Costochondritis or Cancer?

Costochondritis is a temporary or acute inflammation that affects the cartilage in the chest. This type of inflammation attacks the cartilage in the sternum, which is the flat and long bone in the middle of the rib cage. Costochondritis typically causes chest pain that may last for several weeks or longer. Unfortunately, while it is uncommon, several types of cancer that we’ll talk about in this article also include symptoms of chest pain. It is important to have an appointment with your physician if you’re experiencing chest pain, and it is doubly important to follow up with your physician if your chest pain is lasting for weeks, months, or longer.

How Can Cancer Be Mistaken for Costochondritis?

Costochondritis is most commonly associated with chest pain symptoms, and so are some types of cancer. Examples of such cancers include lymphoma (including dlbcl and pmbcl), multiple myeloma, lung cancer, and bone/rib cancer. 

When people experience chest pain, they often fear it is a sign of a heart attack or other cardiac issues. Sometimes chest pain can be diagnosed as costochondritis without necessary additional investigation to rule out other, more rare conditions. Patients are prescribed physical therapy, ibuprofen, etc. for their costochondritis without additional imaging and tests being performed until other serious symptoms begin appearing.

Patients and physicians themselves rarely suspect that this kind of chest pain could be caused by cancer. Though patients presenting with chest pain typically don’t have cancer, without proper imaging via CT scan or X-Ray it can be difficult to realize the source of the pain. Imaging is crucial if you want to explore any abnormalities in the rib cage and chest, especially if you’re looking for signs of cancer. 

Cancer and Chest Pain

One of the major issues with the types of cancer that cause chest pain is that not many people are diagnosed before their cancer has reached advanced stages, which can often impact the prognosis for those patients. Recognizing the symptoms and early screenings are important, particularly for individuals who are at high risk of developing these diseases. We will focus on the most prominent types of cancer that can easily be mistaken for costochondritis. 

Lymphoma cancer (DLBCL and PMBCL)

Lymphoma cancer is a disease that infects the cells in the immune system known as lymphocytes. These cells are the ones responsible for fighting off infections and protecting the immune system. Lymphoma cancer is divided into two types: Hodgkin’s, and Non-Hodgkin’s.

According to statistics, DLBCL (Diffuse large B-cell lymphoma) accounts for 30% to 40% of all non-Hodgkin’s lymphomas, which is why it is the most common form of a tumor. PMBCL (Primary mediastinal large B-cell lymphoma) is a subtype of DLBCL and is much more rare. This type of lymphoma usually materializes in young adults around the age of 35. Based on research, women are far more likely to experience it compared to men. Both of these cancers typically form masses that can cause pain in the chest cavity.

Common signs of lymphoma, particularly PMBCL, are chest pains, lumps, distended veins above the chest, and change in the chest wall mass. However, other symptoms can occur based on the type and stage of the disease.

Aside from chest pain, here are the symptoms that separate lymphoma from costochondritis:

• Diffuse Large B-Cell Lymphoma (DLBCL) Symptoms
  • Sweating at night
  • Exhaustion
  • Sudden weight loss
  • Swollen lymph nodes in the armpit, neck, groin (not painful)
  • Fever

• Primary Mediastinal B-Cell Lymphoma (PMBCL) Symptoms
  • Swelling in the neck, arm, or face
  • Chest, back, or neck pain
  • Shortness of breath
  • Coughing
  • Hoarse voice

Multiple Myeloma

Research shows the most common sign of multiple myeloma is bone pain occurring in 70% to 80% of people. While 90% can experience pain in the ribs or lumbar. If this disease fails to be diagnosed in time, patients can experience bone loss. They will be more prone to bone fractures and can have serious complications. Some of these complications can include acute hypoxemic respiratory failure (AHRF) or flail chest, which can cut the supply of oxygen and result in collapse. This type of cancer is sometimes discovered in a patient by presentation of an unexplained spinal fracture caused by bone weakness.

