Haemoptysis

Scenario

A 55 year old man presents on Thursday night to the ED with a second episode of haemoptysis. He reports that nothing was done last time. You reach the conclusion that he has a typical Pancoast tumour.

Task

1. You are about to ring the ferocious oncologist about the patient, so wonder what you will say. Write it down.
2. Describe the pathoanatomy of this condition.

presentation given

Opinion

What the oncologist had to say ....

The Pancoast tumour is an interesting variant of lung cancer with different prognosis, different treatment issues and different toxicities. And they have a specific set of findings that relate to nerve and rib damage. The term Horner's Syndrome is a related constellation of findings.

The Pancoast tumour belongs to the group of "Superior Sulcus cancers", but is a specific variant. Given that Pancoast seems like an unusual name, it will come as no surprise that Pancoast is some one's name. It may surprise you to know that he was a radiologist in Philadelphia, where the Pancoast Professorial Chair resides at University of Pennsylvania. He was a Quaker, a radiologist and the first radiology professor in the USA. The UPenn website says this -

"Henry K. Pancoast, M.D., was an anesthetist at the hospital when he succeeded Leonard in 1902. Eventually appointed the country's first professor of roentgenology, he gained national recognition for X-ray therapy, especially on inoperable cancer s, for examination of the gastrointestinal tract, and for the improvement of chest X-rays in occupational health.
Pancoast insisted on a staff of professional caliber. Early on, the department began to train residents, whose memoirs testify to the cooperative and educational atmosphere."
1905 - Henry Pancoast described the utility of bismuth and then barium for contrast in radiology studies. Among many other contributions, he is known for his description of Pancoast's tumor. He also later described the relationship of prolonged irradiation and the development of leukemia.and the use of X-rays in the treatment of Hodgkin's disease and leukemias.
1911 - Henry Pancoast was appointed as the first Professor of Radiology (roentgenology) in the United States.
1928 - Although residents were appointed to the radiology service as early as 1898, a formal residency training program was established this year at HUP.

• Prognosis - these tumour are blest with a lower potential for nodal and metastatic spread than the usual intra-pulmonary cancer.
• Treatment Issues - being of lower metastatic potential, it then follows that local eradication will result in a higher survival. Having said those words fairly glibly, one can then move onto a discussion of what type of treatment? A 'typical' case of Pancoast's tumour would include wasting of the hand muscles indicating erosion into the brachial plexus in the supraclavicular fossa. Unfortunately this precludes surgery as a curative option. You can but the toxicity is too high.