Is It Costochondritis or Cancer?

When you think about chest pain, your first thought might be “heart attack.” However, causes of chest pain can range from a minor rib fracture to a serious heart attack. A frequent non-cardiac cause of chest pain is a condition called costochondritis.

Costochondritis is not cancer, but its symptoms can resemble those of some types of cancer. It can also develop after certain types of cancer surgery involving the chest or rib area.

“Chest pain can carry a wide range of serious diagnoses, from cardiac to cancer-related causes. Anyone with chest pain should be seen by a doctor,” said Ryan Gentzler, MD, an American Society of Clinical Oncology (ASCO) expert and associate professor of hematology and oncology at the University of Virginia School of Medicine.

What is costochondritis?

Costochondritis can occur when the cartilage connecting the ribs to the breastbone (sternum) becomes inflamed. The lungs, a central organ in the respiratory system, are protected by the ribs and sternum. The main symptom of costochondritis is chest pain, usually near the breastbone toward the center of the chest.

With costochondritis, the pain tends to:

• Be focused in a specific area of the chest
• Feel more tender when pressed
• Get worse with deep breathing, coughing, or physical movement like reaching overhead
• Improve with rest or over-the-counter pain medication

While uncomfortable, costochondritis is generally harmless. It does not lead to cancer or increase a person’s cancer risk.

What causes costochondritis?

Experts aren’t certain what causes costochondritis, but it seems to be triggered by repeated or extreme strain on the chest. This condition often occurs after an injury, persistent coughing, or heavy lifting. It can also develop from inflammation after surgery in the chest area, such as a mastectomy, procedures for lung conditions, or open-heart surgery.

“Most costochondritis is post-traumatic. It happens after the chest wall has been impacted in some way, such as blunt force or a surgery where they operate on the chest,” said Robert Hylland, MD, a fellow of the American College of Rheumatology and clinical assistant professor at Michigan State University College of Osteopathic Medicine.

How is costochondritis diagnosed and treated?

Costochondritis is diagnosed only after life-threatening conditions have been ruled out as a cause for chest pain. This means the doctor will start by ruling out things like a heart attack or pneumonia, if you had a recent infection or illness.

Evaluation for chest pain may include a physical exam, blood tests, a chest x-ray, or other imaging tests. You’ll likely be asked lots of questions about your pain and any recent health problems. You may be asked to move your arms into various positions and take deep breaths to see how the movements affect the pain.

Costochondritis is what’s called a self-limiting condition. This means it usually gets better on its own within a few days to a few weeks. Treatment your doctor recommends for costochondritis may include:

• Taking over-the-counter pain relievers and anti-inflammatory medicines, like ibuprofen or naproxen
• Applying a heating pad or ice pack
• Resting
• Limiting repetitive motions
• Suppressing your cough, if you have one

Less often, the doctor may suggest physical therapy for stretching and mobility exercises, if needed. These can help to improve chest muscle strength and flexibility, which can help relieve symptoms.

Can symptoms of costochondritis and cancer overlap?

Costochondritis can cause chest pain that gets worse when you move certain ways, take a deep breath, cough, or laugh. While lung cancer in its early stages often doesn’t cause symptoms, this kind of chest pain can also be a symptom of lung cancer. People with more advanced lung cancer might have chest pain, but may also cough up blood, have shortness of breath, or have unexplained weight loss.

“Most patients with lung cancer do not have pain in the chest as a primary symptom. But chest pain can happen as tumors grow and press on or spread to the bone,” said Dr. Gentzler.

More rarely, chest pain can be a symptom of other cancers that can develop in the chest, including mesothelioma, non-Hodgkin lymphoma, multiple myeloma, or bone cancer. 

Can cancer treatment cause costochondritis?

People with different types of cancer can get costochondritis related to treatment. For example, some treatments for lung cancer and breast cancer can affect the chest wall.

“Patients who’ve had extensive surgery, radiation treatment combined with surgery, or complex breast reconstructions tend to have a higher risk of costochondritis. It usually happens within the first few years after a patient undergoes those treatments, but can happen anytime,” said Shelley Hwang, MD, an American Society of Clinical Oncology (ASCO) expert and professor of surgery and radiology at Duke University School of Medicine.

If you experience chest pain after cancer surgery, be sure to tell your doctor. “Your doctor will want to make sure the pain is not due to a cancer recurrence,” said Dr. Hwang.

Seeking help for chest pain

Chest pain should be evaluated right away. Along with possible blood and imaging tests, determining the cause depends on your recent experiences, as well as your family health history.

You will likely be asked these questions:

• Where exactly is the chest pain?
• What is the level of your pain on a scale of 0-10?
• How long has the chest pain been going on?
• What makes the pain better? What makes it worse?
• Do you have any other symptoms?
• Have you had a recent respiratory illness like pneumonia?
• Have you experienced any recent injury to the chest, such as from a car accident or contact sports?
• Have you ever had chest surgery?
• Have you ever had radiation therapy to the chest?
• Do you have a history of heart disease, high blood pressure, diabetes, acid reflux, or blood clots?
• Do you smoke tobacco, or have you smoked in the past?
• Have you had any dietary changes over the past few weeks?

Symptoms of costochondritis can last longer than a few weeks, or they can come back. “I recommend advocating for an x-ray or CT scan if the pain persists for several weeks, especially if your initial diagnosis was costochondritis,” Dr. Gentzler said.

Dr. Gentzler and Dr. Hwang are ASCO members.