Pancoast Tumor - 1290509

Hi Sunny,

Welcome to Grace. It's true a CT especially a hi res CT would pick up a pancoast tumor. You're probably looking for something less complicated. I have to admit we get a lot of people who have shoulder pain that radiates down the arm who are worried they have a pancoast tumor. I hope you also find that there are other much more common and probable reasons why this is happening. The odds are extremely small that a 28 year old with a small smoking history has lung cancer add to that the rarity of a pancoast tumor especially without a significant smoking history. A nerve that is pinched or damaged is tons more common than a pancoast tumor in a 50 year old with a smoking history. I hope you get this resolved hopefully through physical therapy.

All best,
Janine
forum moderator

Hi sunny,

The type of shoulder/arm pain produced by a pancoast tumor is much more likely to be caused by other ailments. This is especially true for younger patients (certainly patients in their 20s and 30s) and persons without a significant smoking history. In a podcast, Dr. Vallieres describes the typical scenario reported by patients as “enormous pain around their shoulder and down their arm, sometimes some changes in their facial expression, who had, on x-ray, a tumor at the top of their lung.” – http://cancergrace.org/lung/2015/09/11/gcvl_lu-e06_pancoast_tumor_histo… As with most cancer pain, it is unlikely to come and go or vary in intensity but more likely to be constant and increase in severity over time.

It’s important to note that a pancoast tumor usually shows up on a chest x-ray, and certainly on a chest CT. As Dr. West has said:

“I think a Pancoast tumor may be the most over-internet diagnosed problem in the cancer world — at least lung cancer. It is extremely common for people vanishingly unlikely to have a Pancoast tumor to scare themselves half to death by a Dr. Google diagnosis. It is overwhelmingly likely that you do NOT have a Pancoast tumor. And while a chest x-ray is a very old technology and CT is better, a chest x-ray would be sufficient to all but prove that it ISN’T a Pancoast tumor.” – http://cancergrace.org/topic/very-scared-of-pancoast-tumor-please-any-a…

I will add that I’ve been active on GRACE for 8 years, and the type of question you post is not uncommon. In that time, I can’t think of a single case of a person who is unlikely to have a pancoast tumor and whose imaging has not revealed such a tumor but later has returned to the site to report that diagnosis. With that in mind, since you already have chest x-ray and CT reports which do not reveal a pancoast tumor, I would feel reassured and turn my attention to other possible (and less concerning) causes for your pain.

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I hope that you can find answers that will aid in resolving your symptoms. If you haven't already, perhaps a consultation with an orthopedist would be in order.

JimC
Forum moderator

Hi my Mum was having shoulder pain. Shortness of breath and fatigue also her left eye went droopy so she went to a n e and they said it looks like she has horners syndrome and took her for a chest X-ray where they confirmed Horners syndrome and found a mass on top of her lung. She then went on to have a ct scan and a mri scan. Also blood tests. They haven’t told her what they think it is or anything. But we have read up and found Pancoast tumor sounds right!! I’m very scared they told us horners and her lung mass are associated.. they have referred her to the multidisciplinary lung team and they are having a meeting on Tuesday. Does this meen they know what it is? She is also waiting for a biopsy. Please help. Thanks.

Hi kaylababez,

Welcome to GRACE. I am sorry to hear that your mum has been experiencing these symptoms, and that the scan findings have caused you such understandable worry . One thing can be said with certainty: the doctors do not "know" whether your mum has a pancoast tumor. The scan results may cause them to suspect it (perhaps among other possibilities they are considering), but the only way to make a definitive cancer diagnosis is by testing the cells collected from a biopsy of the lung mass.

The interdisciplinary meeting to which you refer is a common occurrence at medical centers. It gives a doctor in one specialty a chance to interact with experts in other areas of practice to discuss a particular patient's case, looking for the varying types of insight which each specialist may provide.

I know that the time period waiting for a diagnosis and a decision on treatment is difficult to endure, but please don't feel as though the doctors know something that they are not revealing. When a diagnosis is still pending, they tend not to speculate until all the data is in place. In your mum's situation, they may have the necessary data after the biopsy results are in.

JimC
Forum moderator

Hi Sunny,

I am sorry to read you are still in pain. I would go to the doctor and ask to get some xrays of the shoulder and rib, a referral to physiotherapy and/or massage and a diagnosis of what is causing the pain.

I had this kind of shoulder pain once and started to worry it might be a recurrence in the form of a pancoast tumour, but it went away after several professional massages and I feel much better.

Given you already had a ct scan, and the duration of the pain, and most especially your age, it is very unlikely that the source of your pain is a pan coast tumour. I hope this relieves some of your worries.

Hi Sunny,

Most often this pain isn't a pancoast tumor. My husband had a pancoast tumor and when he was having pain in his shoulder and arm his description sounded just like the pain I get when I'm not actively caring for damage to a cervical nerve. In retrospect I see there were differences because his pain was coming from rib and bracial plexus destruction. An MRI given him didn't pick up the tumor because the mri only looks at a small area and his tumor either was hidden behind bone or it was looking at an area not at all effected by the tumor. Pain in the ribs suggests damage to the ribs and would be picked up by a simple inexpensive xray to that area. An xray of the top of the lung where the tumor would have started would also be picked up by an xray because the pain you're having suggests if it's a pancoast tumor it's large enough to be picked up by an xray. And certainly a chest ct would pick it up. I'm sorry that you continue to have problems. I think onthemark's suggestions are good and I hope you get to the bottom of this. Nerve damage can be elusive and painful and difficult to manage.

All best,
Janine

Hi Sunny,

It's amazing how often young people with shoulder pain start to worry about having lung cancer. You are not alone.

Glad that your xray came clear. You need to ask your doctor to make a diagnosis of your pain and send you for treatment. That might include physiotherapy and/or massage, which is what did the trick for me.

Hello,

I am a 48 yr old male. I have smoked Marijuana for 20yrs. I am experiencing Pain in my back in my upper left mid back. Below my shoulder blade. Some pain in muscle by my collarbone. It is not consistent but has come on gone all week. Goes away for a few hours comes back. I have a lump below my armpit on left side.  Not so much in the arm pit but below it. My left eye is not droopy but pupil is smaller then the right. I fear I have a pancoast tumor! I don't seem to have any other symptoms. No pain down my arm or in elbow or fingers. No fatigue, loss of breath or appitite. I'm not losing weight. No cough or anything. I have worked out all week 30- 40min. With no loss of breath. I always feel great no chest pain or back pain at all when I work out. A lot of cardio. I have a lot  of anxiety. The pain in my mid back seems to hurt most when I am doing dishes. Kinda standing for awhile with my arms out in front of me. Can I get your opinion? 
 

concerned

Hi Cashock,

We can't give medical opinions nor should anyone else online outside of a med health situation.  With that said your symptoms aren't consistent with a pancoast tumor.   However, I would check in with my doc to see what's going on with the lump under my arm. 

Best of luck,

Janine