You may typically associate shoulder pain with a physical injury. Shoulder pain can also be a symptom of lung cancer, and it may be the first noticeable symptom.

Lung cancer can cause shoulder pain in different ways including tumor growth and pinched nerves.

Here’s more on how shoulder pain is related to lung cancer and treatment options.

People who get shoulder pain may worry about it being caused by lung cancer. While this is possible, it’s much more likely that your shoulder pain is caused by something like an injury, tendonitis, or arthritis. Your doctor can help you determine the cause of your pain.

Shoulder pain can be a symptom of lung cancer from early through late stages of the disease.

Read on to learn about the types of lung cancer that can cause shoulder pain.

Pancoast tumors

A Pancoast tumor is a rare form of lung cancer. Shoulder pain is its primary symptom, as well as pain on the inner arm and the hand. These symptoms are very specific and referred to as Pancoast syndrome.

A Pancoast tumor is located at the top, or apex, of the lung, where it pinches certain nerves. It often pushes on or damages the brachial plexus, a group of nerves that runs from the upper chest into your neck and arms.

It’s this pinching of the nerves that causes the specific Pancoast syndrome symptoms. The pain can spread to your upper back, between your shoulder blades, and your arm as the tumor grows.

Pancoast tumors do not cause the usual symptoms associated with lung cancer, such as cough, chest pain, or shortness of breath.

The name Pancoast tumor refers to the location of the tumor and not a specific type of lung cancer. Most Pancoast tumors are non-small cell lung cancer (NSCLC) lung cancer, primarily adenocarcinoma or squamous cell.

Pancoast tumors are rare, accounting for between 3 to 5 percent of lung cancer cases.

Horner’s syndrome

Pancoast tumors can lead to a cluster of symptoms referred to as Horner’s syndrome. Symptoms are seen in the eye and surrounding area on one side of the face.

Symptoms can include shoulder pain, but the more defining symptoms involve the eye. They result from damage to the sympathetic nerves leading from the brain to the face and eyes. These symptoms include:

  • drooping of upper eyelid on the affected side
  • reduced pupil size in one eye, resulting in different pupil size
  • reduced or no sweating on the affected side of the face
  • sinking of the eyeball into the eye socket

Tumors in the lung or chest are not the only cause of Horner’s syndrome. It can result from a large number of conditions that damage the nerve fibers leading to the face and eyes.

About 5 percent of cases are congenital, meaning they occur at birth. The cause of these cases is thought to be genetic. Other causes include:

  • trauma to the head or neck
  • complications of surgery
  • thyroid tumor
  • strokes or blood clots that cause interrupted blood flow to the brain
  • migraine or cluster headaches

Horner’s syndrome is considered a rare disorder. It affects all sexes in equal numbers, and at any age.

The prognosis depends on the underlying cause of the syndrome. The symptoms in themselves do not generally present serious problems, but the cause likely needs immediate diagnosis and treatment.

Malignant mesothelioma

Malignant mesothelioma is a cancer that starts in the mesothelium, which is the lining around certain organs. When the affected lining is in the chest surrounding the lungs, the cancer is called pleural mesothelioma.

The main risk factor for pleural mesothelioma is exposure to asbestos. The number of cases have been dropping in the United States during the past two decades, but there are still about 3,000 new cases each year.

Shoulder pain can be an early symptom of mesothelioma. In one study, about 14 percent of the participants reported shoulder pain as the first symptom of mesothelioma.

They reported the pain as relatively mild, rated 4 out of a possible 10. Some reported a decrease in shoulder mobility as well.

Other symptoms of pleural mesothelioma are similar to those of lung cancer in general:

  • shortness of breath
  • chest pain
  • cough
  • hoarseness
  • trouble swallowing

The average length of time between asbestos exposure and mesothelioma diagnosis is between 10 to 50 years. The average age at diagnosis is 72.

If you have been exposed to asbestos in your lifetime, some doctors advise regular imaging tests, such as chest X-rays and CT scans. However, doctors disagree on how useful these are in diagnosing mesothelioma early.

Metastatic or advanced lung cancer

According to the National Cancer Institute, more than one-half of lung cancer diagnoses are made at the advanced stage when cancer has spread, or metastasized, beyond the lung.

This is called metastatic or advanced lung cancer, classified as stage 4. At this point the cancer may have spread to:

  • both lungs
  • the lymph nodes on both sides
  • the area around the lungs
  • distant organs and parts of the body

Metastatic lung cancer can, in rare cases, also damage your muscles. You may experience intense shoulder pain with metastatic lung cancer. However, shoulder pain is not a common symptom at this point.

If shoulder pain does occur, it can be a signal that lung cancer has spread and damaged your muscles as well.

Shoulder pain from lung cancer is quite similar to other forms of shoulder pain. Because of this, it might be difficult to determine the cause of your shoulder pain.

