A Pancoast tumor is a rare type of lung cancer that begins in the top part of your lung. Symptoms usually include shoulder pain and arm weakness. Pancoast tumors aren’t curable, but in many cases, they’re manageable with treatment. Treatments include chemotherapy, radiation therapy and surgery.
A Pancoast tumor is a rare type of lung cancer. It begins in the upper part of your lung (the apex), above your first rib.
Unlike most lung cancers, Pancoast tumors don’t usually cause coughing or chest pain. Instead, people with Pancoast tumors almost always develop shoulder pain accompanied by arm weakness and other symptoms. Healthcare providers call this collection of symptoms “Pancoast syndrome.”
Because Pancoast syndrome doesn’t cause classic lung cancer symptoms, there may be a delay in the detection of these tumors. In many cases, a clear diagnosis doesn’t occur until the cancer has spread to nearby nerves and blood vessels.
Pancoast tumors get their name from the radiologist who first described them in the early 20th century. Another name for a Pancoast tumor is a superior sulcus tumor.
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Subtypes of Pancoast tumors include:
The majority of Pancoast tumors are adenocarcinomas. These cancers begin in the lining of your airways and alveoli (the air sacs in your lungs) — specifically in your mucus-making gland cells.
Pancoast tumors are rare, making up less than 5% of all lung tumors.
A Pancoast tumor may place pressure on your brachial plexus — a group of nerves that runs from your upper chest into your neck and arms. When this happens, it causes a specific group of symptoms. Healthcare providers call this collection of symptoms Pancoast syndrome or Pancoast-Tobias syndrome.
Pancoast tumor symptoms appear on the affected side of your body. For example, if the tumor is in your right lung, then you’ll develop symptoms that affect the right side of your body.
Pancoast tumor symptoms may include:
Up to 50% of people who have Pancoast tumors may also develop Horner’s syndrome, which may cause:
Causes and risk factors of Pancoast tumors are similar to other lung cancer tumors. Common risk factors include:
When cancer spreads, cancer cells break away from the original tumor, travel through your blood or lymph system and form new tumors in other parts of your body.
Most commonly, Pancoast tumors can spread from your upper lung into your:
In the early stages, Pancoast tumors don’t show up easily on two-dimensional chest X-rays. For this reason, they can be difficult to diagnose.
If your healthcare provider suspects a Pancoast tumor based on your symptoms, they may recommend other diagnostic tests, which may include:
Advanced imaging can give your healthcare provider a clearer view of your lungs. They may order:
During a needle biopsy, a healthcare provider will extract fluid, tissue or cells from any abnormal lumps. Then, they’ll send the sample to a pathology lab for further testing.
During video-assisted thoracic surgery (VATS), a healthcare provider makes an incision (cut) in your chest and inserts a thoracoscope (a thin tube with a tiny camera on the end). This allows them to see inside your chest cavity and detect any tumors or other abnormalities. If they see anything, they’ll take a sample of the tissue and send it to a lab for testing.
In some cases, a healthcare provider may need to perform a thoracotomy. During this procedure, they’ll make an incision (cut) on the right or left side of your chest, between your ribs. This allows them to clearly see the affected lung and take a biopsy of any abnormal tissue.
In most cases, they’ll go ahead and remove the tumor, too. This helps you avoid multiple surgical procedures.
As with other types of lung cancer, healthcare provider categorize Pancoast tumors using the cancer staging system. They use numerals (I, II, III, IV) and subtypes (A, B) to describe how advanced the tumor is and how far it has spread.
For Pancoast tumors, providers also use letters (T, N, M) and numbers (1, 2, 3, 4) to indicate the severity of the condition:
Because Pancoast tumors are difficult to detect in the early stages, most are T3 or T4 at the time of diagnosis. T3 means the cancer has invaded your chest wall or your sympathetic nerves. T4 means the cancer has spread to other structures like your brachial nerves or spinal cord.
It depends on the location of the tumor and how far the cancer has spread. Treatment options include:
Surgery is the preferred treatment, when possible. However, before surgery, providers use chemoradiation (chemotherapy and radiation therapy) to shrink the tumor.
Pancoast tumor surgery can be difficult. Generally, a surgeon must remove your top two ribs. They may also need to remove a major artery and replace it with a vascular graft (an artificial tube to carry blood flow). Your surgeon will let you know what to expect before your procedure.
In some cases, healthcare providers use a combination of surgery and chemoimmunotherapy (a combination of chemotherapy and immunotherapy). While chemotherapy kills cancer cells to slow the growth of a tumor, immunotherapy stimulates your own immune system so it can fight cancer.
Sometimes, surgery isn’t an option. In these cases, your medical team may recommend a combination of chemoradiation and immunotherapy.
If surgery isn’t possible and the cancer has spread to other areas of your body, your provider may recommend stand-alone radiation therapy to slow cancer growth. This supportive care approach shrinks the cancer and eases your symptoms.
Some people benefit from targeted therapy. This treatment targets the genetic mutations (changes) that turn healthy cells into cancer cells.
To find out if you’re eligible for targeted therapy, a healthcare provider will test your cancer cells for specific receptors of particular proteins. If you have questions about targeted therapy, talk to your healthcare provider.
While you can’t totally prevent Pancoast tumors, there are things you can do to reduce your risk for this type of cancer:
In addition, if you have a family history of lung cancer, or you’re predisposed to lung cancer, you may want to ask your healthcare provider about preventive cancer screenings.
If you receive a Pancoast tumor diagnosis, your healthcare provider will assemble a treatment team that’s tailored to your specific needs. Your treatment team will include:
Your medical team will recommend treatment based on the size and location of the Pancoast tumor, as well as whether the cancer has spread to other areas.
In most cases, Pancoast tumors grow slowly. But there are rare instances in which a tumor can grow very rapidly. Your healthcare provider will routinely monitor the growth of the tumor before, during and after treatment.
Pancoast tumor survival rates have gradually improved over the last several years, due to advances in technology. But there’s still a lot to learn.
For people with early-stage, surgically treatable Pancoast tumors, the five-year survival rate is around 30% to 50%. That means that up to half of all people diagnosed with early-stage Pancoast tumors are still alive five years after their diagnosis.
It’s important to know that Pancoast tumor survival rates are just estimates. They can’t tell you how long you’ll live or how well a particular treatment will work for you. For a better understanding of how this cancer affects you, talk with your healthcare provider.
You should see a healthcare provider immediately if you start to have severe shoulder pain, arm pain, hand weakness or other Pancoast tumor symptoms. Early detection is key.
If you or a loved one received a Pancoast tumor diagnosis, here are some questions you may want to ask your healthcare provider:
Some people with Pancoast tumors report that symptoms began with a “pinched nerve” sensation. If you develop this type of pain and it lingers for more than a couple of weeks, let a healthcare provider know.
A note from Cleveland Clinic
Pancoast tumors start in the upper portion of your lung. They differ from other types of lung tumors because they’re difficult to detect in the early stages. A Pancoast tumor diagnosis can bring up a lot of complex emotions. Planning your next steps can feel overwhelming. Your healthcare provider is there to help you. Ask them for additional resources or information about your specific situation. You may also want to join a local or online support group. Talking with others who are going through the same thing can be beneficial for your mental, emotional and spiritual health.
Last reviewed by a Cleveland Clinic medical professional on 03/21/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy