Lung Cancer and Back Pain: How Are They Connected?

This article is medically reviewed by Dr Chandrasekhar Prasad Singh, Consultant - Medical Oncology, HCG-Abdur Razzaque Ansari Cancer Hospital, Ranchi.

Table of Contents

• Overview of Lung Cancer
• Common Symptoms of Lung Cancer
• How Lung Cancer Leads to Back Pain
• Diagnosis of Back Pain in Lung Cancer
• Treatment Options for Back Pain Caused by Lung Cancer
• Palliative Care Approaches
• How to Prevent Lung Cancer?
• Conclusion
• Frequently Asked Questions

Overview of Lung Cancer

Lung cancer is the most common cause of cancer-related deaths globally. Lung cancer occurs when there is uncontrolled growth of abnormal lung cells, which may develop into tumors. There are two primary types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

Even though the primary risk factor is smoking, many cases of lung cancer occur in non-smokers. The stage of cancer is one of the critical factors that decide the disease prognosis. Some treatments include surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy.

Many patients with lung cancer experience back pain. Studies reported an association between lung cancer and back pain. The internet is flooded with questions like, “What does back pain from lung cancer feel like?” or “Is back pain a symptom of cancer?”

In this article, we are trying to answer those burning questions.

Common Symptoms of Lung Cancer

Some of the common symptoms and signs of lung cancer are:

1. Persistent Cough

The most frequent and debilitating symptom in patients with lung cancer is cough; the symptoms involve 57% of the patients and significantly affect the quality of life in all domains—psychological, social, and physical. Inflammation can be caused by irritation or even blockage of the airways due to tumors. Inflammation and infection related to cancer and the general body response to cancer cells contribute to coughing.

2. Chest Pain

Chest pain is seen in 20 to 40% of lung cancer cases, most commonly due to direct effects on nerves from a growing tumor or its impact on breathing. Deep breathing, coughing, and even laughing can exacerbate this pain.

3. Shortness of Breath

Lung cancer could cause fluid to accumulate around the lung, reducing lung expansion either by obstructing the airway or causing inflammation. Common causes include airway obstruction, hypoxemia, and secondary effects of treatments. Dyspnea is distressing but may be very well managed.

4. Unexplained Weight Loss

Unexplained weight loss is common in lung cancer due to cachexia, a metabolic syndrome associated with both muscle and fat loss. Mediators like cytokines inhibit hunger and reduce food intake. Cachexia adversely affects both survival and the quality of life.

5. Fatigue

Fatigue affects up to 40% of cancer patients at diagnosis and manifests as chronic fatigue syndrome (CRF), leading to physical, emotional, and cognitive tiredness. It significantly affects health-related quality of life regarding biological, psychological, and treatment-related aspects.

How Lung Cancer Leads to Back Pain

Lung cancer and back pain may be associated because of the following mechanisms:

1. Tumor Pressure

Backache can also be caused by a tumor in the lung due to its pressure on the nerves, muscles, or the spine. The superior lobes often exert pressure on the nerves. The growing tumor pinches the nerves that exit the chest and back, hence causing pains in the back, shoulders, or neck. This can progress or worsen over time or with activity. Signs of back pain include reduced activity and poor quality of life.

2. Tumor Growth and Nerve Compression

As lung cancer progresses, it can compress the bones of the spine, the spinal cord, or even the nerves that diverge from it. This compression could cause pain in the neck or parts of the back, such as the upper, middle, or lower back. The pain can also be felt in the arms or legs.

3. Metastasis to the Spine

Leptomeninges is the thin layer of cells and tissue that protects the brain and spinal cord. Cancer cells that invade the leptomeningeal region or reach the spinal fluid produce backache and other symptoms, including headaches and pain in the arms and legs.

4. Spread of Cancer Cells to Bone

Bone metastases of lung cancer can cause hypercalcemia, an elevated calcium level in the blood, with symptoms such as back pain, along with others that include nausea, vomiting, thirst, weakness, and headaches.

