When Might Shoulder Pain Be a Sign of Lung Cancer?

Lung cancer or mesothelioma may be disguised as shoulder pain

Many people with lung cancer develop shoulder pain at some point during the course of their disease, and sometimes it is the first symptom. That said, it's important to note that shoulder pain is not a lung cancer telltale. In addition, in people with lung cancer, the shoulder pain may be the result of their disease or instead, due to another cause such as arthritis. Why does lung cancer sometimes cause shoulder pain, and how does this pain different from other causes of shoulder pain?

lung cancer-related shoulder pain
Illustration by Emily Roberts, Verywell

Why Can Lung Cancer Cause Shoulder Pain?

Let's begin by talking about why people may experience shoulder pain with lung cancer. Lung cancer-related shoulder pain can be caused by a number of different mechanisms.

Pain in your shoulder could be referred pain (meaning that the pain is felt in the shoulder but originates somewhere else in the body).

An example of referred pain from lung cancer is when a lung tumor causes pressure on a nerve that travels near the lungs. In this case, the brain interprets pain as coming from the shoulder, when in fact, the nerve is being irritated within the lungs.

Shoulder pain in lung cancer can also be related to the spread of lung cancer to bones in and near the shoulder. Roughly 30 percent to 40 percent of people with lung cancer develop bone metastases (the spread of cancer to bones) at some time during the course of their disease.

Understanding Lung Cancer Metastases to Bone

Pancoast tumors, a form of lung cancer, grow near the upper part of the lungs and can invade tissues near the shoulder. Pancoast tumors often cause pain in the shoulder that radiates down the arm. Due to their location, these tumors are less likely to cause typical symptoms of lung cancer such as a persistent cough, coughing up blood, and shortness of breath. These tumors are also sometimes difficult to diagnose, as they can "hide" on a normal chest x-ray.

Malignant pleural mesothelioma is a cancer of the pleura—the membranes lining the lungs—and is most commonly caused by exposure to asbestos on the job. In one study it was found that 14 percent of patients developed shoulder pain as their first symptom of mesothelioma. If you have worked in construction or done a home remodeling project on an older home, make sure to let your doctor know.

Symptoms, Diagnosis and Treatment of Mesothelioma

How Shoulder Pain From Lung Cancer Differs From Other Causes

Unfortunately, shoulder pain related to lung cancer or mesothelioma can be very similar or identical to that of conditions such as arthritis. If you have any question at all about shoulder pain, it's better to be safe and talk to your doctor.

Symptoms that may be more concerning for lung cancer include shoulder pain that's worse at night, pain that occurs at rest, and pain that's not associated with any loss of motion with activity.

Shoulder pain is also more likely to be something non-skeletal if you do not recall any injury or activities in which you may have overused your shoulder.

Shoulder pain is also more likely to be a symptom of lung cancer if you have other symptoms of lung cancer, such as shortness of breath (this can be mild and only with activity,) a persistent cough, wheezing, hoarseness, coughing up blood, fatigue, or if you are losing weight for no reason.

Keep in mind that the symptoms of lung cancer in women and symptoms of lung cancer in non-smokers are often less typical than those in men—and sometimes very vague, such as the gradual onset shortness of breath with activity and fatigue. Many people dismiss the early symptoms of lung cancer as age-related changes in exercise tolerance, weight gain, or being too sedentary.

Treatment Options

Treatment of shoulder pain related to lung cancer will depend on the underlying cause for your pain.

If the pain is referred pain from pressure on a nerve in the lung, treatment that decreases the tumor within the lungs is the primary goal. Options could include surgery or radiation locally, or systemic treatment with chemotherapy, targeted therapy drugs, or immunotherapy.

If a tumor is growing near the top of the lungs, surgery to remove the tumor or treating the tumor with radiation may relieve symptoms.

If the pain is related to bone metastases, treatment with radiation therapy or bone-modifying agents may reduce symptoms significantly.

A Word From Verywell

If you are experiencing shoulder pain, don't panic. The chance that shoulder pain is related to lung cancer is usually small. If you do not have an explanation for your pain, however, it's important to see your doctor. Pain is the way in which our bodies tell us something is wrong. 

In addition to lung cancer, there are other serious medical conditions which may only have symptoms of shoulder pain at the onset. If you do not recall an injury and haven't used your arm excessively in the recent past, may sure to talk to your doctor even if your symptoms seem to be improving.

If you still do not have a clear explanation for your symptoms even after seeing your doctor, consider getting a second opinion. While shoulder pain is not a common symptom of lung cancer, some people have found their cancers early by listening to their bodies and having their symptoms evaluated. Be your own advocate in your health care. Nobody is more motivated than you are to make sure your symptoms are explained and treated as well as possible.

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