Which sign would most strongly raise concern for metastatic cancer when back pain is present?

Which sign would most strongly raise concern for metastatic cancer when back pain is present?

• A. History of cancer
• B. New lumps or swollen lymph nodes
• C. Chronic cough
• D. Skin rash

Answer: (A)

A prior cancer diagnosis is the strongest red flag for metastatic involvement when back pain is present. The spine is a common site for cancer to spread, so a history of cancer raises the pre-test probability that back pain could be due to metastasis or spinal cord compression. This warrants prompt imaging, typically MRI, to assess for metastatic lesions and potential neurological impact. The other signs—new lumps or swollen nodes, chronic cough, and a skin rash—can be associated with cancer but are less specific for metastasis to the spine in the context of back pain, making them less predictive indicators than a known cancer history.

A prior cancer diagnosis is the strongest red flag for metastatic involvement when back pain is present. The spine is a common site for cancer to spread, so a history of cancer raises the pre-test probability that back pain could be due to metastasis or spinal cord compression. This warrants prompt imaging, typically MRI, to assess for metastatic lesions and potential neurological impact. The other signs—new lumps or swollen nodes, chronic cough, and a skin rash—can be associated with cancer but are less specific for metastasis to the spine in the context of back pain, making them less predictive indicators than a known cancer history.