Symptoms of tailbone cancer include pain, noticeable mass, and weakness or numbness in the lower back and legs. Cancer in the tailbone, also known as the coccyx, may be a chordoma or a cancer that has spread from elsewhere in the body.

Chordomas are a rare type of cancer that can grow anywhere along the spine. They account for only 3% of all bone tumors.

Chordomas are slow-growing, but they can be hard to treat. Cancers of the tailbone are either primary, known as chordoma, or secondary, meaning they have spread from elsewhere in the body.

People with chordoma require ongoing follow-up even after treatment because it often reoccurs. As the symptoms are not specific to the condition, up to 70% of people with chordoma receive a misdiagnosis.

This article will explain the symptoms of tailbone cancer, as well as the types of cancer that can occur in and around the tailbone. It will also detail the causes and treatment.

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The type and severity of symptoms will depend mainly on the tumor size. When the tumor is very small, there may not be any symptoms. As the tumor grows and puts pressure on the nerves and spine, it can start to cause symptoms.

Symptoms of tumors in the lower base of the spine include:

  • lower back pain
  • tenderness
  • tingling
  • weakness in the lower back and legs
  • issues with bladder and bowel function, including loss of control
  • palpable mass in the lower back

Since the symptoms usually occur gradually, they can be easy to miss. A person may not receive a chordoma diagnosis until the tumor is at an advanced stage, making it harder to treat.

The symptoms of a tumor that has spread from another type of cancer will be similar to those of a chordoma. Such a tumor will also press on nerves in the area, causing the same effects as a chordoma.

Read more about the symptoms of bone cancer here.

There are different types of cancer that may grow in and around the tailbone.

  • Chordoma: A chordoma is a type of tumor that may grow anywhere along the spine. It is most likely to grow around the skull base, known as a clival chordoma, and the tailbone area, which is a sacral tumor. Chordomas are rare, with only 1 in 1,000,000 people receiving a diagnosis each year.
  • Colorectal cancer: Colorectal cancer pain may occur in the tailbone, but it is rare for it to spread to the bones. Only about 3–7% of people with colorectal cancer will have it spread to the bones.

Other types of cancer are more likely to spread to the bones. Breast, prostate, lung, thyroid, and kidney cancers account for 80% of all skeletal metastases.

Read more about cancers that occur along the spine, including chordoma, here.

The underlying causes of tailbone cancers are unknown, as they tend to occur spontaneously. Some theories suggest that they can occur due to genetic abnormalities or chromosomal abnormalities, such as an abundance of the T gene on chromosome 6.

Often, cancer spreads from another site in the body. In about 70% of breast and prostate cancer cases where cancer has spread, tumors are found in the bones.

Treatment will depend on the exact type of cancer and the tumor size. For cancers of the tailbone, treatment may include:

  • Surgery: Surgery is the typical first treatment for a sacral chordoma. As they often spread into nearby tissues and grow around nerves, they can be difficult to remove, especially as they continue to grow. If the tumor cannot be completely removed, a surgeon may be able to cut out parts of it.
  • Radiation therapy: Radiation therapy can shrink any remaining tumor. Radiation can also help prevent the tumor from growing again. If surgery is not an option, radiation may be the primary treatment.
  • Immunotherapy: Certain immunotherapy drugs can be used to trigger the immune system to fight cancerous cells. These drugs are only used if surgery or radiation are not an option or not effective.

Chemotherapy does not tend to work well in the treatment of sacral chordoma. Doctors may use it as part of overall treatment if the tumor in the tailbone area has spread from another site.

The outlook for someone with a sacral chordoma depends on how much of the tumor is surgically removed. Sacral chordomas rarely spread to other areas in the body and often grow back in the same place. Even if doctors fully remove the tumor, research shows that it grows back in about half of patients within 15 years.

The best outcome is the complete removal of the tumor. According to a 2022 study, after 5 years, about 50% of patients are in remission without any signs of cancer returning. This survival rate decreases to 20% if doctors cannot remove the entire tumor.

If the tumor in the tailbone area is from cancer that started somewhere else in the body, the survival rate depends on the type and stage of the cancer.

There are a few cancers that may occur in the tailbone area, including primary tumors such as chordoma or secondary cancers that have spread from another area of the body. Colon cancer pain may radiate into the tailbone and sacrum, and it is possible for other cancers elsewhere in the body to spread to the tailbone region.

The main symptoms of cancer in the tailbone include pain, weakness in the lower back and legs, and changes in bowel and bladder control. Treatment for chordoma can include surgery, radiation, and immunotherapy. Chemotherapy is not usually part of chordoma treatment, but it is used for other cancers if they have spread into the tailbone or sacrum.

Chordomas are hard to treat and often grow back in the same place. Full surgical removal of the tumor has the best outcome.