Leukemia (Blood Cancer)

 Pancoast tumors: get their name from Dr. Henry Pancoast who was the first radiologist to describe them these tumors are classified as Pancoast tumors because of their location in the lung apices rather than on the type of lung cancer they emerge from the reason that Pancoast tumors are given special consideration is that the location allows them to interfere with nerves and blood vessels which leads to problems that are unique from tumors in other locations. Lung tumors in general are divided into small cell and non-small cell cancers based on the way they look under a microscope and how they behave.

Generally speaking, small cell lung tumors are made up of small cells which divide rapidly and spread quickly and non-small cell lung cancers which should probably just be called large cell lung cancers have large cells that divide and spread slowly as it turns out the majority of Pancoast tumors are non-small cell lung tumors but a few are small cell lung tumors as well most of the time the signs and symptoms of Pancoast tumors result from the tumor creating local inflammation and swelling and pushing up against nearby nerves or blood vessels which disrupts their function and this phenomenon is known as a mass effect.

In some instances there's tumor invasion which is when tumor cells penetrate and grow directly into surrounding structures now at the first thoracic nerve root or T1 you've got some sympathetic nerves that supply the head neck and eyes this point is super close to the lung apices and so it's susceptible to compression or even invasion from a nearby Pancoast tumor; normally these sympathetic nerves help to dilate the pupil raise the eyelid and help stimulate the sweat glands if a Pancoast tumor pushes on or invades these sympathetic nerves it can cause meiosis a small or constricted pupil Ptosis a droopy eyelid and anhydrosis a failure to sweat together this triad of symptoms is called Horner syndrome and happens on the same side of the face as the nerve that's affected if the tumor cells invade or grow into the brachial plexus which is a collection of nerves that supply the shoulder and arm individuals can get shoulder pain and weakness.

Nerve compression can also cause paresthesia, numbness, and a tingling sensation in the arms and hands also in that area there's the left laryngeal nerve as well as the right laryngeal nerve which run up alongside the trachea to supply the muscles of the larynx or voice box. So if these get compressed it can cause weak or paralyzed larynx muscles which can cause voice hoarseness. A Pancoast tumor in the right lung apex can also compress a large vein called the superior vena cava (SVC) which drains blood from the head upper chest and arms even partial compression of the superior vena cava can cause the venous pressure behind the obstruction to increase venous pressure can cause a flushed appearance from the pooling of blood in the veins as well as edema or swelling of the face and arms from fluid leaking out of the blood vessels and into the tissues.  

The decrease in venous return of the blood to the heart also means that less blood is getting pumped to the lungs leaving individuals feeling short of breath. A Pancoast tumor is usually diagnosed with a ct scan or a chest x-ray which will show a tumor in the lung apex like any suspected lung cancer a biopsy must be done to confirm the cell type. The treatment generally depends on the type of tumor as well as how far the tumor is spread and which structures are involved if it's really close to an important nerve or blood vessel then radiation or chemotherapy might be done to help shrink the tumor and make it easier to remove surgically.

Alright as a quick recap Pancoast tumors describe any lung cancer that has a mass in the apices of the lungs from this unique location a tumor can compress or invade nerves causing horner syndrome shoulder pain and voice changes and it can also compress blood vessels like the superior vena cava which can cause facial flushing.

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