Pancoast tumour (superior sulcus tumour)
Introduction
Pancoast tumours are apical lung cancers that invade adjacent soft tissues, nerves and bone. They are uncommon but important to recognise because presentation is often dominated by local neurological and musculoskeletal signs rather than respiratory symptoms.
Early recognition in the emergency department permits timely imaging, careful neurological documentation and urgent referral into suspected‑cancer and specialist pathways, which materially influence staging and management (treat as NSCLC; multidisciplinary assessment) (NICE NG122, NG12, NG127).
Anatomy and pathophysiology
Tumours at the lung apex lie close to the lower roots of the brachial plexus (C8-T1), the cervical sympathetic chain, the recurrent laryngeal and phrenic nerves, ribs and upper thoracic vertebrae. Local invasion produces:
- Radicular pain, motor and sensory loss from brachial plexus involvement.
- Ipsilateral Horner’s syndrome from sympathetic chain disruption.
- Hoarseness or airway symptoms from recurrent laryngeal or phrenic nerve involvement.
- Bony destruction of ribs or vertebrae.
Clinical features - what should prompt suspicion
Suspect an apical lung tumour when regional neurological or autonomic findings are present, especially when respiratory symptoms are absent or minimal.