pancoast tumor questions - 1260656

Fri, 11/22/2013 - 11:25

In cases of a Pancoast tumor, do Horners syndrome findings (ptosis, miosis, anhydrosis) usually occur before or after the onset of should/back pain, or is it variable? If Horners findings can occur first, how long would be typical before other symptoms start to occur? I've had a constant but variable isolated left ptosis for about 3 years now, but until recently no other signs or symptoms. About a week ago I started have a pain along my left collarbone, that has since spread to the left shoulder and part of the left upper back.My PCP ordered a chest x-ray, which came back normal (although I've read that pancoast tumors are more likely to be missed on x-ray vs. CT). I found one similar case to this one posted on here a while back, so I apologize if this post seems a bit redundant, but I was hoping to get some additional info before deciding whether or not I should request a CT just to be safe at this point.

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It's variable, where symptoms show up depends on where the tumor grows. As small an area you may think of if as there's a lot going on so some people first show symptoms as horners while others may have pain in the top ribs. It just depends on which way the tumor grows from the lung. My husband's moved lower thus showed symptoms first in the ribs and shoulder and never developed horners. Normally, symptoms would happen faster, within a few months, year would be quite indolent, so 3 years is very long to have lung cancer without treatment and still be alive.

Mayo Clinic describes horners well,

X rays don't show much at all so it could easily miss what may be going on. MRI and or CT would show more of a picture of what's going on.

As you've probably read in other posts on pancoast tumors it's highly likely your symptoms are something other than cancer. I hope it is.


Posts: 2

Thanks for your response. That's essentially what I was thinking that 3 years would be an awfully long time for no additional symptoms to show up. Nevertheless, I fell into that trap of getting myself worried by digging around online for the worst-case scenarios.

Dr West
Posts: 4733

I agree that three years of a symptom would be far too long to go without having the cancer be large enough at the end of that time to see on imaging, including a chest x-ray. While I've come to conclude that "nothing's impossible" with cancer, it's a remarkably unlikely scenario to envision. I'd definitely favor an alternate cause of your symptoms.

Good luck.

-Dr. West

Posts: 2

Hello. I am getting a CT scan tomorrow, and yes, I am scared. At least a month of RIGHT shoulder blade pain.Now recent, BOTH arms are tingling including my fingers. My Shoulders do not hurt. But they tingle. My back tingles and feels hot or cold, my brain can't decipher. Tingles sporadically. My pain in my Should blade can be quiet, but then it wakes up. When I was sleeping, BOTH my thumbs and palms tingled and felt a bit numb. My fingers will tingle as well. For example: My RIGHT shoulder blade is aching, and my LEFT bicep is aching with some tingles. I have had a Chest X ray at the ER, came out clear. Saw my primary, my lymph nodes are not swollen. Question: Can Pancoast get into the other lung and can both limbs be affected. Thank you so much. I am a 61 year old female and I am a smoker.

Jim C Forum Mo…
Posts: 147

GRACE Community Outreach Team

Hi Scrappy,

Welcome to GRACE. I'm sorry to hear about the symptoms you've been experiencing. Pancoast tumors are relatively uncommon, and pain from such a tumor tends to be more constant and increases in intensity with time. In addition, a pancoast tumor causing such significant symptoms would normally be large enough to appear on a chest x-ray. And although a pacoast tumor can spread, it usually spreads to nearby tissues and is not likely to create the same symptoms on the other side.

Here is a previous discussion of this topic, with some input from Dr. West:

I'm hoping that your doctors can find the true cause of your symptoms and help you find some relief.

Jim C Forum Moderator

I discovered GRACE when my wife was diagnosed with lung cancer in 2008. After finding so much authoritative information here, I became a forum moderator and now serve as part of the GRACE Community Outreach Team.

JanineT GRACE …
Posts: 544
GRACE Community Outreach Team

Here is a response from scrappy after she received her CT results. So glad she doesn't need to worry about the pain being caused by cancer...and so glad she came back to report. Thanks Scrappy!
From our FB conversation she says, "I have my CT scan final results. These are the findings: In my left apex there is a calcified granuloma.They are not concerned with this, and a very common. I was told these can pop up from an infection. In my lower right lobe I do have a 3mm nodule. Again, they are not concerned. My Primary said they are highly against doing anything invasive, but wants me one a year to get a CT just to keep an eye on it. I looked up both these things and mostly what I read they are benign and caused by infection. So overall, I am grateful for this report. Everything else looked good".

I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.