When Is Itchy Skin a Cancer Symptom?

Both cancer itself and cancer treatments may cause itching (pruritus)

Itchy skin, which is known medically as pruritus, can be a symptom of cancer or even the first sign of cancer, though other causes of itching are certainly much more common.

Cancer occurs when cells in the body start to grow out of control.

Itching may occur due to direct irritation of the skin, such as with skin cancer or a separate cancer that has spread, or metastasized, to the skin.

Other times, itching is from a buildup of bile salts under the skin, such as with blood cancers or bile duct cancer, or due to substances released from a tumor or in response to a tumor. A tumor is an abnormal growth of tissue that can be cancerous.

Though it can be difficult to differentiate itching due to cancer from itching due to other causes, there are a few clues.

This article will explore the types of cancer most commonly linked with itching and potential warning signs.

itchy skin during cancer treatment

Verywell / Brianna Gilmartin

How Common Is it?

Most often, itching is due to something other than cancer.

It's uncertain exactly how often itching occurs as a symptom or first symptom of cancer, but it's estimated that an underlying systemic, or body-wide, disease—such as liver disease, kidney disease, blood disorders, or cancer—is present in 10% to 50% of people who develop itching throughout their body.

This type of itching is known as generalized itching.

In one study looking at almost 17,000 patients with itching in the Johns Hopkins Health System, those who had generalized itching were almost six times more likely to have a cancer than those who did not experience itching.

The cancers that were most commonly associated with itching included:

However, itching can be a symptom of a number of other cancers.

In the study, Black patients were more likely to have skin cancer, soft tissue cancers (such as sarcomas that can start in muscles and fat), and blood-related cancers as the underlying cause of their itching. White patients were more likely to have liver cancer, lung cancer, digestive tract cancers, and cancers of the female reproductive tract, such as ovarian cancer.

Among the participants with newly diagnosed cancer, 30% of those with Hodgkin lymphoma, 15% with non-Hodgkin lymphoma, 5% with leukemia, and over 50% of those with disorders known as myeloproliferative neoplasms that cause the overproduction of blood cells had significant itching.

Lymphomas are types of blood cancer that affect the lymphatic system, such as the lymph nodes, which are part of the immune system

Leukemia is a form of blood cancer that affects the production of white blood cells in bone marrow (the spongy parts of bones where blood cells are made).

Recap

It's unknown how often itching occurs with cancer, but itching all over can be a sign of a body-wide disease up to 50% of the time, according to estimates.

Cancers that are commonly associated with itching include blood, liver, bile duct, gallbladder, and skin cancers.

Is Cancer Causing the Itching?

Itching related to cancer is sometimes identical to itching related to skin conditions or other benign (noncancerous) causes, but there are some characteristics that may differ.

Signs of cancer-related itching may include:

  • Itching in response to water, which is called aquagenic pruritus
  • Lack of any rash or hives (though sometimes a rash occurs due to repeated scratching)
  • The presence of other symptoms such as a yellowish discoloration of the skin (jaundice), and the B symptoms, which are body-wide symptoms of lymphoma including fever, weight loss, and drenching night sweats

In addition, itching associated with cancer may feel the worst on the lower legs and chest and may be associated with a burning sensation.

Recap

Some warning signs that itching might be related to cancer include itching when the skin is wet, the lack of a rash, or additional symptoms such as night sweats or weight loss. Always bring any unexplained itching to your healthcare provider's attention.

How Does Cancer Cause Itching?

There are a number of ways that cancer can lead to itching. The body contains nerve endings that cause itching, similar to pain receptors that cause pain.

In general, anything that irritates these nerve endings can cause itching.

Direct Inflammation

Cancers that involve the skin or mucous membranes that line body structures can cause inflammation that triggers itching.

This may include the different types of skin cancer, breast cancers such as inflammatory breast cancer, Paget's disease of the nipple, and certainly any cancer that spreads to the skin.

Direct inflammation may also give rise to the itch associated with vulvar and anal cancers.

