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Pancoast Syndrome — SCE Medical Oncology MCQ

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EasyLung CancerPancoast SyndromeSCE Medical Oncology

A 58-year-old man presents with a Pancoast tumour (superior sulcus NSCLC) causing ipsilateral Horner syndrome, severe shoulder pain radiating down the arm, and hand weakness. What clinical triad characterises Pancoast syndrome?

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Correct answer: C — Shoulder/arm pain (C8-T2 brachial plexus invasion), Horner syndrome (sympathetic chain involvement), hand weakness/wasting (T1 nerve root)

Pancoast syndrome (from a superior sulcus tumour) classically presents with: (1) shoulder/arm pain radiating to the ulnar distribution (C8-T2 brachial plexus invasion), (2) Horner syndrome (miosis, ptosis, enophthalmos, anhidrosis from stellate ganglion/sympathetic chain involvement), and (3) hand intrinsic muscle wasting (T1 nerve root involvement). Despite the dramatic presentation, Pancoast tumours can be curable with trimodality therapy (neoadjuvant CRT → surgery) if technically resectable.

Reference: NICE NG122; ESMO 2024 NSCLC Guidelines