Patients whose tumors invade the chest wall can sometimes be treated with surgery, which may involve the removal of some of the chest wall, including ribs. Radiation therapy is often used along with surgery.
Some patents with extensive metastatic disease in the center of the chest may develop what is called the superior vena cava syndrome, in which the great vessels in the chest are compressed by the tumor. When this involves the large vein that returns blood to the heart, the blood gets backed up into the tissues of the neck, head and arms. This is an urgent situation and patients should be given prompt radiation therapy.
A special situation under Stage III is called a superior sulcus tumor, which involves cancers in the top of the lung that invade local nerves and cause pain in the arm. These tumors seem to have a reduced potential for distant metastases, so local radiation therapy followed by surgery is the usual approach.
