Lower back and hip pain and cancer

Back pain is one of the most common reasons people see their primary care doctor. It is very rarely a sign of cancer. Back pain is usually caused by other problems, such as:

• Injury
• Overuse
• Spinal problems like disc degeneration, arthritis, or stenosis

Back pain is unlikely to be a sign of cancer. Still, there are some types of cancer that can cause back pain as an early symptom. That's why it's important to be able to recognize symptoms that might point to cancer.

This article looks at back pain as a symptom of cancer. It also looks at when you should see a doctor, and how back pain is diagnosed.

Back Pain and Cancer Statistics

Most back pain is not caused by cancer. While it is important to see a doctor any time you have pain that doesn't go away, back pain is much more likely to be caused by something like a back injury or arthritis.

Key facts:

• About 90% of back pain is caused by something mechanical, like an injury.
• 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

Primary spinal tumors are rare. These are abnormal masses that grow within or around the spinal cord or spinal column. These tumors can be malignant or benign. A malignant tumor is cancerous, and a benign tumor is noncancerous. In either case, spinal tumors can cause pain in the back.

If a spinal tumor is suspected, your doctor will:

• Take a full medical history
• Conduct a neurological exam
• Order imaging tests such as a computed tomography (CT) scan or MRI

Other tests may include blood tests or a biopsy of the area if this can be done safely.

Types of Spinal Tumors

There are two types of spinal tumors. They are categorized by their location and how close they are to the spinal cord.

Intramedullary tumors grow inside the spinal cord. These tumors account for 20-30% of all primary spinal cord tumors. They most often cause back pain that gets worse when you lie down. They can also cause numbness or tingling.

Extramedullary tumors are located outside of the spinal cord itself. They grow inside the thin sac that holds the spinal cord. These tumors often 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.

Recap

Spinal tumors can occur inside or outside of the spinal cord. These tumors tend to cause pain that gets worse when you lie down and/or radiates to your arm or leg.

Other Symptoms

Back pain may be one of the primary symptoms of a spinal tumor, but other symptoms can also occur. If you have any of the following symptoms with back pain, see your doctor.

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

Causes and Risks

There is no known direct cause of spinal cancer. There are, however, several genetic factors that can raise your risk of developing spinal tumors. Talk to your doctor if you have any of the following genetic diseases and you develop back pain.

• Neurofibromatosis type 1 and type 2
• Tuberous sclerosis
• Von Hippel-Lindau syndrome
• Li-Fraumeni syndrome

The risk for spinal cancer goes up if you have had another type of cancer. Spinal tumors of the bone can happen when other cancers spread. This occurs in an estimated 30% of people who have cancer.

Recap

You are at higher risk for spinal cancer if you have certain genetic diseases or you have previously had another kind of cancer.

Complications

An untreated spinal tumor can grow and affect many structures in the area, including:

• The spinal cord
• Nerve roots
• Blood vessels
• The bones around the spine

This growth could lead to:

• Paralysis
• Scoliosis, a spinal deformity
• Loss of bowel or bladder function

If you think you might have a spinal tumor, it is important to see a doctor right away. Spinal tumors can be removed surgically. They can also be treated with chemotherapy or radiation to reduce their size and impact.

Surgery carries risks of its own, such as infection or nerve damage. Your doctor will evaluate the location, size, and type of tumor to determine if surgery is the right treatment.

Recap

An untreated spinal tumor can cause problems like paralysis and loss of bladder of bowel function. Surgery or chemotherapy can help limit the impact of these tumors.

Other Types of Cancer With Back Pain

Primary spinal tumors are a rare and very uncommon cause of back pain. Other cancers, however, can also cause back pain.

Lung Cancer

Worldwide, lung cancer is a leading cancer diagnosis and the leading cause of cancer death. It affects the lungs, but can also spread to other parts of the body. Lung cancer will spread in 30 to 40% of patients. The vertebrae of the spine is the most common site of lung cancer spread.

Back pain that occurs with a lung cancer diagnosis should be evaluated right away. If you have back pain with any of the symptoms listed below, see your doctor at once:

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

Breast Cancer

Breast cancer occurs when abnormal cells in the breast grow out of control. Breast cancer is often found due to a lump. However, there are cases where back pain can be the first sign of breast cancer.

Most of the time, patients will have back pain along with some of the more common breast cancer symptoms. If you have back pain with any of these symptoms, see your doctor right away:

• 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

Recap

Back pain that is related to lung or breast cancer usually happens along with other symptoms. For lung cancer, this can include chronic respiratory problems like coughing and chest pain. For breast cancer, this may include pain and/or visible changes in breast tissue.

