Low Back Pain - Could It Be Cancer?


Pain is a funny thing. Well, okay, not actually laughing funny, but more of the quirky funny. The fact that it can bring us to our knees, stop us in our tracks and make us ask some genuinely terrifying questions about our health. The biggest question of all? Do I have “The Big C”?


When pain feels so intense, we naturally assume that there must be something really serious going on. Low back pain is one of those conditions that can bring about some really intense experiences of pain. It brings our lives to a grinding halt sometimes, and causes us to miss out on work and social events. The good news is that, while low back is a very common condition (it is one of the most common reasons people seek medical attention from their primary care doctor), it is very rarely a sign of cancer.





Cancer And Low Back Pain


Cancer is a very rare cause of low back pain. In fact, the lifetime chance of developing a spinal cord tumor is less than 1%. Most cases of low back pain stem from things like overuse, age-related changes in our spine (arthritis), or injuries from sporting or car accidents. It is also possible to have low back pain as a result of some types of cancer, such as spine cancer, colorectal cancer, or ovarian cancer. We will discuss some of these cancers later, but generally they will go along with other signs and symptoms - not just back pain.


So, while the odds are in your favor that most cases of low back pain are simply low back pain, and not something far more scary, it is always a good idea to be able to recognize some of the symptoms that might point to cancer. When it comes to any type of condition, early detection is vital in making a significant difference to outcomes.






Symptoms of Back Pain related Cancer


For some reason, as humans we tend to correlate the intensity of the pain with the severity of the condition. If the pain feels really bad then it must be something super serious! Ironically, this is not often the case. Back pain doesn’t have to be severe for it to indicate cancer. One of the biggest indicators of cancer in low back pain patients is a previous history of cancer. It is one of the biggest red flags for physicians.


If you have back pain and you think that it could be cancer, you should consider the red flags associated with low back pain, evaluate your specific history and symptoms and then schedule a visit with your healthcare provider. Some key symptoms to look out for include:


  • Back pain that doesn’t get worse when you move around

  • Back pain that doesn’t go away with physical therapy or other commonly used treatments.

  • Any changes in your bowel movements.

  • Back pain that happens mostly at night, and that disappears during the day.

  • Fatigue

  • Unexplained weight loss

  • Any tingling or numbness in your arms or legs.




What Types of Cancer Can Cause Low Back Pain?


So, what sort of cancers can cause low back pain? There are several types of cancer that can cause pain in the lower back. Blood cancers, ovarian cancer, kidney, and thyroid cancer can all be causes of back pain. In this article we will look at some of the most common cancers associated with this condition.


Spinal Tumor:


Spinal tumors can be primary or secondary, meaning that the cancerous tumor originates in the spine or, in the case of secondary tumors, the spine is a source for bone metastasis, where the cancer started in a different location and has now spread to the spine.


Primary spinal tumors are rare, while the American Association of Neurological Surgeons (AANS) believes that between 30- 70 percent of cancer patients will have their cancer spread to their spine. Spinal tumors grow either in the spinal cord and column, or they grow around it, in the protective membranes. Tumors can be either benign (noncancerous) or malignant (cancerous) but either way, a tumor can put pressure on the nerves of the spinal column, causing pain.





Spinal tumors can be broken down into two types, depending on the proximity to the spinal cord, and their location to it. The two types are Intramedullary and Extramedullary tumors. Around 20-30% of tumors are intramedullary, meaning that they grow inside the spinal cord. These are the types that most often cause back pain that feels worse when you lie down and put pressure on the spinal cord. Extramedullary tumors most often cause back pain that radiates to the legs and arms and feels worse at night. These tumors occur most often outside the spinal cord, inside the extending nerve roots.


Your doctor can order imaging tests like a CT scan or an MRI to see if you have a spine tumor. They can also order blood tests or perform a biopsy of the suspected mass to confirm if it is a tumor and if it is malignant or benign. They might also perform a neurological exam to see if there is any nerve damage present.





Lung Cancer


One of the most common cancers that spreads to the spine is lung cancer. Lung cancer accounts for a large majority of cancer cases, with 2.1 million new cases reported world-wide in 2018. Lung cancer is also the leading cause of cancer death in the world.


Lung cancer not only affects the lungs but it can also metastasize easily to other parts of the body. In 30-40% of patients, lung cancer will metastasize, and the spine is one of the most common sites that is affected. Tumors that occur in the lungs can press on the spine, causing issues with nerve transmissions to the lower back and increased sensations of pain.





