Stage 4 Lung Cancer

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.

Symptoms of stage 4 lung cancer include chest pain, coughing, hoarseness, weight loss and fatigue. Lung cancer has two main types: Small cell and non-small cell. Tobacco smoke, asbestos and radon exposure cause both types.

Patients with these risk factors should talk to their doctor about annual screenings. Early detection improves prognosis and treatment options.

How to Cope With Stage 4 Lung Cancer

Advanced lung cancer can be hard to deal with, especially when symptoms are severe. Pain from fluid or pressure can limit activity and lower quality of life. However, talking to your doctor about pain management and symptom tracking can help. This approach allows you to engage more in daily activities and hobbies. Moreover, simple changes like more sleep and light exercise can also enhance your quality of life.

A stage 4 lung cancer diagnosis can lead to intense emotions like depression and hopelessness. The following resources may help:

• Counseling
• Group therapy
• Antidepressant medications
• Expert caregivers

Expert caregivers and counselors may help 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 affects its growth, treatment response and metastasis.

Non-Small Cell Lung Cancer (NSCLC)

Non-small cell lung cancer includes adenocarcinomas, squamous cell and large cell carcinomas. It represents 80% to 85% of lung cancer cases. Stage 4 is classified as 4a or 4b. In this stage, cancer spreads to both lungs or distant organs.

Non-small cell lung cancer fares better than small cell lung cancer. Its survival rates are higher. For stage 4 NSCLC, options include combination chemotherapy, immunotherapy, and palliative radiation. Surgery is possible, but it’s less effective at 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 reacts better to chemotherapy and radiation than non-small cell lung cancer. Yet it spreads faster and is more likely to recur. Treatments like immunotherapy and prophylactic cranial irradiation can slow tumor growth.

Asbestos-Related Lung Cancer

Stage 4 lung cancer from asbestos exposure is similar to lung cancer from smoking or radon. It refers specifically to a type of lung cancer caused by asbestos.

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.

If stage 4 lung cancer has spread to the abdomen, it may cause 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?

Stage 4 lung cancer is diagnosed like most other cancers. Doctors will perform a number of tests to determine a stage 4 lung cancer diagnosis.

Steps to a Stage 4 Lung Cancer Diagnosis

1. Perform a physical exam.
2. Run blood tests.
3. Perform imaging scans.
4. Do biopsies to check the cell type and stage.

Your doctor will inform you of the necessary tests, so you can understand the results and potential next steps.

Physical Exam and Medical History 

A physical exam uses noninvasive tools, like a stethoscope, to check for disease. Doctors consider factors such as smoking, radon and asbestos exposure. They also look at your illness history, family cancer cases and other risks. This helps them understand your health and cancer risk. After a lung cancer diagnosis, doctors may test your lung function. This shows your breathing capacity and lung health.

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.

Imaging Scans 

If you have coughing or wheezing, your doctor will likely first order an X-ray to check for chest disease. For tumors, doctors also use CT, MRI, and PET scans to assess size, position and shape in the lungs and elsewhere.

Biopsies

A thoracoscopy uses a small camera to find and remove small cancers in the chest. For a more complex biopsy, doctors turn to video-assisted thoracic surgery (VATS). After this, pathologists check the samples to identify cells and suggest 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 can cause mesothelioma cancer. Lung cancer and mesothelioma differ mainly in location. Lung cancer develops in the lungs. In contrast, pleural mesothelioma occurs on the lining outside the lungs.ngs.

Stage 4 Lung Cancer Staging

Doctors can classify tumors using the SEER method as localized, regional or distant. Stage 4 lung cancer falls under “distant.” However, doctors can further divide it into 4a and 4b stages using the Tumor Node Metastasis 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.

Lung cancer tumors can double in size in 4 to 5 months. The time to progress from stage 1 to stage 4 lung cancer takes several years and depends on many factors, including:

Non-small cell lung cancer spreads to the brain in about 47% of patients. It also commonly spreads to the bones (36%), liver (22%), adrenal glands (15%), thoracic cavity (11%) and distant lymph nodes (10%). A cancer specialist then designs a treatment plan. This plan often combines surgery and radiation to slow or reverse tumor growth.

How Long Can You Live with Stage 4 Lung Cancer?

Stage 4 lung cancer patients typically survive 6.3 to 11.4 months. This varies by cell type and treatment response. Some patients live longer with effective treatment. Notably, lung cancer is the most common and deadliest cancer in the U.S. among men and women.

Stage 4 Lung Cancer 5-Year Survival Rates by Type

• Non-Small Cell Lung Cancer: Approximately 7% of stage 4 non-small cell lung cancer patients survive 5 years from the time of their diagnosis. This is 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.

Survival rates are only estimates, and each person has a unique response to treatments. Clinical trials are continuously improving stage 4 lung cancer survival rates.

Survival rate data takes years to compile because of long monitoring of patients. Typically, current rates show the last five years. Yet, new treatments and trials could boost life expectancy.

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 ease symptoms, boost quality of life and extend survival. Palliative options include chemotherapy, radiation and surgery. These can slow tumor growth and remove masses causing symptoms.

Patients should discuss their symptoms and quality of life goals with their doctor. They can adjust the treatment to help them cope with cancer.

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.

Palliative care for stage 4 lung cancer is not the same as hospice care. It focuses on improving symptoms and quality of life. Doctors will discuss the side effects and benefits of the treatments with you.

Treatments for Stage 4 NSCLC

• 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.

Small cell lung cancer grows swiftly. Thus, treatments aim to slow its growth or stop its spread. Chemotherapy and immunotherapy, which target the whole body, are better than radiation, which is a targeted treatment.

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.
• 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.

Stage 4 lung cancer makes surgery and treatments less effective. This is due to large tumors and their proximity to vital organs like the heart and brain. Yet cancer centers in the U.S. offer clinical trials with new treatments, 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.

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