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Pancoast Tumour — RACP Adult Medicine MCQ

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ModerateRespiratoryPancoast TumourRACP Adult Medicine

A 75-year-old man with a 60-pack-year smoking history presents with a new Horner syndrome (ptosis, miosis, anhidrosis) and ipsilateral arm pain along the C8-T1 distribution. Chest X-ray shows a right apical opacity. What is the most likely diagnosis?

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Correct answer: D — Pancoast tumour

Horner syndrome (sympathetic chain involvement) with C8-T1 pain (brachial plexus invasion) and an apical lung opacity is the classic presentation of a Pancoast (superior sulcus) tumour. CT/MRI chest and biopsy are required for staging. Treatment typically involves concurrent chemoradiation followed by surgical resection if feasible.

Reference: Cancer Council Australia – 2021 – Optimal Care Pathway for Lung Cancer