Lung cancer: The Daily PANCE Blueprint
A 55-year-old individual with a history of smoking presents to your office with right shoulder pain and weakness in the right hand. On examination, you note ptosis, miosis, and anhidrosis on the right side of the face, along with atrophy of the intrinsic hand muscles. A chest X-ray reveals a mass in the apex of the right lung. What is the most likely diagnosis, and what is the next best step in the management of this patient?
A. Multiple Sclerosis; MRI of the Brain
B. Guillain-Barré Syndrome; Lumbar Puncture
C. Pancoast's Syndrome; Biopsy of the Lung Mass
D. Cervical Radiculopathy; Physical Therapy
E. Carpal Tunnel Syndrome; Wrist Splinting
Answer and topic summary
The answer is C. Pancoast’s Syndrome; Biopsy of the Lung Mass
The patient’s presentation of shoulder pain, hand weakness, and Horner’s syndrome (ptosis, miosis, anhidrosis) along with a mass in the apex of the lung is consistent with Pancoast’s syndrome. Pancoast’s syndrome is associated with a tumor located at the apex of the lung, often leading to compression or invasion of the brachial plexus and sympathetic chain. Most Pancoast tumors are non–small cell lung cancer (NSCLC)—specifically, squamous cell carcinoma (SCC) or adenocarcinomas; only 3-5% are small cell carcinomas. The next best step in management is a biopsy of the lung mass to confirm the diagnosis and guide treatment, which may include surgery, radiation, and chemotherapy.
Incorrect Answers:
A. Multiple Sclerosis; MRI of the Brain – Does not explain the localized findings and lung mass.
B. Guillain-Barré Syndrome; Lumbar Puncture – Does not explain the localized findings and lung mass.
D. Cervical Radiculopathy; Physical Therapy – Does not explain the Horner’s syndrome and lung mass.
E. Carpal Tunnel Syndrome; Wrist Splinting – Does not explain the shoulder pain, Horner’s syndrome, and lung mass.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Pulmonary => Neoplasms => Lung cancer
Also covered as part of the Family Medicine EOR and Emergency Medicine EOR topic lists
