Is My Lower Back Pain Cancer?

Shot of a young businessman experiencing back pain while working in an office at night

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While back pain is one of the most common reasons people seek care from a primary doctor, it is very rarely a sign of cancer. Most often, back pain is caused by injury, overuse, or spinal problems such as disc degeneration, arthritis, or stenosis.

Though the likelihood of back pain being a sign of cancer is rare, there are some types of cancer where back pain can be a symptom. Primary cancers that develop in the spine—spinal cancer, or a spinal tumor—can present with back pain as the first symptom.

Other types of cancer can cause back pain or metastasize and spread to the spine and also cause pain. Even though most back pain is caused by other causes it is still important to know the symptoms that might point to cancer.

Back Pain and Cancer Statistics

Key facts include:

  • Mechanical sources account for 90% of back pain.
  • The lifetime chance of developing a spinal cord or brain tumor is less than 1%.
  • The biggest predictor of spinal cancer is a history of cancer.

Spinal Tumor

Though spinal tumors are rare, they can occur. Spinal tumors are abnormal masses that grow within or around the spinal cord or spinal column. These tumors can be malignant (cancerous) or benign (non-cancerous). In either case, spinal tumors can cause pain in the back.

If your doctor suspects you have a spinal tumor your doctor will take a full history, conduct a neurological exam, and order imaging tests such as a computed tomography (CT) scan, or MRI. They may also take blood tests or biopsy the area.

Types

There are two types of spinal tumors that can occur in the spine. These types are categorized by their location and proximity to the spinal cord.

Intramedullary Tumors

Intramedullary tumors grow inside the spinal cord and comprise 20-30% of all primary spinal cord tumors. These types of tumors most often cause back pain that is worsened when lying down. You may also experience numbness or tingling.

Extramedullary Tumors

Extramedullary tumors grow inside the thin sac that holds the spinal cord but outside of the spinal cord itself. These tumors most commonly develop in the nerve roots that extend from the spinal cord. The most common symptom is back pain at night or pain that radiates to the arm or leg.

Other Symptoms

While back pain may be one of the primary symptoms of a spinal tumor, there are other symptoms that can also occur. If you experience any of the following symptoms along with back pain, you should seek the advice of your doctor.

  • Pain
  • Numbness
  • Weakness
  • Lack of coordination in the arms/legs
  • Paralysis
  • Bladder or bowel problems

Causes and Risks

While there is no known direct cause of spinal cancer, there are several genetic factors that can raise your risk for developing spinal tumors. If you have any of the following genetic diseases,and have back pain you should talk to your doctor.

The risk for spinal cancer increases if you are a cancer patient. Spinal tumors that are found in the bone itself can be caused by metastasis from other cancers. It is estimated that 30% of patients with cancer will have the cancer spread to their spine.

Complications

An untreated spinal tumor can grow and affect the spinal cord, nerve roots, blood vessels, and bones of the spine. This growth could lead to paralysis, scoliosis—a spinal deformity—and loss of bowel or bladder function.

If a spinal tumor is suspected, it is important to seek the advice of a doctor or neurologist right away. Spinal tumors can be removed surgically or treated with chemotherapy or radiation in order to remove them or reduce their size and impact on the body.

Surgery carries risks of its own—such as infection or damage to nerves—and a doctor will fully evaluate the location, size, and type of tumor in order to determine if surgery is the correct treatment.

Other Types of Cancer With Back Pain

While primary spinal tumors are rare and most often not the cause of back pain, there are other cancers that can cause back pain as well. If there is back pain, most of the time there will be other symptoms that indicate a specific cancer.

Lung Cancer

Lung cancer is the leading cancer diagnosis and cause of cancer death worldwide. It affects the lungs but can also metastasize (spread) to other parts of the body. Lung cancer will metastasize in 30% to 40% of patients, with the vertebrae of the spine being the most common site of metastasis.

Back pain that occurs with a lung cancer diagnosis or any of the symptoms below should be evaluated further:

  • A cough that does not go away or gets worse.
  • Coughing up blood or rust-colored spit or phlegm.
  • Chest pain that is often worse with deep breathing, coughing, or laughing.
  • Hoarseness.
  • Shortness of breath.
  • Feeling tired or weak.
  • Loss of appetite.
  • Unexplained weight loss.
  • Infections such as bronchitis and pneumonia that don’t go away or keep coming back.
  • Wheezing

Breast Cancer

Breast cancer occurs when cells in the breast tissue grow out of control. Most patients with breast cancer will find a lump. However, there are cases where back pain can be the only indicator of breast cancer.

