Neck and shoulder pain with hard bump on collarbone

Wed, 02/13/2019 - 23:40

Hello there!  I have reached out for your thoughts before and so appreciate your expertise.  Thank you! 

I am back with another question and could really use your help.  As you may recall, my mom is being treated for NSCLC (stage 4) with 3 weekly Keytruda infusions. Her 8th infusion was last Monday and the last scan, 2 months ago, was encouraging.  It showed that the lymph nodes were no longer visible and the main tumor in the left lung had shrunk.  The cancer in her bones, however, was unchanged.

Last night she had severe pain on the right shoulder, neck & collar bone area resulting in limited range of motion on the right side. She also had pain when swallowing & stretching this side.  So we headed to the ER where my mom received a chest X-ray, neck CT & labs. Thankfully, these came out clear (though the area covered by the CT was limited) . This evening my mom has developed a painful bump on the collarbone where it was hurting yesterday.  We did meet with her oncologist this morning who has ordered full body CT & bone scan.  The lump was not visible in the morning but my mom did point to it.  This evening, hearing about the painful bump, the oncologist suggested we start with an anti-biotic as the labs showed an elevated white blood cell count, pending the new scans.  Any thoughts as to what may be going on?

Thank you as always!


Jim C Forum Mo…

Hi Semone,


I'm sorry to hear of the pain your mom is experiencing, and the concern that it causes in light of her existing diagnosis and presence of bone metastases. When you have cancer, It's quite common to assume that every new symptom is related to that cancer. While it is always advisable to inform the oncologist of such new symptoms, cancer patients are subject to all of the typical maladies that plague everyone from time to time, so it's also good to explore other possibilities. 


In your mom's case, the negative imaging so far, combined with the elevated white blood count, tends to point away from cancer and toward a possible infection, which the antibiotics may help clear up. The fact that her symptoms have changed and in general her pain has lessened tend not to indicate a bone metastasis, as that type of pain usually grows steadily worse rather than waxing and waning. In any event, the larger-scale CT and bone scan should provide a definitive answer regarding bone metastases.


I hope that this proves to be an infection that the antibiotics resolve quickly, and that your mom will obtain rapid relief from her pain and discomfort.


Jim C Forum Moderator

JanineT Forum …

Hi Semone,


I'm sorry your mom is having new issues but Jim has addressed it well.  I hope you will let us know what the CT and bone scan find.


I have just one thing to add.  Assessing the efficacy of treatment of bone metastases isn't as accurate as for soft tissue mets.  So I wouldn't be so sure treatment isn't effective in your mom's bone mets. 


I didn't find reference specific to lung cancer but here is a study that discusses some of the issues in breast cancer on assessing efficacy of treatment on bone mets.  The same applies to lung cancer but research in matters of solid tumors often start in breast cancer.  I used to be jealous that breast cancer got most of the cancer research dollars but I soon realized that a lot of that transfers to lung cancer and I should be glad that there is a body part that people just can't bear seeing sick.  Now that my niece is in treatment for bc I couldn't be happier for all the research.  

I most often just read the abstract then scroll down to the conclusion and discussion before thinking about wading through the actual report


I hope your mom feels better soon.

Take care,



Wow!  Thank you Janine.  This is really informative.  I had no idea how much time and followup are required to properly assess the response to treatment in the case of bone metastases.  I'll educate myself on this further to be able to have a more productive dialogue around the results of the CT and bone scans.   

I am so grateful for you, for Jim and Dr. West.  Thank you all!  I'll be back once we have done the scans and have some results.  The CT is later this evening.

Warm regards,


Jim C Forum Mo…

Hi Semone,


I'm sorry Semone, but detailed interpretation of such test results is beyond the scope of what we can address on this site. (In any event, the reports do not appear). If you have a term or concept from the reports that you would like us to clarify, we would be happy to do so, but the interpretation of the reports is best left to your mom's medical team, who have access to all of the images from these and previous scans, as well as her full medical data. 


I hope that you can have a good discussion with your mom's oncologist, with favorable results.


Jim C Forum Moderator