Research shows that the time between the onset of symptoms and the diagnosis of lung cancer is approximately 12 months. This often happens because the person does not recognize the symptoms or expects them to go away. Back pain is one of those symptoms.
Often people with lung cancer have back pain or even back pain as the first symptom. In fact, there are certain defining symptoms that point to cancer as the cause of back pain.
The main ones are the location and types of pain, which can be very different from your typical chronic back pain. In total, about 25% of people with lung cancer report that back pain is a symptom at some point in their illness.
This article looks at how back pain is associated with lung cancer and how it differs from other types of back pain. It also explains why early treatment of back pain is so important.
How Lung Cancer and Back Pain Are Related
When we think of back pain, cancer is often the last thing that comes to mind. Instead, we associate it with things like injuries like a muscle strain or a ruptured disc. Or we can think that it is due to a degenerative disease such as arthritis or osteoporosis .
Back pain caused by lung cancer has some similarities to many of these conditions. However, it has clear differences. They can refer to how and where cancer causes pain, both directly and indirectly.
Some possible ways that lung cancer can cause back pain include:
- The tumor can put direct pressure on the back structure, most often the middle and upper back , rather than the lower back.
- The tumor can irritate the nerves that serve the lining of the lungs and chest wall. This can cause severe and sometimes chronic nerve pain.
- The spread of cancer ( metastasis ) from the lungs to the spine and bones occurs in about 30% of people with lung cancer.
- Spread of cancer to the adrenal glands occurs in 40% of people with lung cancer and can cause pain just above the kidney.
Healthcare providers may miss possible lung cancer as a cause of back pain, especially in people who have never smoked. However, most people who develop lung cancer today do not smoke. or never smokers or ex-smokers. The incidence of lung cancer is increasing in young women and men who have never smoked.
In fact, due to the location of the type of lung cancer most commonly seen in nonsmokers, called adenocarcinoma of the lung , The typical lung cancer symptoms that most people think of are often absent. These tumors are also more likely than other types of lung cancer to spread to the bones.
Although back pain can be the first sign of lung cancer in some people, it can also indicate multiple myeloma, breast cancer, and other cancers. For example, back pain is the first symptom in about 1% of people diagnosed with breast cancer.
Back pain affects about one in four lung cancer patients, but few people think of back pain as a symptom. In fact, it may be one of the first symptoms, although it may be different from "classic" back pain. Back pain is often associated with lung cancer, which is more common in nonsmokers.
Symptoms That May Indicate Lung Cancer
Back pain symptoms associated with lung cancer may coincide with back pain caused by other conditions. If the cancer affects the spine, it can mimic many of the symptoms of an upper back injury.
The back pain associated with lung cancer may appear dull, like a muscle ache, or it may feel sharp, like a pinched nerve. People with cancer that has spread to the adrenal glands can sometimes say they have "kidney pain" on one side of their back. They can also describe the feeling that they have just received a "hit to the kidney."
However, back pain associated with lung cancer can have certain characteristics. Warning signs that lung cancer can cause back pain include:
- Back pain that is present at rest.
- Back pain that worsens at night.
- Back pain caused by inactivity.
- Back pain that gets worse the longer you lie down
- Back pain that worsens with deep breathing.
- Back pain that does not respond to physical therapy or other treatment.
Back pain can be accompanied by other characteristic signs of lung cancer, such as a persistent cough or shortness of breath. Unintentional weight loss, chronic fatigue, or coughing up blood can further indicate lung cancer.
The "typical" symptoms of lung cancer are less likely to be present with adenocarcinoma of the lung, which often affects nonsmokers. The most common symptoms of this type of cancer are fatigue and shortness of breath with exercise, which people can attribute to age or lack of exercise.
The back pain associated with a fractured spine should also make your doctor think about lung cancer. In metastatic lung cancer, cancer spreads to the bones in about 40% of people. The most common distribution sites are the spine, in about half of the cases, and the large bones of the legs.
Cancer that affects the vertebrae in the spine can lead to brittle and weak bones, and compression fractures are common. These fractures, which occur in a bone weakened by cancer, are called pathological fractures.
One indication that a compression fracture of the spine is associated with lung cancer rather than osteoporosis is that it occurs with minimal trauma.
Lung cancer back pain can feel sharp or dull. It is usually present at rest and worsens at night, and does not improve with physical therapy or other treatment. If cancer spreads to the spine, it can cause fractures. Other symptoms of lung cancer include fatigue, shortness of breath, unexplained weight loss, and coughing.
Back pain treatment
Treatment for back pain in people with lung cancer largely depends on the underlying cause. If the pain is caused by pressure from the tumor, treatment may include:
If the cancer has spread to the bones, it may be helpful to combine radiation therapy with drugs called bisphosphonates , which are often used to treat osteoporosis. Denosumab generally provides significant pain relief. and it also reduces the risk of fractures of the affected bone.
After all, there are many effective treatments for severe pain associated with lung cancer. However, too many people will try to refrain from pain relief because they fear becoming addicted or that drugs will become less effective "when they really need it." Both concerns are unfounded when medications are taken as directed.
When back pain requires immediate attention
Some people with lung cancer that spreads to the spine can develop a condition called malignant spinal cord compression . These symptoms include increased back pain, leg weakness, and sometimes loss of urinary or bowel control. This is a medical emergency and immediate treatment is needed to prevent complications such as paralysis.
Back pain is a symptom of lung cancer much more often than people, even healthcare professionals, might realize. This is quite common, although the pain itself is often different from "back pain" as we often think of it. For many, this may even be the first symptom of lung cancer.
If you have back pain that you don't understand, see your doctor. Be sure to share any other symptoms you may have. If it is cancer, early diagnosis allows treatment to begin early, increasing the likelihood of a better outcome.