Written By: Sean Marchese, MS, RN,
Last modified: November 29, 2021

What Is Stage 4 Lung Cancer?

Stage 4 lung cancer is the final phase of cancer in the lungs. Doctors use stages to measure how far cancer has progressed. At this stage, tumors have metastasized, spreading through lymph nodes in the chest and into distant organs and tissues in the body.

In stage 4 lung cancer, surgery and other treatments may be less beneficial due to the size of malignant tumors and the proximity of cancerous tissue to sensitive organs such as the heart and brain.The two primary types of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Asbestos exposure causes both types of lung cancer, and it also leads to mesothelioma cancer. The main difference between lung cancer and mesothelioma is location. Lung cancer forms within the lungs where oxygen exchange occurs, and mesothelioma develops on the lining outside the lungs.

Stage 4 asbestos-related lung cancer does not physiologically differ from lung cancer caused by smoking, radon or genetic mutations. Patients with these risk factors should discuss annual screenings with their doctor because early detection improves prognosis and treatment options.

A lung cancer diagnosis is not necessarily a death sentence. There are several lung cancer types and stages, and modern research has led to many successful treatments. Patients are living longer than before thanks to more available support and resources for stage 4 lung cancer.

How to Cope with Stage 4 Lung Cancer

Advanced or metastatic lung cancer can feel devastating, especially if symptoms are uncontrollable. Pain caused by fluid buildup or pressure can reduce activity and impact quality of life. Speaking with your doctor about pain management and symptom tracking can improve your ability to perform more of your daily tasks and hobbies.

Along with pain, a stage 4 lung cancer diagnosis can lead to overwhelming feelings of depression and hopelessness. Many support resources, such as counseling, group therapy or antidepressant medications, can help overcome these emotions. Expert caregivers and counselors have experience helping stage 4 patients feel empowered and hopeful.

Types of Stage 4 Lung Cancer

Whether the type of stage 4 lung cancer is caused by asbestos, smoking or random mutation, the origin of lung cancer does not impact its treatment course or progression. Instead, cell type and location dictate how fast lung cancer will grow, its response to treatment and the likely areas of metastasis. 

Asbestos-Related Lung Cancer

Description: When inhaled, airborne asbestos fibers become trapped in the lungs. Over decades, this irritation causes inflammation and cell damage that leads to lung cancer.

Stage 4 Classification: Asbestos-related lung cancer does not have a separate classification. It develops as one of the main types of lung cancer: small cell or non-small cell.

Stage 4 Characteristics: Lung cancer caused by asbestos is physiologically identical to NSCLC or SCLC, depending on cell type. It can take many years to develop and mimic less severe illnesses. 

Treatment: Asbestos-related lung cancer treatment depends on the patient’s diagnosis, stage, cell type and overall health. In stage 4, treatment is typically palliative to control symptoms.

Non-Small Cell Lung Cancer

Description: Non-small cell lung cancer is a category that includes adenocarcinomas, squamous cell and large cell carcinomas, making up 80% to 85% of all lung cancers.

Stage 4 Classification: TNM staging measures tumor size, lymph node involvement and metastasis. Stage 4 can be either 4a or 4b, and cancer involves both lungs or distant organs.

Stage 4 Characteristics: NSCLC has a better prognosis than SCLC, and survival rates are more favorable. NSCLC arises from lung epithelial cells in the central bronchi to terminal alveoli.

Treatment: Stage 4 NSCLC treatment options include combination chemotherapy, immunotherapy and palliative radiation. Surgery is possible, but less effective in this stage.

Small Cell Lung Cancer

Description: Roughly 15% of lung cancers involve small cells, which grow aggressively with a high chance of recurrence. Median survival with extensive SCLC is 6 to 12 months with therapy. 

Stage 4 Classification: SCLC is extensive or distant-stage after metastasis (spreading), including malignant pleural effusions. Over 65% of SCLC patients have an extensive disease at diagnosis. 

Stage 4 Characteristics: SCLC is more responsive to chemotherapy and radiation therapy than non-small cell lung cancer. However, SCLC spreads faster and has a higher chance of recurrence. 

Treatment: Extensive-stage SCLC treatment options include combination chemotherapy, radiotherapy, immunotherapy and prophylactic cranial irradiation to slow tumor growth.

Stage 4 Lung Cancer Symptoms

Asbestos cancer develops slowly over many years. Once malignant tumors have formed in the lungs, symptoms such as cough, shortness of breath and chest pain become more noticeable.

Lung cancer symptoms depend on location and stage rather than the cancer cause or cell type. In stage 4 lung cancer, symptoms are often severe and involve areas outside the chest, such as the brain or kidneys.

