This tumour, described by Pancoast in 1924, causes pain at C8, D1 and D2, muscular atrophy in the region of the ulnar nerve and destruction of the ribs. For a long time, treatment has been unsatisfactory. Key points Pretreatment assessment of patients is essential. This involves careful clinical and neurological examination, good quality imaging and formal histological investigation. Fine-needle biopsy appears to be the most worthwhile technique used to diagnose Pancoast's syndrome.
Curative treatment aims to obtain the best possible local control.
The progress of pain reflects the progress of the disease. Scotland A significant turning point in the outgrowth of palliative care from the hospice movement in the UK has been the development of palliative medicine as a recognised specialty in medicine. In December 1987, the UK Joint Committee on Higher Medical Training approved the introduction of an accredited training programme for doctors in palliative medicine. This led to the design of a four-year senior registrar training programme, including two years in one or more specialist units. This ongoing research project aims to place the role of the palliative physician in a realistic context.