Pancoast Tumor

A cancerous growth in the apex of the lung. 90% of patients present with shoulder symptoms, not respiratory. Upon clinical exam, a patient with a pancoast tumor may have atrophy of the hand intrinsics. In advanced stages, there will be increased deep tendon reflexes related to cord compression and cervical myelopathy. A history of smoking may also be associated with this condition.

Signs similar to thoracic outlet syndrome:
  • Can present with numbness and tingling in 4th and 5th digits
  • May present with diminished pulse secondary to compression of subclavian artery and vein
  • Pain in shoulder, scapula, medial aspect of arm in C8-T1 dermatomes
Signs differing from thoracic outlet syndrome:
  • Symptoms frequently awaken the person at night and symptoms worsen
  • No relief from NSAIDS or physical therapy
(Kim et. al., 1993)