While back pain is one of the most common reasons people seek care from a primary doctor, it is very rarely a sign of cancer. Back pain is usually caused by injury, overuse, or spinal problems, such as disc degeneration, arthritis, or stenosis.1
Though the likelihood that back pain is a sign of cancer is rare, there are some types of cancer that can cause back pain as an early symptom.
Primary cancers that develop in the spine can present with back pain as the first symptom. Other types of cancer can cause back pain or metastasize (spread) to the spine and cause pain.
Even though most back pain isn't caused by cancer, it is still important to be able to recognize the symptoms that might point to cancer.
Back Pain and Cancer Statistics
Key facts include:
Mechanical sources account for 90% of back pain.2
The lifetime chance of developing a spinal cord or brain tumor is less than 1%.3
The biggest predictor of spinal cancer is a history of cancer.4
Though primary spinal tumors are rare, they can occur. Spinal tumors are abnormal masses that grow within or around the spinal cord or spinal column. These tumors can be malignant (cancerous) or benign (noncancerous).5 In either case, spinal tumors can cause pain in the back.
If your doctor suspects you have a spinal tumor, they will take a full history, conduct a neurological exam, and order imaging tests such as a computed tomography (CT) scan, or MRI. They may also take blood tests or a biopsy of the area if this can be done safely.6
There are two types of spinal tumors, categorized by their location and proximity to the spinal cord.
Intramedullary tumors grow inside the spinal cord and comprise 20-30% of all primary spinal cord tumors.7 These types of tumors most often cause back pain that is worsened when lying down. You may also experience numbness or tingling.7
Extramedullary tumors grow inside the thin sac that holds the spinal cord, but outside of the spinal cord itself. These tumors most commonly develop in the nerve roots that extend from the spinal cord.5 The most common symptom is back pain at night or pain that radiates to the arm or leg.8
While back pain may be one of the primary symptoms of a spinal tumor, there are other symptoms that can also occur. If you experience any of the following symptoms along with your back pain, you should seek the advice of your doctor.
Pain of the extremities
Diminished coordination in the arms/legs
Bladder or bowel problems9
Causes and Risks
While there is no known direct cause of spinal cancer, there are several genetic factors that can raise your risk for developing spinal tumors. If you have any of the following genetic diseases, should talk to your doctor if you begin to experience back pain.10
Neurofibromatosis type 1 and type 2
Von Hippel-Lindau syndrome
The risk for spinal cancer increases if you already have another type of cancer. Spinal tumors that are found in the bone can be caused by metastasis from other cancers. It is estimated that 30% of people who have cancer will have metastases to the spine.5
An untreated spinal tumor can grow and affect the spinal cord, nerve roots, blood vessels, and bones around the spine. This growth could lead to paralysis, scoliosis—a spinal deformity—and loss of bowel or bladder function.
If a spinal tumor is suspected, it is important to seek the advice of a doctor right away. Spinal tumors can be removed surgically or treated with chemotherapy or radiation in order to reduce their size and impact.
Surgery carries risks of its own—such as infection or nerve damage—and your doctor will fully evaluate the location, size, and type of tumor in order to determine if surgery is the correct treatment.5
Other Types of Cancer With Back Pain
While primary spinal tumors are rare and a very uncommon cause of back pain, there are other cancers that can cause back pain as well.
Lung cancer is the leading cancer diagnosis and cause of cancer death worldwide.11 It affects the lungs, but can also metastasize to other parts of the body. Lung cancer will metastasize in 30 to 40% of patients, with the vertebrae of the spine being the most common site of metastasis.12
Back pain that occurs with a lung cancer diagnosis or any of the symptoms below should be evaluated further:
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
Shortness of breath
Feeling tired or weak
Loss of appetite
Unexplained weight loss
Infections, such as bronchitis and pneumonia that don’t go away or keep coming back
Breast cancer occurs when abnormal cells in the breast grow out of control.14 Sometimes breast cancer is identified due to a lump. However, there are cases where back pain can be the first indicator of breast cancer.
In most breast cancer cases that are associated with back pain, people will experience some of the more common breast cancer symptoms while also experiencing back pain.15
If you have back pain along with any of the following symptoms, you should be evaluated by a doctor:
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
Swollen lymph nodes16
Signs of Early, Metastatic, and Inflammatory Breast Cancer
Gastrointestinal cancers include stomach, colon, and rectal cancers. Back pain may be a symptom of these cancers, but it is most frequently accompanied by other symptoms that are more common to gastrointestinal cancers.17
The following symptoms could indicate gastrointestinal cancer and should be further evaluated by a doctor:
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's not relieved by having 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 loss18
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
Vomiting, with or without blood
Swelling or fluid build-up in the abdomen19
Melanoma is a type of skin cancer. Melanoma that has gone undetected and spread through the body can spread to the spine, causing back pain.20 It is important to have your skin evaluated by a doctor and to report any of the symptoms that would indicate a skin cancer before the cancer can spread.
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—scaliness, oozing, bleeding, or the appearance of a lump or bump
Blood cancers include myeloma, lymphoma, leukemia. Blood cancers, while they affect the bone marrow, rarely present with back pain as the only symptom.22
Blood cancer symptoms:23
Shortness of breath
When to See a Doctor
Most back pain resolves over a few weeks with conservative treatment. If you have unexplained back pain or pain that persists for longer than six weeks, it is best to seek the advice of a doctor.
If you have back pain along with weakness, difficulty walking, pain when awakening in the morning, or loss of bowel or bladder control you should be examined immediately, as these symptoms can indicate a more serious problem.
If your back pain persists after conservative treatment, let your doctor know. They may refer you to a specialist for further evaluation. Injections to help with the pain can help, or surgery could be necessary. Back pain that is accompanied by signs of cancer should be further evaluated.2
Signs It's Time to See a Doctor for Neck or Back Pain
Diagnosing Cause of Back Pain
Living with back pain can be very difficult. Walking can be hard, sleeping might be disrupted, exercise can be painful, and your work can be affected by back pain.
To diagnose the cause of your back pain you will need to see a doctor.
The most common causes of back pain are:
Spondylolisthesis—a slipped vertebrae
Vertebral compression fracture
When diagnosing your back pain, your doctor will conduct a variety of tests to find the cause. They will take a complete history and ask how the pain affects your everyday life. They will conduct a physical exam to test and assess your range of motion and strength.2
Most often you will be treated conservatively with NSAIDs like Aleve (naproxen), modifications to your daily life, physical therapy, or exercise. Most low back pain can be treated conservatively, without surgery.
Response to Other Treatments
If these treatments do not work and your doctor suspects that there is another cause of your back pain, they may order more tests. These tests can include blood tests, MRI, and computed tomography (CT) scans, depending on your symptoms, medical history, and physical examination.
The goal of treatment is to restore function and increase strength so that you can return to your daily activities with little to no pain. When the pain does not respond to conservative treatments, surgery may be indicated in instances where there is disc herniation or other structural damage.24
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 study that examined misdiagnoses of back pain showed that less than 1% of patients with back pain had cancer.25
Most back pain can be treated once it's properly assessed. If you have unexplained back pain or pain that persists, talk to your doctor. If you have a history of cancer and are now experiencing back pain, you should talk to your doctor immediately as it can be a sign of metastasis