Adam Holloway initially assumed his shoulder pain was a simple strain caused by regularly playing an energetic new virtual reality (VR) computer game.
The pain came on ‘very gradually’ and while the 49-year-old father from Chelmsford, in Essex, wasn’t concerned at first, when things didn’t improve after a couple of weeks in August 2023 he decided to see his GP.
The doctor diagnosed a trapped nerve in his left arm, prescribed the painkiller co-codamol and referred Adam for nerve testing, involving a six-month wait. Meanwhile, his pain escalated.
‘About two weeks after seeing my GP, I was waking up screaming in the middle of the night, with shooting and stabbing pains – I was only getting an hour or two of sleep,’ says Adam, a stay-at-home father to seven children aged between ages nine and 25.
His painful shoulder meant he couldn’t lift his arm or grip anything – ‘even eating dinner and washing in the shower were a struggle’. His worried wife, Katie, then 44, urged him to return to the GP.
Between August and December 2023, Adam had 12 GP appointments and two A&E visits. Each time, he was told the pain was musculoskeletal.
Even though he was barely able to function, Adam was repeatedly sent home with stronger painkillers – first naproxen, then amitriptyline, celecoxib and morphine – none of which eased his pain.
‘I knew something wasn’t right,’ he says. But frustratingly ‘we saw a different doctor every single time, so I had to explain the issue from scratch in every appointment. They couldn’t see how much worse it was getting.’
Between August and December 2023, Adam Holloway had 12 GP appointments and two A&E visits. Each time, he was told the pain was musculoskeletal
Shortly after a weekend in the Lake District for a friend’s wedding in October 2023 – which Adam spent hunched over in pain – a ‘pins and needles’ sensation began spreading across his chest.
Finally in December, four months after the pain started, Katie, accompanied him to yet another GP appointment and insisted he needed a scan.
The GP put Adam on a two-week cancer pathway – not because cancer was suspected, but simply as the quickest way to get an X-ray and CT scan.
Waiting for the results, he was in such agony he could barely walk, drive, pick up a kettle or even stand – so the couple returned to A&E the day before Christmas Eve, while Katie’s mum looked after the children.
The duty doctor called up the results of Adam’s CT scan: ‘His face dropped before telling us that there was a large mass on my lung and I had lung cancer,’ says Adam.
‘He sent us back to the waiting room where we just sat there amongst other patients, trying to take in the news.’
No further tests could be done until after Christmas, so Adam was given painkillers and the couple returned home in the early hours of Christmas Eve.
Although Adam’s diagnosis came as a bolt from the blue, in fact it’s not unusual for lung cancer to present as chest pain symptoms rather than the classic cough or breathing problems, says Dr James Wilson, a consultant clinical oncologist at the Cromwell Hospital, London.
As he explains: ‘Unfortunately, lung cancer can progress silently until it’s locally advanced or has spread. There’s very little pain sensation within the lung tissue itself, because the alveoli [tiny air sacs] and bronchioles [small air passages] have very few pain fibres.’
However, the membrane surrounding the lungs has a network of nerves, so tumours on the edge of the lung can cause pain.
Dr Wilson adds: ‘Tumours involving the airways cause coughing, so symptoms often don’t appear until the cancer involves the central airways or spreads to sites that can actually feel pain. This is exactly why lung cancer screening is so important.’
In Adam’s case, the tumour was pressing on a nerve leading to his neck, causing shoulder pain.
Lung cancer can also lead to irritation of the diaphragm (the dome-shaped muscle separating the chest and abdominal cavities), causing referred pain in the shoulder tip.
This is because the nerves that supply the diaphragm originate in the neck area and also supply the skin of the shoulders – ‘the brain can’t differentiate between the two,’ says Dr Wilson.
He adds: ‘It’s quite common for cancer to spread to lymph glands just above the collarbone, and when that happens it can cause pain or discomfort in the shoulder.’
Shoulder pain can be triggered by other conditions in other parts of the body, as well as lung and other cancers, adds Dr Wilson.
‘Conditions that irritate the diaphragm can refer pain to the shoulder, including gallbladder disease, liver disease, spleen conditions, ectopic pregnancy [when a fertilised egg implants itself outside the womb], or pancreatitis [inflammation of the pancreas].
‘Other causes of shoulder pain include heart attack, pericarditis [inflammation of the sac surrounding the heart], and pulmonary embolism, a sudden blockage in a lung artery.
