Upper body pain: possible tipoff to Pancoast tumor

Abstract

The bone scans and chest and spine films may say no, but the pain says yes. In patients with Pancoast (superior pulmonary sulcus) tumors, at least, the most reliable indicator of initial, recurrent, or progressive disease may be as simple as pain in the shoulder, chest, or arm. Pancoast tumors represent 3% to 4% of all lung cancers and often can be detected only by an apical lordotic chest film, which is not routinely requested. Moreover, because of the tumors' proximity to the brachial plexus and the spinal column, one of their major neurological complications, epidural spinal cord compression (ESCC), may be missed. According to Ronald M. Kanner, MD, initial radiation therapy for the tumor may include the vertebral body and reduce osteoblastic activity, or the tumor may grow into the intervertebral foramen without producing bone changes. Thus, the ability of bone scans to detect ESCC is impeded. Myelography is