Stage 4 Lung Cancer
Stage 4 is the final stage of lung cancer. In this stage, lung cancer tumors have spread into both lungs or other body parts like the bones or brain. While stage 4 lung cancer is the hardest stage to treat, it’s still possible to become a long-term survivor.
What Is Stage 4 Lung Cancer?
In cases of stage 4 lung cancer, tumors have spread through the body and reached places far beyond the lungs.
- Adrenal glands
- Bones
- Both lungs (lung cancer typically starts in one lung only)
- Brain
- Liver
Stage 4 lung cancer may also be called advanced stage lung cancer or metastatic lung cancer. “Metastatic” means the cancer has spread very far from where it started.
Lung cancer can spread into stage 4 if cancer cells travel to other body parts through a patient’s blood or lymph node system, according to the Cancer Treatment Centers of America (CTCA). This spread is known as metastasis. Once lung cancer cells have reached a different part of the body, they can start to form new tumors.
Because stage 4 lung cancer tumors are in many parts of the body, lifesaving treatment options are limited. But there is some good news: Some stage 4 lung cancer patients have been able to live for years or even decades with treatment.
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Types of Stage 4 Lung Cancer
There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
NSCLC accounts for over 80% of all lung cancer cases and has 5 stages (stages 0-4). Many NSCLC patients will be diagnosed in either stage 3 or stage 4.
SCLC is much less common and is classified into either a limited or extensive stage. With extensive stage SCLC, the cancer has spread throughout and beyond the lung. In most cases, this stage is equal to stage 4 NSCLC.
Stage 4 Non-Small Cell Lung Cancer
Patients are diagnosed with stage 4 non-small cell lung cancer if doctors find one or more lung cancer tumors outside of the lung. The American Cancer Society (ACS) notes that the size of the tumors doesn’t affect the staging.
Stage 4 NSCLC has two substages:
- Stage 4A: One lung cancer tumor is found outside of the lungs.
- Stage 4B: More than one lung cancer tumor is found beyond the lungs.
NSCLC can spread to any part of the body if the cancer cells get into the bloodstream or lymph system.
Stage 4 NSCLC tumors are often found in the brain, bones, liver, pleura (lung lining), or pericardium (heart lining). The tumors may also invade the heart, blood vessels, or major lung airways.
It’s more common to be diagnosed in stage 4B than stage 4A, according to the CTCA.
Stage 4 Small Cell Lung Cancer
As noted above, there’s technically not a fourth stage of small cell lung cancer. That said, extensive stage SCLC is similar to stage 4 NSCLC as the cancer has metastasized.
In extensive stage SCLC, the cancer may have spread to lymph nodes, bones or bone marrow, the brain, the pleura, or both lungs, as noted by the American Society of Clinical Oncology (ASCO).
Further, doctors may determine a patient has extensive stage SCLC if they find more than one tumor in a lung.
Stage 4 Lung Cancer Symptoms
While there are typically little to no symptoms in the early stages of lung cancer, patients often experience uncomfortable symptoms in stage 4.
- Appetite loss
- Bone pain
- Chest pain
- A cough that won’t go away
- Coughing up blood
- Droopy eyelids
- Fatigue
- Muscle weakness
- Shortness of breath
- Swelling in lymph nodes
- Weight loss
Further, there are several symptoms that occur because the cancer has spread to other body parts.
For example, stage 4 lung cancer patients may suffer from headaches, dizziness, or numb limbs due to brain metastasis. They may also develop jaundice (yellowing of the skin or eyes) if the tumors reach the liver and prevent it from functioning normally.
Fluid may also build up in the lining of the lungs or heart in cases of stage 4 lung cancer. These are known as pleural effusions and pericardial effusions, respectively. Both can cause chest pain and breathing problems.
If you or a loved one is having any of the symptoms listed above and lung cancer is suspected, see a doctor as soon as possible. Stage 4 lung cancer is life-threatening, but prompt treatment can ease symptoms and possibly help you live longer.
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Diagnosing Stage 4 Lung Cancer
If a doctor thinks you may have stage 4 lung cancer (or cancer in another stage), they’ll take several steps to make a diagnosis.
First, your doctor will request an initial meeting where they can take note of your symptoms, any family history of cancer, and your overall health. All of these will help the doctor to narrow down the possible causes of your symptoms.
If your doctor thinks you may have cancer after this visit, they’ll likely order imaging tests. These tests will allow doctors to see inside the lungs for possibly cancerous tumors. Imaging tests can also be used to see if the cancer has reached other parts of the body.
Tests used to make a stage 4 lung cancer diagnosis include:
- CT scans: CT (computed tomography) scans take pictures of the inside of your body at different angles. These scans can help doctors see if there are tumors in your lungs and if the tumors have reached the lymph nodes or organs like the liver or brain.
- MRI scans: Magnetic resonance imaging (MRI) scans use magnetic waves to generate pictures of the body’s insides. This scan is especially effective for examining the brain and/or spinal cord for lung cancer tumors.