Common Symptoms of Stage 4 Lung Cancer
  • Chest pain that worsens with deep breaths
  • Coughing up blood (hemoptysis)
  • Persistent or worsening cough
  • Hoarseness or changes in voice
  • Decreased appetite or weight loss
  • Weakness and fatigue
  • Night sweats or fevers
  • Recurring pneumonia or bronchitis
  • Joint or bone pain
  • Headaches, dizziness or confusion
  • Referred neck pain or back pain

If stage 4 lung cancer has spread into the abdomen, patients may also experience jaundice (yellowing of the eyes and skin), bloating, nausea or digestive issues. Many stage 4 lung cancer symptoms mimic less severe conditions. Some patients do not experience any symptoms until stage 4.

Lung cancer tumors can double in size in four to five months. The time to progress from stage 1 to stage 4 lung cancer takes several years and depends on many factors, including:

  • Genetic mutations
  • Smoking status
  • Gender
  • Ethnicity
  • Cancer type and stage

Every patient is different when it comes to cancer progression and diagnosis. Speaking with a specialist about potential risk factors is the best way to determine when to start lung cancer screenings.

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How Is Stage 4 Lung Cancer Diagnosed?

When a patient expresses lung cancer risk factors, such as asbestos exposure, smoking or genetic history, their doctor may schedule regular screenings to identify cancer early. However, most patients discover they have lung cancer after experiencing issues such as difficulty breathing.

When a doctor suspects lung cancer, they will perform a panel of blood tests, imaging scans and biopsies to determine cell type and stage. Doctors may use the SEER method to describe tumors as localized, regionalized or distant. Stage 4 lung cancer is considered “distant” in SEER, but doctors can further differentiate into 4a and 4b using the TNM system.

The TNM system measures tumor, lymph node and metastasis progression. Tumors can be any size in stage 4, and lymph nodes may or may not be involved, but metastasis must have occurred.

Stage 4a

Cancer has spread outside the origin site in the lung into the pleural fluid surrounding the lungs, the pericardial fluid around the heart or as a solid tumor to a distant lymph node or organ, such as the brain, bones or liver.

Stage 4b

Malignant tumors can be any size and may or may not involve structures or lymph nodes near the lung of origin. Multiple tumors have spread outside the chest to distant lymph nodes or other organs.

Finalizing a diagnosis requires multiple tests and physical exams. Standard lung cancer diagnostic tests include the following:

Physical Exam

A physical exam checks for signs of disease using noninvasive tools such as a stethoscope or percussion hammer.

Medical History

Asbestos exposure, history of illness, familial cancers and other risk factors help doctors get a complete picture of overall health history and risk of cancer.

Lung Function Tests

After a lung cancer diagnosis, a doctor may perform a lung or pulmonary function test to determine your breathing capacity and how well your lungs are working.

Blood Tests

An arterial blood gas test measures how much oxygen and carbon dioxide are in circulation. A complete blood count and blood chemistry identify infections and organ damage.

Chest X-ray

If you present with respiratory symptoms, such as coughing or wheezing, your doctor will typically order an X-ray first to identify potential areas of disease in the chest.

Computed Tomography (CT)

A CT scan uses X-ray technology to combine many pictures into a visual slice that shows a tumor’s size, position and shape in the lung and other areas.

Magnetic Resonance Imaging (MRI):

MRI scans use radio waves and powerful magnets to create detailed images that reveal cancer in soft tissues such as the brain or spinal cord.

Positron Emission Tomography (PET)

This test uses a mildly radioactive tracer to pinpoint cancer cells with high metabolic activity and provides clarity when combined with a CT scan.

Thoracoscopy

A thoracoscopy uses a small camera inserted into the chest to identify and remove small areas of cancer. A more involved procedure is known as video-assisted thoracic surgery (VATS).

Biopsy

A thoracoscopy can collect tissue samples for a biopsy. Pathologists examine these samples under a microscope to determine cell type and narrow down the best treatments.

Non-small cell lung cancer metastasizes to the brain in about 47% of patients. Typical stage 4 metastasis sites also include bone (36%), liver (22%), adrenal glands (15%), thoracic cavity (11%) and distant lymph nodes (10%). The most frequent small cell lung cancer metastasis sites are the brain, liver, bones and distant lymph nodes.

Through proper testing and staging, doctors will know the most likely sites of metastasis for a patient. A cancer specialist plans a course of multimodality treatment to slow and reverse tumor growth using a combination of therapies such as surgery and radiation.

Stage 4 Lung Cancer Survival Rates

One of the most staggering lung cancer statistics is that it’s the most common cancer in the U.S. and the deadliest cancer among men and women. After a late-stage lung cancer diagnosis, many patients search for information on current survival rates. One thing to keep in mind is that survival rates are only estimates, and everyone responds to cancer and treatment in different ways. Clinical trials are continuously improving stage 4 lung cancer survival rates.