‘Neck pain can also radiate into the shoulder.’
Gordan Grahovac, a consultant neurosurgeon and spinal surgeon in London, says there are two reasons why we might experience pain in one part of the body when the actual source is elsewhere.
One is because nerves from different parts of your body (for instance, your heart and your left arm) converge on the same spinal cord segments.
The other is because the brain misinterprets the pain signals it receives – for instance, an internal organ may send a pain signal, but the brain interprets this as coming from a more familiar source with more densely-packed nerve endings (such as skin or muscle).
So for example, a heart attack might appear as pain in the left shoulder, arm, neck or jaw – while a gallbladder or liver problem might manifest itself in right shoulder pain.
‘Flank or groin pain can mean there is a problem with the kidneys, and hip problems can create referred pain in the knee due to the interconnected nature of the musculoskeletal system,’ adds Mr Grahovac.
There are several different types of referred pain a person can experience – including sharp, dull, tingling, burning, stabbing, radiating and constant, according to the location and severity of the problem.
Possible red flags include pain where there is no evidence of a direct injury or that the cause is musculoskeletal, says Mr Grahovac.
His painful shoulder meant he couldn’t lift his arm or grip anything – ‘even eating dinner and washing in the shower were a struggle’. His worried wife, Katie, urged him to return to the GP
If you develop unexplained pain that is combined with neurological changes (e.g. limb weakness), high blood pressure or increased heart rate or pain that is getting worse and waking you at night, then you should ‘see a doctor as soon as possible’, he adds.
Despite having smoked for most of his life, Adam was shocked to hear he might have lung cancer – ‘I didn’t have any other symptoms – no cough, chest infections, coughing up blood or breathlessness’, he says.
Dr Wilson says that one challenge for GPs in reaching a diagnosis is that shoulder pain can have many causes – ‘and lung cancer might not be the obvious one’.
But a recent (and so far unexplained) rise in cases of lung cancer among younger people and those who have never smoked means doctors should consider the possibility, he says.
He also urges anyone eligible to take advantage of the NHS lung cancer screening programme for those aged 55 to 74 with a significant smoking history.
‘It’s always better to detect cancer before symptoms develop – you’re far more likely to be eligible for curative treatment.’
Katie and Adam agreed not to tell their children the bad news straightaway – watching the happy children opening their presents while in pain and wondering if it would be his last Christmas with his family was ‘the hardest day of my life,’ says Adam.
In early January 2024, a PET scan, MRI and biopsy revealed a stage 4, incurable small-cell lung cancer (SCLC), which had spread into a nerve in his neck.
Normally caused by smoking, it’s responsible for up to 15 per cent of lung cancers, is often fast-growing and can spread rapidly.
Adam was only given a year to live.
‘I was absolutely heartbroken,’ says Katie. ‘It didn’t seem real.’
The couple informed their children and Adam was admitted to Southend Hospital for urgent chemotherapy and immunotherapy.
Despite the bleak prognosis, there was progress.
By May 2024 the tumour had shrunk from 16cm to 5cm. Adam also underwent radiotherapy to his chest and brain. The treatment saved his life but caused profound neurological effects.
‘We called it radio rage,’ explains Katie. ‘He’d be fine one minute and furiously shouting the next without knowing he was doing it.
‘His memory has been affected, he can’t concentrate, drive or even play a computer game anymore. Physically he has been doing amazingly, but mentally he’s really struggling.’
Katie gave up her job as a waitress to look after Adam and their younger children and found support through the Helen Rollason Cancer Charity in Chelmsford.
She completed the London marathon for the charity in April 2025, raising £2,800 – and was delighted that Adam was there to cheer her on.
She’s now planning a party for Adam’s 50th birthday next month – a milestone they feared he might not reach.
‘It’s incredible that Adam is still here two years after his diagnosis,’ says Katie.
‘Shoulder pain is listed as one of the symptoms of lung cancer on the NHS website, so why didn’t doctors ever suggest a scan?’
Adam’s tumour currently measures 2.9cm and he continues to have immunotherapy every three weeks.
Dr Wilson advises anyone with persistent, unexplained shoulder or chest pain to see their GP – and to ask for a second opinion if their concerns are not addressed.
Meanwhile, Adam is ‘determined to keep going’, he says. ‘I just want to be here as long as possible for Katie and the children.’