- PET scans: Doctors inject a tiny amount of radioactive sugar into the patient’s body. The sugar settles where the cancer cells are. Doctors then use a positron emission tomography (PET) scan to see where the cancer tumors are located within the body.
The last step in diagnosing stage 4 lung cancer is called a biopsy. This is an extraction of a tissue or fluid sample from an area that could be cancerous. Doctors will take out a small sample and look at the cells under a microscope to see if they are indeed lung cancer cells.
Doctors can then determine if you have lung cancer based on the results of the biopsy and if it’s in stage 4 by looking at the imaging scans to see where it has spread. Doctors may also order follow-up imaging scans in other areas if they only looked at your lungs.
Most lung cancer patients are diagnosed with stage 4 lung cancer due to the fact that many symptoms do not appear until the cancer has begun to spread throughout the body.
In fact, a 2021 study found that between 60% and 70% of NSCLC patients are diagnosed in the fourth stage. Additionally, the ACS found that roughly 66% of SCLC patients will be diagnosed in the extensive stage.
Stage 4 Lung Cancer Prognosis
Stage 4 lung cancer has the worst prognosis (health outlook) of all stages. The cancer has often spread beyond just the lungs in this stage, so doctors won’t have as many treatment options at their disposal.
That said, certain prognostic factors (such as the patient’s age, health, and where the cancer spread to) can all impact overall survival.
A stage 4 lung cancer prognosis is measured in survival rates (the number of people still alive after a set period of time) and life expectancy (how long the average patient lives for). Learn about each below.
Stage 4 Lung Cancer Survival Rate
Survival rates for cancer are typically measured in years. In general, long-term survival rates for stage 4 lung cancer are low.
The 5-year survival rate for patients with stage 4 NSCLC is 7%, according to ASCO. The 5-year survival rate drops to 3% for patients with extensive stage SCLC.
Anywhere from 25-30% of patients with stage 4 NSCLC pass away after just 3 months, according to a 2021 study from the medical journal Frontiers in Oncology.
Stage 4 Lung Cancer Life Expectancy
Those with stage 4 lung cancer often have a poor life expectancy. A 2020 report found that patients with stage 4 NSCLC live for just 4-9 months on average. Patients with extensive stage SCLC live for roughly 8-13 months.
That said, it’s possible for stage 4 lung cancer patients to live for years or decades if they get medical care. The aforementioned 2021 study from Frontiers in Oncology found that some stage IV patients could live for 10-15 years or longer with treatment.
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Stage 4 Lung Cancer Treatment
Once doctors have made a stage 4 lung cancer diagnosis, they’ll recommend a treatment plan that can help the patient live longer and with less pain.
Your cancer care team can help you determine which lung cancer treatment options will be best in your case.
Stage 4 Lung Cancer Surgery
Surgery is the best first-line treatment for many cases of lung cancer. However, major surgeries may or may not be used to treat stage 4 lung cancer.
“Surgery is usually not recommended if the tumor cannot be completely removed.”
— American Society of Clinical Oncology (ASCO)
Oncologists (cancer doctors) may sometimes use surgery in cases of advanced non-small cell lung cancer if other treatments like chemotherapy shrink larger tumors. It’s used more frequently in cases of stage 4A NSCLC, as there is only one additional tumor outside of the lungs, meaning doctors have a better shot at removing all visible cancer tumors.
Surgery is rarely used to treat extensive stage small cell lung cancer because of how widespread the tumors are.
Chemotherapy for Stage 4 Lung Cancer
Many cases of stage 4 lung cancer are treated with chemotherapy (cancer-destroying medication that’s usually given through an IV).
It’s the main treatment used in extensive stage SCLC, according to the ACS. Chemotherapy is also commonly used in cases of stage 4 NSCLC, where it can destroy tumors in the lung and other areas like the liver or bones.
A patient must be in fairly good overall health to undergo chemotherapy, as the side effects like fatigue, nausea, and hair loss can be taxing.
Immunotherapy for Stage 4 Lung Cancer
Lung cancer cells can sometimes avoid being destroyed by the immune system. Immunotherapy medications can right this wrong and help the body fight cancer.
Immunotherapy can be used to treat both stage 4 NSCLC and extensive SCLC. It is usually administered alongside chemotherapy medications.
Immunotherapy can cause side effects such as fatigue and bowel movement problems, which should be reported to caregivers and doctors if they occur.
Radiation Therapy for Lung Cancer Stage 4
Radiation therapy (beams of energy that shrink cancer tumors) is often used to boost the effects of other stage 4 lung cancer treatments.
For example, radiation may be used after surgery in cases of stage 4A NSCLC or alongside chemotherapy treatments in stage 4B NSCLC or extensive stage SCLC.
The ACS also notes that radiation therapy may be used as the main treatment for stage 4 lung cancer if the patient cannot safely tolerate chemotherapy.