If you’ve recently fallen or injured your shoulder in some way, lung cancer is unlikely to be the cause of your shoulder pain. There are many reasons for shoulder pain that aren’t lung cancer.

Lung cancer is more likely to be the cause of your pain if you’re a smoker and your pain:

  • occurs during rest
  • isn’t associated with any strenuous activity involving the shoulder
  • happens at night
  • doesn’t resolve itself after a few weeks

Your shoulder pain is also more likely to be a symptom of lung cancer if you have other lung cancer symptoms as well. These might include:

  • shortness of breath, often mild and with activity
  • a persistent cough
  • hoarseness
  • coughing up blood
  • fatigue
  • losing weight without a reason

People who have shoulder pain from lung cancer often describe it as a radiating pain from the shoulder down their arms to their hands. There may also be numbness or tingling. At other times, it can feel like a deep ache.

Lung cancer frequently causes chest pain as well. Sometimes, this chest pain is a result of bouts of coughing.

In other cases, the pain of lung cancer is a result of a large tumor pressing on other structures or growing into the chest wall and ribs.

Tumors in the lungs can also press on blood vessels and lymph nodes. That causes a buildup of fluid in the lining of the lung, and it can cause pain or shortness of breath.

As mentioned, if you have shoulder pain, the odds are you don’t have lung cancer. A variety of health conditions cause shoulder pain including:

  • minor injury
  • poor posture when sitting or standing
  • a frozen shoulder, or stiffness and pain in the shoulder joint
  • a broken arm or broken collarbone
  • disorders of the rotator cuff
  • tendonitis
  • osteoarthritis
  • a dislocated shoulder
  • problems with the AC joint (acromioclavicular joint) at the top of the shoulder
  • bursitis
  • an overactive thyroid, or hyperthyroidism

Your doctor’s first step in treating your shoulder pain will be to pinpoint its cause. Your doctor will first review your symptoms with you. They’ll then likely order various tests to explore possible causes.

Treatment for shoulder pain from lung cancer

If your doctor thinks lung cancer may be causing your shoulder pain, they will begin the screening process by ordering imaging tests.

They’ll use a screening procedure such as a CT scan or a positron emission tomography scan to get an internal image of your lungs. This gives a clearer picture of any potentially cancerous growths.

If they still suspect lung cancer following your screening, they may ask to take a small piece of tissue from the lungs to examine it closely for cancer cells. This is called a biopsy.

Doctors can perform lung biopsies in two different ways. They may pass a needle through the skin to your lungs and remove a small amount of tissue. This is called a needle biopsy.

Alternatively, your doctor may use bronchoscopy to perform the biopsy. In this case, your doctor inserts a small tube with an attached light through your nose or mouth and into your lungs to remove a small tissue sample.

If they find cancer cells, your doctor may conduct a genetic test. This can help determine what type of lung cancer you have and possibly identify underlying causes, such as genetic mutations.

If you have lung cancer, your doctor may use a variety of treatments based on your specific circumstances, including:

  • surgery
  • chemotherapy
  • radiation
  • targeted drugs
  • immunotherapy

Doctors will often use more than one method to treat lung cancer. For example, they might prescribe chemotherapy or radiation to shrink a tumor before surgery.

They may also try a different method if the first one doesn’t work. Some of these treatments have side effects. You can manage side effects with proper planning and education.

Scientists are exploring new treatment options for lung cancer that offer hope for better outcomes. Two of the most promising ones are gene therapy and immunotherapy.

Treatment for shoulder pain from other causes

If your shoulder pain isn’t due to lung cancer, it’s important to determine the cause. This will help your doctor come up with a treatment plan.

For example, they may recommend physical therapy if you have shoulder pain due to tendonitis.

If you have shoulder pain due to frozen shoulder (a symptom of diabetes), your doctor may recommend a combination of glucose-lowering drugs and a low carbohydrate diet.

You can manage shoulder pain properly if you deal with its underlying cause. If your doctor diagnoses you with lung cancer, it’s important to get the best treatment available.

You can try home treatments for your shoulder pain while you’re waiting to see your doctor:

  • Avoid using your injured shoulder.
  • Try icing your shoulder for 15 to 20 minutes at a time. This may help reduce pain and swelling.
  • Try wrapping your shoulder with an elastic bandage. Using compression can help you avoid overusing your shoulder.
  • Elevate your shoulder above your heart as much as possible. You can use pillows to help you with this.

Most forms of shoulder pain aren’t symptoms of lung cancer. But shoulder pain is a commonly overlooked symptom of lung cancer.

If you experience shoulder pain and have other symptoms of lung cancer or are at high risk for it, don’t delay in speaking with your doctor.

Early diagnosis is the key to getting effective treatment for lung cancer.