Symptoms - Chest Pain

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

Lung cancer is the most common cancer in the world, and pain is the most common symptom of lung cancer. Approximately 25 percent of people with lung cancer have chest pain at diagnosis. The prevalence of pain increases when assessing patients with more advanced lung cancer. One study found the rate of pain present in 90 percent of lung cancer patients receiving palliative care (pain/symptom management), with the most common sites of that pain being the chest and the spine.1,2

Types of pain in lung cancer

Pain is often caused by multiple factors and its management needs to be multi-disciplinary to address all these aspects. In cancer, pain can be characterized into two areas: acute pain and chronic pain. Acute pain is usually due to a definable injury or illness. Acute pain may be a secondary cause of cancer, such as a severe bleeding into a tumor, bone pain caused by a metastasis (spread of cancer), or abdominal pain caused by a metastasis that obstructs the bowel. Acute pain is usually experienced for a limited duration and is predictable. It is usually associated with clinical signs such as increased heart rate, high blood pressure, sweating, and pale skin.1

Chronic cancer pain may be a result of the same causes as acute pain but it is experienced for a much longer duration. Chronic pain can persist for more than 12 hours a day and often has a gradual or poorly defined onset. Approximately 75 percent of cancer patients live with chronic pain.1

Many cancer patients experience flares of pain despite using pain medications. These flares are called breakthrough cancer pain. Breakthrough pain greatly impairs a patient’s quality of life and can cause additional psychological burden.1

Causes of pain

The three most common causes of pain in patients with advanced lung cancer are:

  • Metastasis of lung cancer to the bones, which accounts for approximately 34 percent of lung cancer pain
  • Presence of a Pancoast tumor, located at the top of the lung close to the brachial plexus nerves and cervical sympathetic nerves, which accounts for approximately 31 percent of lung cancer pain
  • Spread of the cancer into the chest wall, accounting for approximately 21 percent of lung cancer pain1

Managing chest pain

Palliative care is a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments, such as chemotherapy. However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress.4

The management of pain due to lung cancer may include a combination of medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioids (pain medications), and antidepressants. For metastases to the bone, radiation therapy and the use of bisphosphonates (drugs to help prevent bone breakdown) can alleviate pain. In addition, smoking cessation (stopping smoking) is recommended, as surveys have revealed that lung cancer patients who continue to smoke after diagnosis have a higher incidence of pain and other lung cancer complications than nonsmokers and those who quit smoking.1,2

Additional symptoms of lung cancer

While chest pain is one of the most common symptoms of lung cancer, other symptoms include:

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