Your health care team can help determine if radiation therapy is right for your case. Radiation therapy also causes side effects like fatigue and hair loss, but if these are less severe than the side effects of chemotherapy, it may be a better fit for you.
Targeted Therapy for Lung Cancer Stage 4
One of the most important stage 4 non-small cell lung cancer treatments is targeted therapy. Targeted therapies identify lung cancer cells based on gene mutations and destroy them.
In cases of stage 4B NSCLC, targeted therapies are often the first treatments used, according to the ACS. Doctors will test a patient’s tumor and see if a targeted therapy is usable.
There are several targeted therapies and each works in a slightly different way. For example, an EGFR inhibitor prevents lung cancer cells from dividing by blocking a protein found within the cells. In these cases, the lung cancer cells divide faster than regular cells since their EGFR genes have mutated.
Most targeted therapies are given in pill form and several can be used alongside other treatments like chemotherapy and radiation. That said, targeted therapy is only available for stage 4 NSCLC patients, so those with late-stage SCLC will need other treatments.
Clinical Trials for Lung Cancer Stage 4
Patients with stage 4 lung cancer may be able to access newer treatments that aren’t widely available through a clinical trial. These trials test out emerging treatments or new combinations of existing ones to see if they help patients.
Patients can find nearby clinical trials for lung cancer by visiting the National Cancer Institute website. Or, patients can ask their doctor if there are any local clinical trials for late-stage lung cancer that they can join.
There are many clinical trials that are testing treatments for various types and stages of lung cancer. As a result, not every clinical trial will accept stage 4 lung cancer patients based on what the trial is studying.
Stage 4 Lung Cancer Palliative Care Options
Because stage 4 lung cancer has spread throughout the body, it may not be possible to safely undergo life-extending treatments. However, patients can still receive palliative care to ease their symptoms and improve their quality of life.
Palliative treatments for stage 4 lung cancer include:
- Laser therapy (destroying tiny cancer tumors with lasers)
- Low doses of chemotherapy and radiation
- Photodynamic therapy (using light to kill cancer cells)
- Pleurodesis (sealing the lung lining to prevent fluid buildup)
- Scaled-down surgeries
- Stent placement (a stent can be inserted to help patients breathe better)
- Thoracentesis (draining fluid buildup in the lung lining with a needle)
Palliative therapies can be given alongside life-extending ones or they may be the only treatments used, according to the CTCA.
How to Beat Lung Cancer Stage 4
A stage 4 lung cancer diagnosis is often shocking and scary. Fighting cancer can be an incredibly stressful time for you and your family. The good news is that support is available to help you live as long as possible with stage 4 lung cancer.
Lung cancer is one of the most common cancers, and there are well-qualified doctors across the country that can provide treatment to help you. With the right medical team behind you, it may even be possible to beat stage 4 lung cancer.
You might worry about how you’ll pay for the medical care needed to fight stage 4 lung cancer. Thankfully, you may be eligible for financial aid to help pay for stage 4 lung cancer treatments. Learn if you qualify right now with a free case review.
Stage 4 Lung Cancer FAQs
How long can you live with stage 4 lung cancer?
Your life expectancy after being diagnosed with stage 4 lung cancer depends on many factors, including your overall health and how your body responds to treatments.
The average life expectancy for stage 4 lung cancer patients ranges from 4-13 months, according to recent data. That said, some people may go on to live for years or even decades longer than expected.
Doctors can recommend treatments to help you live as long as possible with stage 4 lung cancer.
Is stage 4 lung cancer always terminal?
No. Though stage 4 lung cancer is very serious, it’s possible to become a survivor. For example, ASCO recently profiled a woman with stage 4 lung cancer who is still alive as of 2022 — six years after being diagnosed.
The Cleveland Clinic also reported on a woman who was diagnosed with stage 4 lung cancer in 2010. Over the years, the cancer spread to her brain, abdomen, both lungs, and her bowels — but she has survived thanks to various treatments like chemotherapy and radiation.
Is stage 4 lung cancer very serious?
Yes. If your doctor says you have stage 4 lung cancer, you’ll need to get medical treatment in order to live as long as possible.
Stage 4 lung cancer means the cancer has spread to different parts of your body, making it harder to treat. It can quickly be fatal if you don’t get it treated.
Is stage 4 lung cancer the same as stage 4 mesothelioma?
No. Mesothelioma is a very rare cancer (with only about 3,000 new cases per year) that affects the linings of major body organs. Mesothelioma is sometimes mistaken for lung cancer since it often develops in the lung lining.
That said, stage 4 mesothelioma is not the same illness as stage 4 lung cancer. Doctors must take a different approach when treating stage 4 mesothelioma than would be used if the patient had stage 4 lung cancer.
Since both mesothelioma and lung cancer can be caused by asbestos exposure — and since the cancers have similar symptoms — it’s important to talk to your doctor and get correctly diagnosed before starting treatments.