Buildup of Bile Salts

Bile is a digestive liquid that's produced by the liver and mostly made of bile salts.

Blocked bile ducts, which are the tubes that carry bile from the liver, or the breakdown of red blood cells can both lead to the buildup of bile salts under the skin. This often leads to severe itching.

This may occur with leukemias and lymphomas due to the breakdown of blood cells. It may occur in abdominal cancers, such as those of the liver and gallbladder, and any cancer that spreads to the liver such as breast, lung, colon cancers, and more.

Sometimes the buildup of bile salts is associated with jaundice, though not always.

Release of Chemicals

Substances released by cancerous tumors or by the body in response to the tumor can affect many body systems and lead to certain signs and symptoms, including itching.

When symptoms occur due to these chemical substances, they are called paraneoplastic syndromes.

This itching is often most severe in the legs.

In some cases, symptoms such as itching may happen weeks or months leading up to the diagnosis of cancers such as non-small cell lung cancer, lymphomas, breast cancer, or ovarian cancer.

It's estimated that paraneoplastic syndromes develop in roughly 20% of people with cancer.

Some of the chemicals that can contribute to itching include:

  • Cytokines, which are inflammatory proteins released from cells of the immune system and often in response to lymphomas
  • Substance P, a signaling substance that can be recognized by the immune system and the nervous system
  • Prostaglandins, which are hormones that influence pain signals and inflammation

Some of these chemicals act directly on the nerve endings to cause itching, whereas others may cause the release of histamine, a protein involved in allergic reactions. Histamine is released by mast cells, immune cells that are prominent in the skin.

Itching as a symptom of cancer may occur alone, or may be associated with rashes such as:

  • Erythroderma: Severe red and scaly skin that starts in patches and spreads throughout the body
  • Acanthosis nigricans: Dark and thickened skin located in skin folds
  • Dermatomyositis: A rash that occurs along with muscle weakness
  • Grover's disease: An itchy rash on the chest and back
  • Eruptive seborrheic keratosis: The sudden appearance of wart-like growths

Hormonal Changes

Hormonal changes related to cancer or cancer treatments can lead to itching in a few ways.

Menopause, or the end of menstruation (periods), in women can cause skin dryness. This can occur regardless of whether menopause occurs naturally, surgically, or is medically brought on due to treatments, such as those for breast cancer.

Hormonal changes may also lead to hot flashes. These hot flashes, often followed by sweats, can easily lead to itching.

Other Processes

There are a number of other ways in which cancer may cause itching.

For example, mast cells that release histamine may become overactive with some cancers, especially when exposed to hot water, such as during a hot shower.

This is most common with blood-related cancers.

Cancers That May Cause Itching

As noted earlier, there are some cancers that are more likely to lead to itching than others.

Sometimes the itching is severe and frequent, whereas other times it may occur off and on or only after taking a hot bath or shower.

Blood Cancers

Any type of blood-related cancer may lead to itching, but the most common culprits include:

Cutaneous T cell lymphoma is a rare type cancer that begins in T cells, a type of white blood cell, and can cause them to attack the skin. It can lead to rash-like redness, scaly patches, or tumors.

The most common type of cutaneous T cell lymphoma is called mycosis fungoides. A less common form called Sezary syndrome can lead to redness across the entire body.

With cutaneous T cell lymphomas, the cancer can cause itching both due to direct skin involvement and due to the release of inflammatory substances, such as a cytokine called interleukin-31.

Other examples that can lead to itching include myelodysplastic syndomes that cause low numbers of blood cells and myeloproliferative disorders that cause an overproduction of blood cells.

Myelodysplatic syndromes and chronic myeloproliferative disorders are considered types of cancer. Some myelodysplastic syndromes progress to leukemia.

With slow-growing blood cancers, such as T cell lymphomas or chronic myelodyplastic syndromes, itching triggered by water may even be present for years before a cancer is diagnosed.

Skin Cancer

Skin cancer is a common type of cancer to cause itching.

