The purpose of the preoperative irradiation is to shrink the tumor and to block the cancer from spreading through the lymphaticβs temporarily. An interval of 2-4 weeks after radiation therapy allows the radiation to have a maximal effect. After 4 weeks, all patients are reassessed for surgery. If the cancer has not spread to distant areas of the body, surgery is offered. The tumor is then completely removed with the chest wall.
The presence of Horner syndrome or ipsilateral (same side) supraclavicular node involvement does not mean that the combination of preoperative radiation and surgery is completely inadvisable. In current practice, radioisotopes are implanted (called brachytherapy [radiotherapy that involves the placement of the source of radiation in or close to the area being treated]) in association with external radiation therapy. Steroids are also given to reduce swelling.
Primary radiotherapy
Radiation therapy is used as the sole treatment only for persons with tumors that cannot be removed or for persons who are not fit for surgery. Radiation therapy provides excellent pain relief, but the patient will not survive if the primary tumor is not controlled.
The most common site of recurrence after removal is the central nervous system, especially if the primary tumor is an adenocarcinoma (a cancerous tumor that originates in a type of tissue called the glandular epithelium) or large-cell cancer. In these situations, radiotherapy to the brain should be administered if the Pan coast tumor is under control to prevent the cancer from spreading to the brain.
The most important preventive step is to avoid using tobacco products. Quitting tobacco can reduce the risk of lung cancer. For more information, see Cigarette Smoking.
Taking precautions to reduce exposure to harmful substances in the environment (eg, asbestos) can reduce the risk of developing lung cancer.
In the past, Pan coast 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 ulna 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 meditational lymph nodes, the median expected survival period is less than 9 months.
Factors that are associated with a poor prognosis include Horner syndrome, meditational 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: