PANCOAST’S SYNDROME

Pancoast’s Syndrome involves:

• Apical lung cancer

• Rib erosion (2nd and 3rd ribs)

• Vertebral involvement (about 5% get cord compression)

• Brachial plexus (pain and weakness)

• Sympathetic nerve damage (ptosis)

C8, T1 nerve roots are affected, with wasting of muscles in the hand and forearm and nerve pain up the medial aspect of hand and arm. Sympathetic nerve damage causes ptosis (dropped eyelid), a small pupil, and sometimes flushing and absent sweating on that side of the face (Horner’s Syndrome).

Palliative radiotherapy (with the field usually including the vertebral bodies since it is known these are commonly involved) can abolish or reduce pain in 80% of patients. Average survival after treatment is 9 months, and some patients survive 2 years.

The most difficult symptom to treat is usually the nerve pain radiating into the arm, which can be severe. Once the nerves are destroyed by advancing tumor the pain may stop. (see Nerve Pain)

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