Itching is more common with basal cell carcinoma and squamous cell carcinoma than with more dangerous melanoma.

Liver, Bile Duct, Pancreatic, and Gallbladder Cancer

Any cancer that interferes with the bile ducts can lead to obstruction and the consequent buildup of bile salts in the skin that can lead to itching.

With pancreatic cancer specifically, this buildup and itching is most common with cancers located in the head of the pancreas. Other symptoms may include yellowing of the skin, abdominal pain, a collection of fluid in the abdomen (ascites), and abdominal pain.

Vulvar Cancer and Anal Cancer

Itching in the vulvar and vaginal region or anal region is more likely due to another cause, but this is still sometimes seen with cancers in these regions.

Breast Cancer

Itching as a symptom of breast cancer isn't common, but it may occur.

A less common type of breast cancer called inflammatory breast cancer blocks lymph and blood vessels in the breast and often looks at first like a rash or breast infection (mastitis).

Sometimes, symptoms begin with itching and a small rash that could even be dismissed as a bug bite before it worsens.

Paget's disease of the breast may also present with itching that is often associated with a dry, scaly rash of the nipple.

Metastatic Cancer

Cancer that originated somewhere else in the body and spread to the skin, known as metastatic cancer to the skin or skin metastases, may cause itching.

Common sources of skin metastases include:

  • Breast cancer
  • Lung cancer
  • Colorectal cancer

Liver metastases, or cancer that started someplace else and spread to the liver, may also lead to itching, similar to the itching associated with primary liver cancers that began in the liver.

The most common cancers to spread to the liver are:

Itching Due to Cancer Treatments

There are many cancer treatments that can lead to itching. They include:

  • Chemotherapy, or the use of medications to kill cancer cells, particularly if there is a sensitivity to the drug. Many medications can also cause allergic reactions or inflammation of the liver, which also can lead to itching.
  • Immunotherapy drugs, or treatments that stimulate your immune system to fight the cancer, especially interferon and interleukin-2
  • Radiation therapy, or using high-powered waves of energy to destroy cancer cells, commonly causes itching, especially later on in treatment when the skin begins to heal.

Diagnosis

The first step in diagnosis includes a careful history and physical examination looking for any obvious causes of itching.

Blood tests may include a complete blood count to check levels of blood cells and liver function tests.

If leukemia, lymphoma, or a myeloproliferative disorder is suspected, a bone marrow test is often needed to either confirm or rule out a problem.

Imaging tests may be needed as well. Symptoms related to chemicals released by tumors or in response to tumors are not uncommon with lung cancer. The evaluation may include a chest CT scan (chest X-rays can miss up to 25% of lung cancers).

If an abdominal cancer is a possibility, an abdominal CT scan as well as other imaging tests may be needed.

Even if no cancer is found, careful follow-up is necessary. Itching may occur weeks to months before other symptoms with lung cancer, and, as already noted, itching may appear years before the diagnosis of a T cell lymphoma is made.

If an obvious underlying medical cause is not determined (either benign or cancerous), keeping a symptom diary is sometimes helpful, as well as letting your healthcare provider know if any new symptoms arise.

Recap

A combination of blood tests, bone marrow tests, or imaging tests can help diagnose cancer if it is suspected based on itching and other signs and symptoms.

Management

Managing itching with cancer is very important in improving quality of life, especially when itching is severe, such as with liver metastases or T cell lymphomas.

Often times, treatment of the underlying cancer reduces itching. However, this isn't always possible, such as with advanced cancers. It can take some time to resolve the itching.