5. Other Related Factors

Other causes of back pain in lung cancer patients could be pain in the lungs that often radiates to the back and infections that are seen more frequently in the patient because of the lowered immunity. Additionally, chronic inflammation or spine fractures resulting from metastatic disease can lead to the weakening of the vertebral bones and cause pain.

6. Inflammatory Response

Lung cancer causes inflammation, which contributes to tumor promotion. Chronic inflammation stimulates the metastatic spread of the tumor and contributes to a poor prognosis. It may also cause back pain.

Diagnosis of Back Pain in Lung Cancer

Some of the diagnostic techniques for back pain in lung cancer are:

1. X-ray

If the patient has persistent pain, the doctor may refer him for an X-ray to identify the cause. Back pain may be caused by other diseases, such as osteoporosis, fractures, arthritis, degenerative disc disease, and spinal curvature disorders, rather than lung cancer.

2. CT Scan

A CT scan may be performed to determine the cause of persistent back pain. However, doctors usually do not order a CT scan for regular back pain unless there is a strong suspicion of infection or cancer based on physical examination and history.

3. MRI

MRI is beneficial in detecting back pain due to lung cancer as it captures pictures of soft tissues, nerves, and bones. It diagnoses spinal metastases, tumors, and nerve compression; therefore, crucial information is provided about what cancer does to the spine for diagnosis and treatment planning.

4. PET Scan

PET scans are excellent at showing back pain due to lung cancer by lighting up any areas with high metabolic activity, such as a cancerous tumor. PET helps diagnose whether the lung cancer has spread to the spine or tissues around the vertebrae, making it a beneficial technique in assessing how far along the cancer is and how treatment should be taken.

Treatment Options for Back Pain Caused by Lung Cancer

In most cases, a comprehensive lung cancer treatment plan focuses on treating the disease as well as the symptoms caused by it. Removing or delbulking tumors through surgery, shrinking tumors through radiation therapy or chemotherapy, or killing them through different treatment approaches can reduce back pain caused by lung cancer. However, in some cases where the patient is terminal, pain medications may be recommended to manage the back pain.

That said, the following are the different treatment approaches available for lung cancer and the back pain caused by it.

1. Surgery

Surgery is the first line of treatment for lung cancer, especially in the early stages. Techniques used include wedge resection, segmentectomy, lobectomy, and pneumonectomy. Robotics and video-assisted methods are also frequently used in wedge resections and occasionally in segmentectomy procedures as a minimally invasive approach to treat lung cancer. The debulking surgery is recommended for patients with advanced-stage lung cancer, where the tumor pressing on the spine or the back is removed as much as possible to reduce the back pain.

2. Chemotherapy

Chemotherapy reduces the size of lung cancers, palliates symptoms, and prolongs survival, especially when used with other treatments. It is useful in EGFR-mutant and ALK-positive lung cancers, as it achieves almost doubling response rates. Chemotherapy alone or in combination with radiation therapy shrinks tumors and reduces the number of cancer cells, which eventually helps reduce back pain.

3. Targeted Therapy

Targeted therapy, also known as precision or personalized medicine, uses drugs to attack cancer cells specifically. These drugs work on cancer cells' mutations by inhibiting their function; each drug targets one mutation and can only be used in patients with that exact genetic change. Targeted therapy may indirectly alleviate back pain by reducing the tumor load in the body.

4. Immunotherapy

Immunotherapy is crucial in improving patient outcomes, both alone and with the conventional therapeutic strategy. It increases the body's immune system, allowing it to recognize and attack cancer cells. Immunotherapy may help reduce back pain by reducing cancer cells in the body.

5. Radiation Therapy

Radiation to a small-cell lung cancer patient is usually given based on the stage of the cancer and other factors. It can be combined with chemotherapy (concurrent chemoradiation). It is used to decrease the risk of metastasis to the brain or to shrink tumors to alleviate symptoms such as pain, breathing problems, and difficulty swallowing.

Treatments Specifically Recommended to Treat Back Pain

1. Medications

Back pain in lung cancer patients is often managed with medications, such as steroids and bisphosphonate drugs. Depending on the severity of the pain, the doses may vary.