Gastrointestinal Cancers

Gastrointestinal cancers include:

• Stomach cancer
• Colon cancer
• Rectal cancer

Back pain may be a symptom. When it is, it is often accompanied by other symptoms more common to these cancers. If you have any of the following symptoms, see your doctor at once:

• A change in bowel habits, such as diarrhea, constipation, or changes of the stool that last for more than a few days
• A feeling that you need to have a bowel movement that doesn't go away when you have 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

Recap

Gastrointestinal cancers that may cause back pain include stomach, colon, and rectal. Again, back pain tends to occur alongside other common symptoms.

Melanoma

Melanoma is a type of skin cancer. When it goes undetected it can spread to the spine, causing back pain. It is important to have your skin looked at regularly by a dermatologist. If you have any of these symptoms, see a doctor before the cancer has a chance to spread.

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, such as scaliness, oozing, bleeding, or the appearance of a lump or bump

Recap

When melanoma causes back pain, it is usually because it has spread to the spine. This is why it is so important to have regular skin exams so you can catch melanoma in the early stages.

Hematological Malignancies

Blood cancers include:

• Myeloma
• Lymphoma
• Leukemia

Blood cancers affect the bone marrow. Rarely, they can present with back pain as the only symptom. Other blood cancer symptoms include:

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

Recap

Rarely, back pain can be the only symptom of blood cancers like lymphoma and leukemia.

When to See a Healthcare Provider

With home care, most back pain resolves over a few weeks. If you have unexplained back pain or pain that goes on longer than six weeks, it is best to seek the advice of a doctor.

If you have back pain with any the following other symptoms, see your doctor right away:

• Weakness
• Difficulty walking
• Pain when awakening in the morning
• Loss of bowel or bladder control

These symptoms can point to a more serious problem.

If your back pain doesn't go away after home care, tell your doctor. You may need to be evaluated by a specialist. Injections can help with the pain, or you may need surgery. Back pain that occurs along with signs of cancer should be seen by a doctor right away.

Recap

Most back pain can be treated at home. If your pain doesn't go away after a few weeks of home care, see your doctor.

Diagnosing the Cause of Back Pain

Living with back pain can be very difficult. The pain can interfere with walking, sleeping, exercise, or your work. It is always a good idea to see a doctor if your pain doesn't go away on its own.

The most common causes of back pain are:

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

Healthcare Provider Exam

To diagnose your back pain, your doctor will do a variety of tests. First, they will take a complete history and ask how the pain affects your life. A physical exam to test and assess your range of motion and strength will help with a diagnosis.

Most often you will be treated with things like:

• Pain medications like Aleve (naproxen)
• Modifications to your daily life
• Physical therapy
• Exercise

Most low back pain can be treated conservatively, without surgery.

Response to Other Treatments 

If these treatments don't work and your doctor suspects there is another cause of your back pain, you may need more tests. These can include:

• Blood tests
• MRI
• Computed tomography (CT) scans

Your doctor will decide which test to order based on your symptoms, medical history, and physical examination.

The goal of treatment is to restore function and increase strength so you can return to your daily activities with little to no pain. If the pain does not respond to treatment, surgery may be required. This is usually necessary if there is disc herniation or other structural damage.

Recap

Back pain is usually caused by injury or something like arthritis. It is usually treated with conservative strategies like pain medication and physical therapy. If it doesn't resolve after a few weeks, your doctor may want to order more tests.

Summary

Back pain is rarely a sign of cancer. When it is, it tends to happen along with other symptoms of cancer.

Some cancers that cause back pain include spinal tumors, lung cancer, breast cancer, gastrointestinal cancers, and blood cancers. Undiagnosed skin cancer can also spread to the spine, causing back pain.

See a doctor if you have back pain that doesn't go away after treatment at home. You should also see a doctor if your back pain occurs with symptoms that can indicate cancer.

A Word From Verywell

Back pain as the main symptom of cancer is quite rare. Your back pain is most likely caused by something other than cancer. A 2006 study that looked at misdiagnoses of back pain found that less than 1% of patients with back pain had cancer.

Most back pain can be treated once the cause is found. If you have unexplained back pain or pain that doesn't go away, talk to your doctor. If you have a history of cancer and have new back pain, talk to your doctor immediately as it can be a sign that the cancer has spread.

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