Some of the most frequent symptoms of multiple myeloma include:

• Bone pain (back or ribs)
• Kidney issues (kidney failure or damage)
• Bone issues (weak or brittle bones, bone pain, unexplained fractures)
• Insufficient amount of healthy blood cells
• Getting sick too easily
• Nausea
• No appetite
• Sudden weight loss
• Feeling thirsty too often 
• Confusion
• Feeling dizzy

Lung Cancer

Lung cancer is the leading cause of cancer deaths in men and women within the United States, and there are two major types that include small cell and non-small cell lung cancers. Lung cancer may start in the lungs but can enter the bloodstream and affects other organs and tissues throughout the body even if it doesn’t spread to them. 

Not all lung cancers can cause symptoms, however. In fact, some individuals may not experience any. But, those in the early stages can have symptoms and they can help identify the cancer in its early stages. In these early stages, treatment typically proves more effective.

Here are some common symptoms of lung cancer people can experience:

• Chest pain getting gradually worse with coughing, breathing, laughing
• Infections like pneumonia or bronchitis are re-occurring
• Coughing blood
• The cough gets gradually worse and doesn’t go away
• Exhaustion
• No appetite
• Breathlessness
• Hoarse voice
• Sudden and unexpected weight loss

Bone, Rib, and Chest Well Cancer

Bone cancer can occur or spread (metastasize) to literally any bone in the body, including the ribs and chest well. Rib cancer and chest well cancer can both cause chest pain, swelling and tenderness in the chest. Some of these symptoms can often be mistaken for costochondritis.

Typical symptoms of bone cancer may include:

• Fever
• Weight loss
• Anemia
• Limping
• Weakened bones
• Bone pain
• Stiff or swelled joints

Similarly, chest wall cancer also causes chest pain and swelling, as well as muscle atrophy and impaired movement. Chest wall cancer is rare, and accounts for less than 5% of all cancers in chest area.

When Chest Pain Turns Out To Be Cancer

One extremely rare form of cancer that accounts for less than 5% of all bone tumors and less than 1% of all non-Hodgkin’s lymphomas is primary bone lymphoma. Because of how rare it is, it is easy to misdiagnose or miss. 

In one particular case, published in 2012, the lymphoma could have easily been undetected. A 52-year-old man was analyzed with a small lump on the chest that complained about the growing chest pain. The lump progressed over a couple of months. Since he had a history of fever, he was treated with antibiotics first. However, the antibiotics were of no use which is why he had to do an X-ray. There was nothing wrong for the first screening of the lump. It showed only minimal changes in the tissue component. But with further scanning, the tumor was located inside the bone via biopsy – it was a hidden lymphoma. Immediately after the cancer was detected, the patient received proper treatment including chemotherapy and radiation. Fortunately, he responded positively to the radiation and successfully treated the disease. 

Another similar case took social media by storm, when a young girl Olivia Rose Smith, then 22, was diagnosed with lymphoma cancer. She claimed her chest pains were initially dismissed by many physicians. However, those chest pains actually turned out to be Hodgkin’s lymphoma. She is now trying to raise awareness of the impact of misdiagnosis and why it’s important to get diagnosed on time.

Since cancer can be easily left undetected or misdiagnosed, it’s important to get screened in time. If you believe you may have persistent chest pain that includes other symptoms, make sure to work with your doctor and ask if an evaluation, blood tests, CT scans, or X-rays are appropriate. Quick intervention can help detect cancer in its early stages and aid with treatment.

If you are experiencing chest pain, it is important to see a physician, and if your pain is lasting for many months it can be of the utmost importance to follow up with your physician for extra testing to make sure it’s not a more serious condition.

Have you experienced chest pain that turned out to be cancer? Feel free to leave a comment about your experience below.

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a surgery resident practicing plastic surgery and working on his masters degree. Dr. Zayed has a passion for helping people live healthy lives, and has authored several books. He has contributed to publications such as the Washington Post, HuffPo, Chicago Tribune, and more. Dr. Zayed has an MD from the University of Alexandria, one of the largest medical schools in Egypt.