UICC World Cancer Congress 2006

Objective:Pancoast tumour(PCT) is a mass at the thoracic inlet producing a constant and characteristic clinical presentation of pain in the distribution of 8th cervical / 1st and 2nd thoracic trunk. Methods: About 95% of(PCT)is squamous cell carcinomas/adenocarcinomas, &3-5% are small cell carcinomas.About 80-90% patients have direct exposure to smoking a dose response relationship, a degree of exposure to smoking are significant while environmental smoke,occupational hazards(radon, nickel, arsenic,asbestose ) & genetic factors are important risk associates . Potential biological explanations include gender differences in nicotine metabolism, male /female variations in cyrtochrome P450 enzymes, effect of harmones on the development of lung cancer. Diagnosis may be rested upon, 1.sputum cytology which may be helpful Initially 2.Chest x-rays(Lordotic view) reveals a thin plaque, pleural thickening, a small cap or a large mass, invasion of one /more ribs, vertebrae,mediastinal braodning,atelectasis, consolidation, and pleural effusion. 2.CT scanning may reveal invasion of chest wall, brachial plexus, an overall accuracy of 63% in evaluation of extent of the disease, with contrast CT/ arteriogram/ venogram discloses the involvement subclavian vessels. 3.MRI, showing much better assessment of the mediastinal invasion of lymph nodes by tumor with overall accuracy of 94%. 4.Percutaneous needle biopsy either with the guide of fluoroscopy or with CT-guided procedures, about 95% diagnosis is based on the histological examination 5. In some cases open lung biopsy in others ultrasound examination/histology assist in staging of disease & diagnostic yield in 90% cases. Results: History of smoking ,radiological follow up & biopsy /histological examination yields significant diagnostic accuracy.