Which statement about Pancoast tumors is true?

• A. Most are non-small cell cancers
• B. They are always central
• C. They arise from adenocarcinoma only
• D. They never metastasize

Answer: (A)

Pancoast tumors are apical lung neoplasms that invade nearby structures at the thoracic inlet, often causing shoulder/arm pain and Horner’s syndrome from sympathetic chain involvement. The statement that best reflects their usual histology is that most are non-small cell lung cancers, including squamous cell carcinoma and adenocarcinoma. Small cell lung cancer tends to originate centrally and shows early widespread metastasis, which is not the typical apical, locally invasive pattern of a Pancoast tumor. Thus, saying they are predominantly non-small cell captures the common pathology. They can metastasize and are not restricted to adenocarcinoma, and they are not confined to a central location, so those other statements aren’t accurate.