Survival rate data has a lag time of several years as researchers monitor patients over long periods. “Current” survival rates typically reflect statistics over the last five years. Emerging treatments and clinical trials may offer improved life expectancies.

Non-Small Cell Lung Cancer 5-Year Survival Rate

Approximately 7% of stage 4 non-small cell lung cancer patients survive five years from the time of their diagnosis, according to the National Cancer Institute’s SEER database.

Small Cell Lung Cancer 5-Year Survival Rate

Approximately 3% of distant-stage small cell lung cancer patients survive five years from the time of their diagnosis.

Lung Cancer Survival Time

The average survival time following a stage 4 lung cancer diagnosis ranges from 6.3 months to 11.4 months, depending on cell type and treatment response.

Many factors can influence stage 4 lung cancer survival rates, including age, gender, ethnicity, smoking status and overall health. A 2016 analysis of NSCLC progression in the SEER database indicated that lung cancer develops more rapidly in Caucasians than in African Americans or Asian Americans. Women also tend to survive longer with stage 4 lung cancer than men.

The 5-year survival rate varies primarily by tumor cell type. End-stage asbestos-related lung cancer does not differ from other types of lung cancer. Someone who developed asbestos lung cancer in New York after 9/11 would generally have the same lung cancer as a smoker.

Is Stage 4 Lung Cancer Curable?

Stage 4 non-small cell and distant small cell lung cancer are terminal and without a cure. Treatments aim to reduce symptoms, improve quality of life and prolong survival. Palliative options, such as traditional chemotherapy, radiation and surgery, slow tumor growth or remove masses that cause symptoms.

The best treatments for stage 4 lung cancer depend on how well a patient can tolerate aggressive options, such as surgery, and potential side effects or complications. Patients should discuss symptoms and quality of life goals with their physician, who can reduce dosages or treatment frequency to help them cope with cancer treatment.

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Treatment for Late-Stage Lung Cancer

There are numerous lung cancer treatments for patients with an end-stage diagnosis. Many more are available through experimental clinical trials offered at cancer centers throughout the United States.

Some treatments for stage 4 non-small cell lung cancer, such as chemotherapy, also apply to distant small cell lung cancer. However, because small cell lung cancer progresses more rapidly, treatments tend to focus on slowing growth or pretreating likely sites of metastasis.

Treatments for Stage 4 NSCLC
Surgery

A thoracotomy provides surgical access to the lungs, and a lobectomy surgery removes the cancerous lung lobe or region.

Chemotherapy

Cisplatin with pemetrexed (Alimta) is one of the most common chemotherapy combinations for stage 4 NSCLC.

Radiation Therapy

Stereotactic body radiotherapy (SBRT) can slow tumor growth and reduce stage 4 lung cancer symptoms.

Targeted Therapy

Antiangiogenic drugs, which prevent tumor blood vessel growth, and gene therapy for NSCLC are targeted therapies.

Immunotherapy

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are popular immunotherapies that utilize immune cells.

Treatments for Extensive-Stage SCLC
Chemotherapy

Carboplatin and irinotecan can extend life expectancy for patients with extensive-stage or recurrent SCLC.

Immunotherapy

Atezolizumab (Tecentriq) and durvalumab (Imfinzi) are effective immunotherapies for small cell lung cancer.

Radiotherapy

Prophylactic cranial irradiation (PCI) for extensive-stage SCLC can reduce metastasis and extend overall survival.

Because small cell lung cancer spreads rapidly, systemic options such as chemotherapy and immunotherapy are more effective than targeted treatments such as radiation. However, PCI is a targeted therapy for SCLC that can prevent or slow brain metastasis. Across both types of lung cancer, priorities include slowing cancer growth, relieving symptoms and prolonging life.

Palliative care options are appropriate for both late-stage non-small cell lung cancer and small cell lung cancer. Palliative treatments, not to be confused with hospice, are modified forms of traditional options such as chemotherapy. When discussing palliative care, your doctor will help you weigh treatment side effects alongside their potential benefits.

Life Expectancy Without Treatment

Depending on a patient’s needs, they may choose to forego treatment and avoid any potential side effects or reduced quality of life. Lung cancer prognosis is generally poor for patients with a late-stage diagnosis who go without treatment.

The average survival time from diagnosis is about seven months for NSCLC patients without treatment and roughly two to four months for SCLC patients. With early detection and aggressive treatment, stage 4 lung cancer patients can live for several years. Additionally, researchers are actively working to reduce side effects and improve stage 4 lung cancer life expectancy.


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