Lifestyle Measures

Simple strategies for managing itchy skin, including during cancer treatment, includes:

  • Stay well hydrated.
  • Use quality lotions and creams and avoid any scented products.
  • Apply baking soda or oatmeal mixtures to your skin.
  • Use a humidifier if the air is dry in your home.
  • Avoid shaving.
  • Bathe in lukewarm rather than hot water.
  • Try to limit bathing to every few days rather than daily, and avoid sitting in a tub more than 30 minutes.
  • Allow your skin to dry naturally after bathing rather than rubbing your skin with a towel.
  • Wear comfortable and loose clothing.
  • Avoid clothing that creates friction or rough clothing such as wool. Cotton and linen are preferable to synthetic fabrics.
  • Keep the thermostat down or the air conditioning up to decrease sweating that can aggravate itching.
  • Use distraction, such as conversations, music, or anything that helps you get your mind off of the itching.
  • Keep your fingernails short to avoid scratching when you are sleeping.
  • Use insect spray when spending time outside to avoid bug bites.
  • Avoid your personal triggers for itching. Sometimes keeping a symptom diary can help you determine what makes the itching worse and what helps the most.
  • Try to reduce stress, when possible, as emotional stress can make itching more severe.

Avoiding scratching, is of course, important, but often easier said than done. To relieve the itch, you may try patting the area, massage, gentle pressure, or vibration as alternatives to scratching. Cold compresses are helpful for some people.

Medications

A number of different medications have been used to help relieve itching. Before using any over-the-counter (OTC) remedies, however, make sure to talk to your healthcare provider or oncologist, a physician who specializes in diagnosing and treating cancer.

Some medications can interfere with cancer treatments. For example, Benadryl (diphenhydramine) counteracts the effects of the breast cancer drug tamoxifen.

Options recommended by your doctor may include:

  • Antihistamines
  • Topical or oral steroids
  • The anti-nausea drug Zofran (Odansetron)
  • Questran (cholestyramine), which attaches to bile acids and allows them to pass from the body, may be helpful for people who have itching due to liver metastases or tumors that are causing bile duct obstruction.
  • Selective serotonin reuptake inhibitors (SSRIs) such as Paxil (paroxetine)
  • Serotonin-norepinephrine reuptake inhibitors (SNRI) such as Cymbalta (duloxetine)
  • Neurontin (gabapentin), a seizure drug, or Remeron (mirtrazapine), an antidepressant, may be helpful for the severe itching associated with T cell lymphomas.
  • Emend (aprepitant), a medication often used to prevent nausea and vomiting associated with chemotherapy, stops the action of substance P, which plays a role in itch signaling.
  • Tagamet (cimetidine), which blocks histamine, with or without aspirin may help with itching related to Hodgkin lymphoma.

Summary

Itching is usually due to something other than cancer. However, it can sometimes be a symptom or even the first sign of cancer and can happen due to cancer treatments. The itching tends to occur all over the body.

Itching can occur for many different reasons in those with cancer. It can be due to direct skin involvement and inflammation, a buildup of bile acids under the skin, or due to chemicals released by tumors or in response to them.

A Word From Verywell

If you have itching that is not otherwise explained, it's important to make an appointment to see your healthcare provider to determine the underlying cause.

In addition to cancer, there are other medical conditions ranging from liver disease to kidney disease that could be a factor. Treatment of these conditons or cancer is often most successful when the condition is discovered earlier rather than later.

Finally, even though it may be considered a "nuisance symptom" by some, itching can seriously reduce your quality of life. Talking to your healthcare provider may help you determine the underlying cause and find relief.

Frequently Asked Questions

  • Why am I more itchy at night?

    More intense itching at night can be caused by several diseases and disorders. Some of these include skin conditions such as atopic dermatitis, psoriasis, and lichen planus, as well as non-skin conditions such as liver disease, chronic kidney disease, schizophrenia, substance abuse, stress, and restless leg syndrome.

  • Which types of cancer can cause itchy skin?

    Many types of cancer are sometimes associated with itchy skin. These types include leukemia, Hodgkin's lymphoma, cutaneous T cell lymphoma, liver, skin, bile duct, pancreatic, gallbladder, breast, anal, vulvar, and skin cancers, as well as skin metastatic cancer (cancer that spread to the skin from elsewhere in the body).

    Cancer treatments such as chemotherapy, immunotherapy drugs, and radiation therapy can also lead to itchy skin.

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11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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