In most breast cancer cases, patients will experience some of the more common breast cancer symptoms while also experiencing back pain. If you have back pain along with any of the following symptoms you should be evaluated by a doctor:

  • Swelling or skin dimpling of all or part of the breast
  • Breast or nipple pain
  • Nipples that turn inward
  • Nipple or breast skin that is red, dry, flaking, or thickened
  • Nipple discharge
  • Swollen lymph nodes

Gastrointestinal Cancers

Gastrointestinal cancers include stomach, colon and rectal cancers. Back pain may be a symptom of one of these cancers, but it is most frequently accompanied by other symptoms that are more common to gastrointestinal cancers.

The following symptoms could indicate a gastrointestinal cancer and should be further evaluated by a doctor:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • A feeling that you need to have a bowel movement that's not relieved by having one
  • Rectal bleeding with bright red blood
  • Blood in the stool, which might make the stool look dark brown or black
  • Cramping or abdominal pain
  • Weakness and fatigue
  • Unintended weight loss
  • Poor appetite
  • Vague discomfort in the abdomen, usually above the belly button
  • A sense of fullness in the upper abdomen after eating a small meal
  • Heartburn or indigestion
  • Nausea
  • Vomiting, with or without blood
  • Swelling or fluid build-up in the abdomen

Blood and Tissue Cancers

Blood and tissue cancers include myeloma, lymphoma, leukemia, and melanoma. Blood cancers, while they affect the bone marrow, rarely present with back pain as the only symptom.

Melanoma that has gone undetected and spread through the body can spread to the spine causing back pain. It is important to have your skin evaluated by a doctor and to report any of the symptoms below that would indicate a skin cancer before the cancer can spread.

Blood cancer symptoms:

  • Fatigue
  • Weight loss
  • Bruising
  • Diarrhea
  • Shortness of sreath

Melanoma symptoms:

  • A changing mole
  • A sore that doesn’t heal
  • Spread of pigment from the border of a spot into the surrounding skin
  • Redness or a new swelling beyond the border of the mole
  • Change in sensation, such as itchiness, tenderness, or pain
  • Change in the surface of a mole—scaliness, oozing, bleeding, or the appearance of a lump or bump

When to See a Doctor

Most back pain resolves over a few weeks with conservative treatment. If you have unexplained back pain, or pain that persists for longer than six weeks it is best to seek the advice of a doctor.

If you have back pain along with weakness, difficulty walking, pain when awakening in the morning, loss of bowel or bladder control you should be examined immediately as these symptoms can indicate a more serious problem.

If your back pain persists after conservative treatment, let your doctor know. They may refer you to a specialist for further evaluation. Injections to help with the pain or surgery may become necessary. Back pain that is accompanied by signs of cancer should be further evaluated as well.

Diagnosing Cause of Back Pain

Living with back pain can be very difficult. Unlike other injuries, like a sprained ankle that can be elevated and rested, back pain is hard to escape since the spine is involved in most parts of everyday life.

Walking can be hard, sleeping might be disrupted, exercise can be painful, even your work can be affected by back pain. When pain disrupts your life, diagnosing the cause of your back pain becomes a priority so that you can return to living a pain-free life.

To diagnose the cause of your back pain you will need to see a doctor.  The most common causes of back pain are:

  • Muscle sprain/strain
  • Arthritis
  • Disk herniation
  • Spondylolisthesis—a slipped vertebrae
  • Vertebral compression fracture
  • Spinal stenosis
  • Infection

Doctor Exam

When diagnosing your back pain your doctor will conduct a variety of tests to find the cause. They will take a complete history and ask how the pain affects your everyday life. They will conduct a physical exam to test and assess your range of motion and strength, and to see what provokes the pain, if anything.

Most often you will be treated conservatively, with NSAIDs like Aleve (naproxen), modifications to your daily life, physical therapy, or exercise. Most low back pain can be treated conservatively, without surgery.

Response to Other Treatments 

The goal of treatment is to restore function and increase strength so that you can return to your daily activities with little to no pain or hindrance. When the pain does not respond to these treatments, surgery may be indicated in instances where there is disc herniation or other structural damage.

If these typical treatments do not work and your doctor suspects that there is another cause of your back pain, they will order more tests. These tests can include blood tests, MRI, and computed tomography (CT) scans depending on the type of disease process they suspect.

A Word From Verywell

Back pain as the main indicator of cancer is quite rare. Your back pain is most likely caused by something other than cancer. In an older study that looked at misdiagnoses of back pain less than 1% of patients with back pain had cancer.

Most back pain can be treated once properly assessed. If you have unexplained back pain or pain that persists, talk to your doctor. If you have a history of cancer and are now experiencing back pain, you should talk to your doctor immediately as it can be a sign of metastasis.

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Additional Reading
  • Casiano VE, Dydyk AM, Varacallo M. Back Pain. [Updated 2020 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/