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Can Shoulder Pain Be a Symptom of Lung Cancer?

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Updated April 07, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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Can a painful shoulder be a sign of lung cancer?

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Question: Can Shoulder Pain Be a Symptom of Lung Cancer?

Answer:

Yes, shoulder pain can indeed be a symptom of lung cancer. In fact, shoulder pain is sometimes the first symptom of lung cancer.

Many people with lung cancer develop shoulder pain during the course of their disease. That said, it's important to note that shoulder pain is not a lung cancer telltale. In addition, in patients with lung cancer, the shoulder pain may be the result of their disease or another cause, such as arthritis.

Why Can Lung Cancer Cause Shoulder Pain?

Lung cancer-related shoulder pain can be due to a number of things.

It could be referred pain that is due to pressure from a tumor on the phrenic nerve within the lungs. In this case, the brain interprets pain as coming from the shoulder, when in fact the nerve is being irritated within the lungs.

Shoulder pain in lung cancer can also be related to the spread of lung cancer to bones in and near the shoulder. Roughly 30% to 40% of people with lung cancer develop metastases (spread of cancer) to bone at some time during their disease.

Pancoast tumors, a form of lung cancer, grow near the upper part of the lungs and can invade tissues near the shoulder. Pancoast tumors often cause pain in the shoulder that radiates down the arm. Due to their location, they are less likely to cause typical symptoms of lung cancer such as a persistent cough, coughing up blood and shortness of breath.

How Is Shoulder Pain Due to Lung Cancer Different From Other Causes of Shoulder Pain?

Unfortunately,shoulder pain related to lung cancer can be very similar to that of conditions such as arthritis. Symptoms that may be more concerning, however, include shoulder pain that is worse at night, pain that occurs at rest, and pain that is not associated with any loss of motion with activity.

Treatment

Treatment of shoulder pain related to lung cancer depends upon the underlying cause. If the pain is referred pain from pressure on a nerve in the lung, treatment that decreases the tumor within the lungs is the primary goal. If a tumor is growing near the top of the lungs, surgery to remove the tumor or treating the tumor with radiation may relieve symptoms. If the pain is related to bone metastases, treatment with radiation therapy may reduce symptoms significantly.

Sources:

Bruzzi, J. et al. Imaging of Non-Small Cell Lung Cancer of the Superior Sulcus. Part 1: Anatomy, Clinical Manifestations, and Management. RadioGraphics. 2008. 28:551-560.

Francyk, D. et al. Pain in abdomen and shoulder. The Journal of Family Practice. 2009. 58(10):545-548.

Jung, Y. et al. Right Shoulder Pain due to Metastatic Lung Cancer: A case report. Korean Journal of Pain. 2008. 21(2):164-167.

Khaw, P. and D. Ball. Relief of non-metastatic shoulder pain with mediastinal radiotherapy in patients with lung cancer. Lung Cancer. 2000. 28(1):51-4.

National Institute of Health. Medline Plus. Lung cancer - non-small cell. Updated 08/24/11. http://www.nlm.nih.gov/medlineplus/ency/article/007194.htm

 

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