2. Nerve Blocks

A nerve block is an injection that combines a local anesthetic and steroids. When injected into the back, nerve blocks can temporarily or permanently relieve pain.

3. Spine Surgery

In some cases, spine surgery may be recommended to reduce back pain in lung cancer patients. These procedures help in decompressing or restabilizing the spine. However, the prognosis of this approach is poor.

Palliative Care Approaches

Similar to any other category of cancer, palliative care in lung carcinoma also focuses on providing relief from symptoms and improving the quality of life of the patient. The techniques include:

1. Symptom Management: Pain, breathlessness, and coughing are managed by medications. Other techniques, such as oxygen therapy and relaxation exercises, may also be used.

2. Emotional and Psychological Support: Counseling for anxiety, depression, and fear is done for patients, and family members are educated on such problems.

3. Spiritual and Cultural Needs: Most patients in India seek comfort through spiritual practices, such as meditation or prayer, which can have a significant calming effect.

4. Holistic Care: Holistic care includes nutritional support and physical therapy to enhance strength and alleviate pain in various parts of the body.

How to Prevent Lung Cancer?

Lung cancer prevention measures include:

Early Detection

Chest X-rays may be used for screening for lung cancer in high-risk populations but were not shown to improve survival. Low-dose CT scans are currently only recommended for at-risk patients, which include smokers or ex-smokers.

The evidence has shown that an annual low-dose CT scan reduces lung cancer mortality through the detection of the disease before the onset of symptoms.

Awareness and Regular Check-ups

Some factors can be avoided to reduce the risk of lung cancer. The significant risk factors include smoking cigarettes, cigars, or pipes, exposure to secondhand smoke, a family history of lung cancer, HIV infection, environmental risks, and beta-carotene supplements in heavy smokers.

The protective factors for lung cancer include not smoking, quitting smoking, reducing exposure to workplace hazards, and lowering radon exposure.

Conclusion

Lung cancer is a life-threatening condition with symptoms such as persistent cough, chest pain, inability to breathe, unexplained weight loss, or fatigue. Lung cancer and back pain have a connection.

This connection may be because of pressure from the tumor, compression of nerves because of the presence of cancer, metastasis, and inflammation. It may be diagnosed by imaging techniques such as X-ray, CT, MRI, and PET scans. Treatment techniques include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy.

References

Lung Cancer - StatPearls - NCBI Bookshelf

Understanding cough and its management in lung cancer

Cough in Patients With Lung Cancer: A Longitudinal Observational Study of Characterization and Clinical Associations

Chronic Cough - StatPearls - NCBI Bookshelf

Dyspnea Management in Early Stage Lung Cancer: A Palliative Perspective - PMC

Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement

Clinical Management of Pain in Advanced Lung Cancer - PMC

Lumbar Spine X-Ray as a Standard Investigation for all Low back Pain in Ghana: Is It Evidence Based? - PMC

Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

Lumbar Spine X-Ray as a Standard Investigation for all Low back Pain in Ghana: Is It Evidence Based? - PMC

Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

Red flags to screen for malignancy in patients with low‐back pain - PMC

Positron emission tomography imaging of lung cancer: An overview of alternative positron emission tomography tracers beyond F18 fluorodeoxyglucose - PMC

Surgical Treatment of Lung Cancer

Radiation Therapy for Small Cell Lung Cancer

Lung Cancer Early Detection | Lung Cancer Screening | American Cancer Society

About the Author

Author Bio : Dr. Chandrashekhar Prasad Singh
Consultant - Medical Oncology
MBBS, MD (Medicine), DNB (Medical Oncology)

Dr. Chandrashekhar is an experienced medical oncologist who specializes in the management of breast, thoracic, and GI tract malignancies. He is available for consultation at HCG-Abdur Razzaque Ansari Cancer Hospital, a leading cancer hospital in Ranchi. He graduated with an MD degree and a gold medal and has multiple publications in medicine in renowned Indian and international journals. His approach to cancer care is patient-centric, and he strives to provide the best care possible for his patients.