Stage 4 Lung Cancer
Stage 4 lung cancer involves cancer in both lungs or metastasis to distant organs that can cause severe symptoms. Palliative care can slow tumor growth and improve symptoms. Most patients with stage 4a or 4b live less than one year with treatment.
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Whitmer, M. (2023, April 3). Stage 4 Lung Cancer. Asbestos.com. Retrieved May 31, 2023, from https://www.asbestos.com/cancer/lung-cancer/stage-4/
Whitmer, Michelle. "Stage 4 Lung Cancer." Asbestos.com, 3 Apr 2023, https://www.asbestos.com/cancer/lung-cancer/stage-4/.
Whitmer, Michelle. "Stage 4 Lung Cancer." Asbestos.com. Last modified April 3, 2023. https://www.asbestos.com/cancer/lung-cancer/stage-4/.
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.
Common symptoms of stage 4 lung cancer include chest pain that worsens with deep breaths, coughing, hoarseness, weight loss and fatigue. The two primary types of lung cancer are small cell lung cancer and non-small cell lung cancer. Both types of lung cancer have the same causes, including exposure to tobacco smoke, asbestos and radon.
Patients with these risk factors should discuss annual screenings with their doctor because early detection improves prognosis and treatment options.
How to Cope With Stage 4 Lung Cancer
Advanced or metastatic lung cancer can be 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. Certain lifestyle changes, such as getting more sleep and gentle exercise, may improve your quality of life.
Along with pain, a stage 4 lung cancer diagnosis may cause patients to feel a rush of emotions or overwhelming feelings of depression and hopelessness. Many support resources, such as counseling, group therapy or antidepressant medications, can help manage these emotions. Expert caregivers and counselors have experience helping stage 4 patients feel empowered and hopeful. They can also help guide families through health care decisions.
Types of Stage 4 Lung Cancer
The different types of lung cancer are classified by cell type. All types of lung cancer may arise from any cause. There’s no specific type of lung cancer that is associated with a certain cause.
Lung cancer cell type dictates how fast lung cancer will grow, its response to treatment and the likely areas of metastasis.
Non-Small Cell Lung Cancer (NSCLC)
Non-small cell lung cancer is a category that includes adenocarcinomas, squamous cell and large cell carcinomas. Non-small cell cases make up the majority of lung cancer diagnoses, accounting for 80% to 85% of all lung cancers. Stage 4 can be either 4a or 4b, and cancer involves both lungs or distant organs.
Non-small cell lung cancer has a better prognosis than small cell, and survival rates are more favorable. 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 (SCLC)
Roughly 15% of lung cancers involve small cells. They are more aggressive and carry a high chance of recurrence. Median survival with stage 4 SCLC is six to 12 months with treatment. Stage 4 SCLC has metastasized (spread) to both lungs or distant organs. It may include malignant pleural effusions. Over 65% of SCLC patients have late-stage disease at diagnosis.
Stage 4 small cell lung cancer is more responsive to chemotherapy and radiation therapy than non-small cell lung cancer. However, it spreads faster and has a higher chance of recurrence. Other treatment options include immunotherapy and prophylactic cranial irradiation to slow tumor growth.
Asbestos-Related Lung Cancer
Stage 4 lung cancer caused by asbestos exposure does not physiologically differ from lung cancer caused by smoking or radon. It is not a type of lung cancer, but rather refers to lung cancer caused by asbestos exposure.
Asbestos-caused lung cancer develops as one of the main types of lung cancer: small cell or non-small cell. Treatment depends on the patient’s stage, cell type and overall health.
Stage 4 Lung Cancer Symptoms
Lung cancer symptoms depend on location and stage rather than the cancer cause or cell type. Common stage 4 symptoms include cough, shortness of breath and chest pain.
Symptoms in the final stage are often severe and involve areas outside the chest. Patients may feel intense fatigue, muscle weakness and pain that greatly affects their quality of life. Many stage 4 lung cancer symptoms mimic less severe conditions. Some patients do not experience any symptoms until stage 4.
- Chest pain that worsens with deep breaths
- Coughing up blood (hemoptysis)
- Decreased appetite or weight loss
- Headaches, dizziness or confusion
- Hoarseness or changes in voice
- Joint or bone pain
- Night sweats or fevers
- Persistent or worsening cough
- Recurring pneumonia or bronchitis
- Referred neck pain or back pain
- Weakness and fatigue
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.
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.
How Is Stage 4 Lung Cancer Diagnosed?
When a doctor suspects lung cancer, they will perform a physical exam, blood tests, imaging scans and biopsies to determine cell type and stage.
