PANCOAST TUMOURS

Definition:

Pancoast tumour is a type of lung cancer that originates in the upper part of the lung and extends into the thoracic cavity.
These tumours are typically apical, located near the apex of the lung.

Clinical Features:

Shoulder pain is a common symptom, often accompanied by numbness or weakness in the arm.
Horner's syndrome can occur due to involvement of the sympathetic nerves, causing ptosis, miosis, and anhidrosis.
Pancoast tumours can also cause arm swelling or weakness due to the involvement of the brachial plexus.
Clubbing of the fingers can occur due to chronic hypoxia.
Weight loss, fatigue, and cough are also common symptoms.
Superior vena cava syndrome can occur if the tumour compresses the superior vena cava.

Types:

Causes:

The exact cause of Pancoast tumours is unknown, but smoking is a significant risk factor.
Exposure to asbestos and radon has also been linked to an increased risk.
Genetic predisposition may also play a role.

Investigations:

Chest X-ray is often the first imaging modality used to diagnose Pancoast tumours.
CT scan is essential for staging the tumour and assessing the extent of local invasion.
PET scan can help determine the presence of metastatic disease.
MRI is useful for assessing the involvement of the brachial plexus and other neural structures.
Biopsy is necessary for histopathological diagnosis.

Complications:

Superior vena cava syndrome is a life-threatening complication that requires emergency treatment.
Brachial plexus neuropathy can cause significant morbidity.
Horner's syndrome can occur due to involvement of the sympathetic nerves.
Weight loss and fatigue are common complications.

Management:

Surgical resection is the primary treatment for Pancoast tumours.
Preoperative chemotherapy and radiotherapy can help reduce tumour size and improve resectability.
Postoperative radiotherapy can help prevent local recurrence.

Indications for Surgical Management:

Resection of the tumour is possible without compromising the function of the surrounding structures.
The patient is a good surgical candidate with no significant comorbidities.
The tumour is localized and has not spread to distant sites.

Surgical Steps:

The patient is positioned in a supine position with the arm on the affected side abducted and externally rotated.
The incision is usually made in the second intercostal space, parallel to the ribs.
The pleura is opened, and the pulmonary artery is identified and dissected free.
The superior vena cava is identified and mobilized, if necessary.
The brachial plexus is dissected and resected, if necessary.
The tumour is resected en bloc, along with any involved lymph nodes.
The chest is closed, and the patient is extubated.

SUPERIOR VENA CAVA SYNDROME

Definition:

Superior vena cava syndrome is a medical emergency that occurs when the superior vena cava is compressed or obstructed.
This can lead to a decrease in venous return to the heart, causing symptoms such as facial swelling, arm swelling, and shortness of breath.

Clinical Features:

Management:

The patient is positioned in a supine position with the head of the bed elevated.
A chest X-ray is taken to rule out any other causes of the symptoms.
CT scan is essential for diagnosing the cause of the superior vena cava syndrome.
Biopsy may be necessary to confirm the diagnosis.
Treatment depends on the underlying cause, but may include:
Endovascular stenting or balloon dilatation to relieve compression.
Chemotherapy or radiotherapy to treat underlying cancer.
Corticosteroids to reduce inflammation and swelling.

HOMOEOPATHIC THERAPEUTIC MEDICINES

Arnica: For pain and swelling.
Bryonia: For pain and swelling in the arm.
Calcarea carbonica: For general symptoms of cancer, such as fatigue and weight loss.
Conium: For weakness and numbness in the arm.
Lachesis: For facial swelling and shortness of breath.
Pulsatilla: For general symptoms of cancer, such as fatigue and weight loss.
Silica: For general symptoms of cancer, such as fatigue and weight loss.
Thuja: For general symptoms of cancer, such as fatigue and weight loss.

Indications:

Arnica: For pain and swelling after surgery.
Bryonia: For pain and swelling in the arm after surgery.
Calcarea carbonica: For general symptoms of cancer, such as fatigue and weight loss.
Conium: For weakness and numbness in the arm after surgery.
Lachesis: For facial swelling and shortness of breath.
Pulsatilla: For general symptoms of cancer, such as fatigue and weight loss.
Silica: For general symptoms of cancer, such as fatigue and weight loss.
Thuja: For general symptoms of cancer, such as fatigue and weight loss.

Dosage: