Woman, 71, finds tumour following shoulder pain and right hand signs

Cancer symptoms: Top 14 early signs to look out for

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A case study published in the BMJ Case Reports underscores the importance of getting a doctor’s opinion on anything that seems out of the ordinary for you. A 71-year-old lady was referred by her general practitioner to an orthopaedic clinic for management of shoulder pain. The patient also complained of pain in the chest region.

The pain was exacerbated by walking, sitting and turning in bed.

In addition to a normal shoulder examination, this patient also described symptoms of sleep disturbance, chest tightness and reduced appetite.

Curiously, the woman also described reduced sensation and power in her arm.

The patient reported “right hand symptoms” of grip weakness, loss of dexterity and a feeling of her arm “not belonging to her”.

The 71-year-old also reported worsening of her respiratory symptoms.

This patient had not undergone any investigations prior to attending the orthopaedic clinic.

Researchers initially conducted an isotope bone scan to investigate further.

An isotope bone scan is a method of looking at your bones to show conditions not seen using X-rays.

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It requires an injection of a small amount of radioactive fluid, which is then taken up by the bones. This scan is performed three hours after the injection.

The scan revealed a large Pancoast tumour – a type of cancer that starts in the top part of the lung (the apex).

Pancoast tumours are often challenging to diagnose as they are difficult to detect on plain chest x-ray.

This patient’s case was discussed at the local respiratory multi-disciplinary team meeting and a decision was taken that the tumour was “inoperable and too large for radical radiotherapy”.

A mixture of palliative radiotherapy and chemotherapy was given.

Sadly, the patient died within a year of diagnosis.

“This case study highlights the importance of considering non-musculoskeletal conditions which cause referred shoulder pain,” the case study authors wrote.

Pancoast tumour – most common signs to be aware of

Because the cancer is at the top of the lungs, it might put pressure on or damage a group of nerves that runs from the upper chest into your neck and arms. The group of nerves is called the brachial plexus.

According to Cancer Research UK, pressure on the brachial plexus can cause several very specific symptoms:

  • Severe pain in the shoulder or the shoulder blade (scapula)
  • Pain in the arm and weakness of the hand on the affected side
  • Horner’s syndrome.

Horner’s syndrome is the medical name for a group of symptoms. You get flushing on one side of the face and that side doesn’t sweat.

The eye on the same side has a smaller (constricted) pupil with a drooping or weak eyelid.

“Whatever your age, it’s always best to listen to your body and talk to your doctor if something doesn’t feel quite right,” says Cancer Research UK.

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