When Should You Worry That Your Back Pain Might Be Cancer?

Any new symptom that doesn't go away in a few days can be worrisome. Back pain is no exception. If you pull a muscle while lifting heavy boxes, you know the cause. When the pain appears without an injury or other known trigger and it sticks around for a while, it's natural for your mind to jump to the worst-case scenario. You might wonder, is my back pain cancer?

Probably not, says Alan Alper Sag, MD, a cofounder of the Adult Cancer Pain & Bone Metastasis Tumor Board at the Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine. "Back pain due to cancer is quite rare," he says. "And the vast majority of back pain is related to musculoskeletal causes."

"Pain that lingers, worsens, or keeps you up at night — those are things that should raise red flags," Dr. Sag says. If this is the case, seek medical attention, especially if you've had cancer in the past or you're currently being treated for it.

Typical Back Pain vs. Cancer-Related Back Pain

Also, your natural pain control system is turned off at night. "The body normally produces steroids in the morning, and that helps to relieve cancer pain," says Andrew J. Fabiano, MD, the chair of the department of neurosurgery and the director of spinal oncology at Roswell Park Cancer Institute in Buffalo, New York.

Cancer Types That May Cause Back Pain

These are the cancer types most likely to cause back pain.

• Lung Cancer Tumors in the lungs can spread to bones of the spine or press on nerves around the spinal cord. Up to 25 percent of the time, bone pain is the first symptom of lung cancer. Back pain plus a smoking history may justify having a lung CT scan or other tests.

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• Breast Cancer When breast cancer spreads to the bones, it most often goes to the vertebrae of the spine. The pain from metastatic breast cancer is usually felt in the lower back.

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• Prostate Cancer This cancer, which mainly affects older men, usually grows very slowly. Advanced prostate cancer sometimes spreads to bones of the spine, ribs, or hips before any other symptoms appear. The pain might feel like a dull ache or radiate out from the bone.

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• Spinal Cancer Tumors can grow on or near the spine, although cancer in this location is rare. Pain from spinal cancer may radiate from the back to the legs, hips, arms, or chest. When a tumor presses on the spine, it also can cause numbness, tingling, or difficulty walking. Vertebrae might fracture if the tumor grows large enough.

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• Colon Cancer Back pain can happen with colon cancer if the tumor compresses nerves near the spine. Along with pain, you'll usually have bowel symptoms such as constipation, diarrhea, or bloody stools.

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• Kidney Cancer Your kidneys are located in the upper-middle part of your back, on either side of your spine, but pain from early-stage kidney cancer probably won't be in that location. "When you have pain in your kidney, it tends to be more in the flank area, which is off to the side," Sag says. Advanced kidney cancer often spreads to the spine, which does cause back pain.

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• Pancreatic Cancer The pancreas is another organ located toward the back of your body. Pain from pancreatic cancer is focused in the middle of the back, just under the shoulder blades.

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• Testicular Cancer Back pain isn't a common symptom of testicular cancer. A lump or swelling in the testicle is usually the first sign. Low back pain can occur if the cancer spreads to lymph nodes behind the belly.

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Symptoms You Shouldn’t Ignore

Back pain alone isn't a reason to worry. This one symptom probably doesn't signal cancer. But if pain appears with any of the following symptoms, you'll want to call a doctor to have it checked out.

• Neurological Symptoms Weakness, numbness, trouble walking or balancing, or difficulty controlling your bladder or bowels are signs that a tumor might be pressing on nerves in your spine.

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  "Those are symptoms we take very seriously," Sag says.
• Unexplained Weight Loss or Fevers Unless you've been actively trying to lose weight or you have an infection, these could be signs of cancer.

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• Progressive, Unrelenting Pain Cancer pain doesn't improve with rest or over-the-counter medication, and it may get progressively worse.

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  It's worth getting checked if back pain lasts more than a week, and especially if it hasn't resolved in a month, Sag says.
• Cancer Diagnosis A history of breast, prostate, lung, or kidney cancer elevates back pain into a symptom that requires immediate attention, because these tumors have a tendency to spread to the spine.

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  "Pain is a very important warning sign, and in patients who have a cancer history, particularly of cancers that are known to spread to the spine, it's one that we should take seriously," Sag says.