In people with stage 4 lung cancer, tumors have metastasized (spread) to other parts of the body outside the lungs. The bones are a common site for lung cancer to spread — particularly the spine. Outside of having lung cancer symptoms, people with spinal metastases can also experience back pain and nerve problems.

In this article, we’ll cover how lung cancer spreads to the spine and what symptoms you may experience. We’ll also discuss how doctors treat spinal metastases and what they mean for your prognosis (outlook) with lung cancer. To learn more about your individual case, talk to your doctor or oncologist (cancer specialist).

What Are Spinal Metastases in Lung Cancer?

Metastasis refers to the spread of cancer away from the main or primary tumor. Cancer cells can break off of the primary tumor and enter the bloodstream or the lymphatic system — the part of your immune system that filters blood and carries white blood cells to fight infections. Eventually, the cancer cells can reach the bones and form new tumors.

More than half of people diagnosed with lung cancer have metastatic disease at the time of diagnosis. This is because lung cancer doesn’t typically cause any symptoms until the cancer has grown, making it harder to detect. Data from the National Cancer Institute show that 53 percent of people have distant lung cancer — meaning it’s spread in the body.

Spinal metastases are tumors that form in the spinal column. This includes the spinal cord, which is the long band of tissue with nerves that run from the brain to the lower back. Metastases can also form in the bones of the spinal column, known as vertebrae.

Researchers have found that the most common place for lung cancer to spread is the bones. Some studies show that 40 percent to 50 percent of people with lung cancer have bone metastases. Of these, 63 percent have metastases in the spine.

The chances of cancer spreading to the spine depend on the type of lung cancer you have. For people with non-small cell lung cancer (NSCLC), the spine is the most common place for metastasis.

Symptoms of Spinal Metastases in Lung Cancer

When lung cancer spreads to the spine, it presses on or damages the nerves and bones. This can lead to a range of symptoms, including:

• Back pain — This often occurs if the tumor damages the vertebrae (the bones that surround and protect the spinal cord). Specifically, a person may experience back pain caused by spinal cord compression (the tumor compressing or collapsing a bone in the spine) or from bone fractures in the vertebrae.
• Numbness or tingling in your arms, chest, or legs — This may occur alongside muscle weakness.
• Fatigue, confusion, increased thirst, or digestive symptoms due to high levels of calcium in your blood — The spread of cancer can cause bones to break down, which in turn releases calcium into the bloodstream.
• Loss of ability to control urination and defecation.

If you’ve experienced any of these symptoms or have been diagnosed with spinal metastases, you’re not alone. Many MyLungCancerTeam members have shared their experiences and symptoms from when their lung cancer spread to the spine.

• “I had back pain for three months before I was diagnosed with stage 4 lung cancer. The actual reason for the pain was a metastasis on my spine.”
• “My small lung cancer is spreading. It’s in my spine, which is causing my feet and hands to go numb. Has anyone else experienced that?”
• “I cracked my L3 (lower lumbar spine) and when they went to do surgery, they found out I had cancer that had metastasized to my spine.”

Diagnosing Spinal Metastases in Lung Cancer

If your doctor thinks you may have spinal metastases, they’ll likely order a few different tests. An X-ray is useful for finding any masses or tumors on the spine. If your doctor finds a mass, they may order a computed tomography (CT) scan or magnetic resonance imaging (MRI).

A CT scan uses X-rays taken at different angles to make a 3D image of your body. They’re useful for looking for problems with your vertebrae. An MRI uses strong magnetic and radio waves to create extremely detailed pictures of your nerves and spinal cord.

A bone scan helps your doctor look for cancer spread to the bones all throughout your body. You’re injected with a radioactive tracer that travels through your bloodstream to any tumors on the bones. The scanner takes pictures to show exactly where the lesions are.

Your doctor may also take a blood sample to measure your calcium levels. If they’re high, it may be a sign that your cancer has spread to the bones and is breaking down the tissue.

Treating Spinal Metastases in Lung Cancer

When treating spinal metastases, doctors usually offer palliative care. This type of care focuses on relieving pain and discomfort to improve your quality of life.

Radiation therapy and surgery are common palliative treatments. Your doctor may also choose to prescribe other treatment options like chemotherapy or immunotherapy to shrink tumors.

Radiation Therapy

Radiation therapy — also known as radiotherapy — is a common palliative treatment for spinal metastases. This treatment uses beams of radiation (X-rays) to target and shrink tumors. Stereotactic radiosurgery is a specific type of radiation that uses a narrow beam to prevent damage to other tissues in the spine.

Your doctor may order radiation therapy to relieve your pain and discomfort caused by tumors pressing on the spine.

Spinal Decompression Surgery

If a tumor is pressing on your spine or has fractured vertebrae, you may need surgery. You may have a vertebroplasty or kyphoplasty to treat pain from bone breaks.

During this surgical treatment, your provider will inject medical-grade cement into the fractured bone. Studies show that vertebroplasty also kills tumor tissue to relieve your symptoms.

Chemotherapy, Targeted Therapy, and Immunotherapy

Chemotherapy uses toxic chemicals to kill cancer cells. You may take a pill or receive an injection of a chemotherapy drug. It then travels through your bloodstream and to your spine to shrink any tumors.

Your doctor may also prescribe drugs like targeted therapy and immunotherapy to treat your cancer. Targeted therapies block specific mutations found in lung cancer cells. Because spinal metastases come from your lung cancer, they may also respond to treatment.

Immunotherapy drugs activate your immune system to recognize and destroy cancer cells. Studies show that combining immunotherapy with radiation therapy can be effective in treating spinal metastases.

How Do Spinal Metastases Impact Prognosis With Lung Cancer?

Unfortunately, it’s hard for doctors to treat lung cancer that has spread to the spine. The tumors grow quickly and are usually associated with a poor prognosis. This means people with spinal metastases tend to have shorter survival times compared to those without them.

Some studies have looked at the median overall survival (OS) with lung cancer and spinal metastases. Median OS refers to the amount of time after diagnosis at which half of people with a disease are still alive. One report found that the median OS for people with lung cancer spread to the spine was 5.9 months. This means that 5.9 months after diagnosis, half of the study participants were still alive.

It’s important to remember that studies can’t predict your exact life expectancy. However, they can help your doctor better understand how you may respond to treatments.

Doctors and researchers continue looking for new ways to treat spinal metastases to help people live longer lives with advanced cancer. They hope new treatments will keep improving survival rates and improve quality of life.

Find Your Team

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you living with spinal metastases from lung cancer? What symptoms did you experience before your diagnosis? What treatments have you had? Share your experience in the comments below, or start a conversation by posting on your Activities page.