Pancoast Tumour: The Role of Early Palliative Care-Case Report

Abstract

Background: Tumours of the superior pulmonary sulcus (Pancoast) still entail poor outcomes when curative multimodal therapy is unfeasible. Case: We report an 84‑year‑old male on long‑term warfarin (INR 9.1) who presented with progressive left shoulder pain and Horner’s syndrome. Thoracic CT and PET‑CT revealed an apical mass infiltrating the brachial plexus, costal arches 1‑4 and a left adrenal metastasis. Brain CT confirmed a 21×14 mm cerebellar lesion. Given extreme anticoagulation, frailty (ECOG 3) and stage IV disease, surgery and chemoradiotherapy were ruled out. A palliative‑care‑centred pathway was started; opioid rotation and psychosocial support achieved acceptable comfort until death on day 10 of admission. Conclusion: Uncontrolled anticoagulation may turn a potentially operable Pancoast tumour into an unresectable one and stresses the value of early specialist palliative care to manage neuropathic pain and decision‑making in advanced lung cancer.