What Is Stage 4 Lung Cancer? | Symptoms | Treatments | Outlook | Get Support

In stage 4 lung cancer, tumors have spread to both lungs or to other parts of the body outside of the lungs. Cancer spreading from one location to another is called metastasis. During metastasis, cancer cells break off from a tumor and travel through the body through the bloodstream or the lymphatic system. Once the cells reach a new location, they may start a new tumor there.

What Is Stage 4 Lung Cancer?

Doctors use staging information to estimate which treatment options may be most effective and to predict outlook. Stages of lung cancer describe how far the cancer has spread in the body. Doctors assign a stage during the process of lung cancer diagnosis.

Lung cancer is staged on a scale from stage 0 to stage 4. Stages are also sometimes written using Roman numerals — stage 4 is also called stage IV. Lower-stage cancers are smaller and located in one area. Tumors that are stage 4, the most advanced cancer stage, have spread to other parts of the body. Doctors can also stage cancers as being limited (in the same organ), regional (spread into the lymph nodes), or distant (found in other organs).

Lung cancer staging is different for each of the two main types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

Non-Small Cell Lung Cancer

There are two substages for stage 4 NSCLC. Stage 4A (stage IVA) tumors can be any size. They may or may not have spread to the lymph nodes (glands that help filter out cancer cells). Stage 4A lung cancer has one or more of the following features:

• Tumors are growing in both lungs.
• A lung tumor has spread into the tissue that covers the lungs or the tissue that covers the heart.
• Cancer cells are found in the fluid that surrounds the lungs or the heart.
• One tumor is growing in another distant organ or tissue, such as the brain, liver, or bones.

Stage 4B (stage IVB) lung tumors may also be any size, and they may or may not have spread to lymph nodes. Stage 4B lung cancer consists of two or more tumors in other locations far from the lungs.

Small Cell Lung Cancer

There are two SCLC stages: limited stage and extensive stage. Limited-stage SCLC exists in just one part of the chest. It is usually discovered incidentally, such as when doing imaging of the lung for another reason. Extensive-stage SCLC includes tumors that have spread to the other lung or to other organs and tissues. Extensive-stage SCLC is similar to stage 4 NSCLC. Around 2 out of 3 people have extensive-stage cancer when they are diagnosed with SCLC.

Stage 4 Lung Cancer Symptoms

All stages of lung cancer may cause symptoms, but symptoms are more common in later-stage disease. At any stage, lung cancer signs and symptoms may include coughing, shortness of breath, chest pain, tiredness, and weight loss.

Later-stage lung cancer can cause additional symptoms. These symptoms may vary from person to person depending on where the lung cancer has spread. People with stage 4 lung cancer may experience:

• Bone or joint pain
• Finger or toenail problems
• Changes in voice, such as sounding hoarse
• Trouble swallowing
• Nerve problems, such as drooping of the eyelids or face, dizziness, weakness, or numbness
• Headaches
• Enlarged lymph nodes, which may appear as lumps in the neck
• Swelling in the face or arms
• Jaundice (yellowing of the skin or eyes)

Other health conditions can also cause these symptoms. If you are experiencing any health changes that could possibly be lung cancer symptoms, talk to your health care team.

Treatments for Stage 4 Lung Cancer

Not all stage 4 lung cancer is treated the same way. When recommending treatments, doctors consider many factors, including:

• The person’s overall health
• Type of lung cancer
• Where in the body tumors are located
• Gene changes present in the cancer cells

Deciding on a treatment plan can be difficult. Ask your doctor about both the risks and the benefits of all potential treatment options. Getting a second opinion from another doctor may help you know you are making the right choice. You also may want to ask your doctor about participating in cancer research. People with advanced-stage lung cancer may be able to receive new treatments by participating in a clinical trial.

Treating Stage 4 NSCLC

Treatment of advanced NSCLC may begin with treating metastases (tumors that have spread to distant locations). Surgery and radiation therapy, followed by chemotherapy, may be able to treat or cure one or a few distant metastases.

Most people with stage 4 NSCLC have cancer that has spread widely throughout the body. Chemotherapy and biological therapies are mainstays of treatment for metastatic disease. Doctors don’t usually recommend surgery and radiation therapy for these cases. Instead, they use systemic therapy — medication that travels through the bloodstream to kill cancer cells in all locations.

Systemic therapy for stage 4 NSCLC often includes targeted therapy. Targeted therapy drugs attack specific molecules, sometimes called markers or targets, found in cancer cells. They largely leave normal cells alone. In order to know which targeted therapy will work best, doctors test lung cancer cells for gene changes that produce these molecules. This provides a clue as to which treatments may have the greatest effect. For example, people with changes in a gene called ALK often use drugs called ALK inhibitors, while those with a change in the EGFR gene use an EGFR inhibitor. Targeted therapies may be combined with immunotherapy (medications that help the body’s immune system fight cancer) or chemotherapy.

People with stage 4 lung cancer often choose to use palliative treatments. Palliative care is not the same thing as hospice care or end-of-life care. Palliative care focuses on relieving symptoms and improving quality of life. It can be used along with standard treatments, and even with curative treatments. Palliative treatments might include opioids or radiation therapy to treat pain, or metal implants to strengthen bones weakened by cancer cells.

Treating Stage 4 SCLC

Most people with extensive-stage SCLC receive chemotherapy and immunotherapy treatments. These initial treatments often last three to four months and include a combination of multiple drugs. Once the initial treatments are done, people with SCLC usually continue to take an immunotherapy drug. Doctors may recommend radiation treatments to shrink tumors in the lungs or to prevent or treat SCLC cells spreading to the brain.

Outlook for Stage 4 Lung Cancer

People with stage 4 lung cancer often have a poor prognosis (outlook). Those with NSCLC who have distant metastases have a five-year relative survival rate of 7 percent. This means that people with this type of cancer are about 7 percent as likely to live for five years or more compared with people who don’t have cancer. The five-year relative survival rate for advanced SCLC is 3 percent.

These lung cancer survival rates are based on studies from people who were diagnosed between 2010 and 2016. Lung cancer treatments are continually improving. People who are diagnosed today may have a better prognosis than those who were diagnosed several years ago.

Other factors also affect your individual prognosis. People with large cell carcinoma or small cell lung cancer may have a worse outlook than those with other subtypes of NSCLC. In addition, people who lose weight due to lung cancer may have a shorter life expectancy. If you want to learn more about what to expect from advanced lung cancer, talk to your health care team. Your doctor can help you understand your individual risk factors and outlook.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

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