Symptoms of lung cancer:


  • Fatigue

  • Shortness of breath

  • Wheezing

  • Coughing up blood or blood-tinted phlegm

  • Loss of appetite

  • Unexplained weight loss

  • A persistent cough

  • Chest pain

  • Recurring bronchitis or pneumonia





Breast Cancer


Breast cancer is another type of cancer that is more common and that also often metastasizes to the back. Back pain is not a typical symptom of breast cancer but it can happen in rare instances. Most of the time, breast cancer is identified by the presence of a lump in the breast tissue, but there have been some rare cases where back pain was the first symptom that led to the diagnosis.


Just like with lung cancer, if a tumor in the breast presses on the nerves that lead to the spine, there can be increased sensations of pain. If you have any of the following symptoms along with your low back pain you should definitely make an appointment with your doctor to have a full check up.




Symptoms:


  • Breast or nipple pain

  • Nipples that turn inwards

  • Nipple discharge

  • Breast skin or nipple that is red, dry, flakey

  • Swollen lymph nodes

  • Breast rash

  • Changes in the shape, size of appearance of the breast

  • Changes in the skin over the breast, like swelling or dimpling

  • Redness or pitting of the breast skin (orange peel skin)

  • Lump of mass in the breast that feels different from the surrounding tissue.




Gastrointestinal Tract Cancer


There are several cancers that are associated with the gastrointestinal tract. These include stomach cancer, colon cancer and rectal cancer. All of these can cause low back pain as the pain radiates out from the site of the cancer to the lower back. Again, back pain is not the most common symptom associated with these types of cancer, but it should be evaluated further, especially if you have a history of cancer. More common symptoms of these types of cancer include:


Symptoms:


  • Unexplained and sudden weight loss

  • Rectal bleeding with bright red blood

  • Dark blood (occult blood) in the stool

  • Feeling of incomplete bowel movements

  • Changes in bowel habits (new diarrhea, constipation)

  • Fatigue

  • Poor appetite

  • Abdominal pain/cramping

  • Nausea

  • Heartburn

  • Vomiting

  • Swelling of the abdomen (fluid build-up)




Melanoma


Melanoma is the most serious type of skin cancer and it can develop anywhere on your body. Fortunately melanoma is fairly rare but if it goes undetected it can quickly spread to other parts of the body, including the spine. Regular check ups with your dermatologist or doctor can help catch melanoma in the early stages, which is much easier to treat and has a high recovery rate. If you have any of the following symptoms then you should definitely make an appointment with your doctor.


Symptoms:


  • Changes to the look of an existing mole (border, color, shape)

  • Development of new, unusual growths on your skin

  • Sores that don’t heal

  • Redness or swelling beyond the border of your mole

  • Itchiness, pain or tenderness of the mole

  • Oozing, bleeding, scaliness of the mole




Blood Cancers


Blood cancers like lymphoma, leukemia and myeloma affect the bone marrow and rarely present with back pain as a stand alone symptom. If you are experiencing any additional symptoms, along with your low back pain, you should set up an appointment with your healthcare provider and give them a history of your symptoms. Common symptoms of these cancers include:


  • Unexplained weight loss

  • Bruising

  • Fatigue

  • Diarrhea

  • Shortness of breath




Prostate Cancer


Prostate cancer is another very common type of cancer. Fortunately this cancer develops fairly slowly and is therefore often very treatable. If the cancer goes undetected and it becomes advanced then it can spread to the bones such as the ribs, hips and spine. Back pain is not typical but it can occur.


Symptoms:


  • Difficulties urinating

  • Blood in the urine or semen

  • Weakness or numbness in the legs or feet

  • Loss of bladder or bowel control

  • Erectile dysfunction


When Should You See Your Doctor?


If you have read through all of this information and are worried that you might have some symptoms related to any of these cancers, you should definitely make an appointment with your healthcare provider to discuss your concerns. You should also see your doctor if you have:


  • A history of cancer

  • You can feel a lump in your spine

  • Your back pain isn’t due to an injury or movement-related

  • Your back pain has started suddenly





Conclusions


While the thought of having cancer is extremely scary and concerning, it is good to remember that statistics show that less than 10 percent of spinal tumors actually start in the spine. It is also good to remember that even if the doctors discover a tumor in your spine, it doesn’t mean that it is cancerous- it could be a benign tumor and be easily removed.


By paying attention to the symptoms you are experiencing and discussing your concerns with your healthcare provider right away, your cancer might be very treatable. When it comes to cancer, early detection and intervention is always a good thing and can make a significant difference to the outcome of the disease.