Physical Exam and Medical History
A physical exam checks for signs of disease using noninvasive tools such as a stethoscope or percussion hammer. Smoking, radon and 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. 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.
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.
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. Doctors also use CT, MRI and PET scans to see a tumor’s size, position and shape in the lung and other areas.
A thoracoscopy uses a small camera inserted into the chest to identify and remove small areas of cancer. A more involved biopsy procedure is known as video-assisted thoracic surgery, or VATS. Pathologists examine these samples under a microscope to determine cell type and narrow down the best treatments.
All types of asbestos cancer develop slowly over several decades. Many patients forget to mention their past exposure, which can delay the diagnostic process.
Asbestos exposure also causes mesothelioma cancer. The main difference between lung cancer and mesothelioma is location. Lung cancer forms within the lungs where oxygen exchange occurs, and pleural mesothelioma develops on the lining outside the lungs.
Stage 4 Lung Cancer Staging
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 Tumor Node Metastasis staging system.
TNM measures tumor size, lymph node involvement and metastasis. 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 original 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.
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:
- Cancer type and stage
- Genetic mutations
- Smoking status
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%). A cancer specialist plans a course of multimodal treatment to slow and reverse tumor growth using a combination of therapies such as surgery and radiation.
How Long Can You Live with Stage 4 Lung Cancer?
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. Some patients respond well to treatment and outlive these average survival times. One of the most concerning lung cancer statistics is that it’s the most common cancer in the U.S. and the deadliest cancer among men and women
- Non-Small Cell Lung Cancer: 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: Approximately 3% of distant-stage small cell lung cancer patients survive five years from the time of their diagnosis.
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 because 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.
Factors That Affect Your Survival Rate
Factors that influence stage 4 lung cancer survival rates include age, gender, ethnicity, smoking status and overall health.
A 2016 analysis of non-small cell lung cancer 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.
Is Stage 4 Lung Cancer Curable?
Stage 4 lung cancer is terminal and has no cure. However, a lung cancer diagnosis is not necessarily a death sentence. Some patients are living longer than ever before thanks to immunotherapy, chemotherapy and other palliative treatments.
Treatments aim to reduce symptoms, improve quality of life and prolong survival. Palliative options, such as chemotherapy, radiation and surgery, can slow tumor growth and remove masses that cause symptoms.
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.
Treatment for Late-Stage Lung Cancer
Stage 4 lung cancer treatments aim to control cancer growth, reduce symptoms and prolong life. Treatment options depend on the cell type, but each type may be treated with immunotherapy, chemotherapy and radiation.
A palliative approach to treatment, not to be confused with hospice, are traditional treatment options that improve symptoms and quality of life. When discussing palliative care for stage 4 lung cancer, your doctor will help you weigh treatment side effects alongside their potential benefits.
- Chemotherapy: Cisplatin with pemetrexed (Alimta) is one of the most common chemotherapy combinations for stage 4 NSCLC.
- Immunotherapy: Nivolumab (Opdivo) and pembrolizumab (Keytruda) are popular immunotherapies for lung cancer.
- Radiation Therapy: Stereotactic body radiotherapy, or SBRT, can slow tumor growth and reduce stage 4 lung cancer symptoms.
- Surgery: A thoracotomy provides surgical access to the lungs, and a lobectomy surgery removes the cancerous lung lobe or region.
- Targeted Therapy: Gene therapy and antiangiogenic drugs, which prevent tumor blood vessel growth, are targeted therapies.
Because small cell lung cancer progresses rapidly, treatments tend to focus on slowing growth or pretreating likely sites of metastasis. Systemic options, such as chemotherapy and immunotherapy, are more effective than targeted treatments such as radiation.
- 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.
- Radiation Therapy: Prophylactic cranial irradiation for extensive-stage SCLC can reduce metastasis and extend overall survival. PCI is a targeted therapy for SCLC that can prevent or slow brain metastasis.
In stage 4 lung cancer, surgery and other treatments may be less beneficial because of the size of tumors and the proximity of cancerous tissue to sensitive organs such as the heart and brain. Experimental clinical trials at cancer centers throughout the United States offer innovative therapies, including immunotherapy.
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 non-small cell lung cancer patients without treatment and roughly two to four months for small cell patients. Life expectancy for lung cancer caused by asbestos exposure is the same as cases caused by smoking or radon.
With early detection and aggressive treatment, stage 4 lung cancer patients may live for several years. Researchers are working to reduce side effects and improve stage 4 lung cancer life expectancy.