Your outlook in stage 4 lung cancer depends on the type of cancer and how far it has spread. Doctors use chemotherapy, immunotherapy and other therapies to block tumor growth and relieve symptoms.
These treatment options may extend life expectancy. However, some patients choose to avoid treatment because of poor health or side effects.
Treatment Options
Stage 4 lung cancer is when the cancer has spread to other parts of the body. It is difficult to cure at this stage, but treatment can help ease symptoms and slow the cancer’s growth. Treatment is usually a combination of chemotherapy and/or immunotherapy with or without radiotherapy.
Doctors may use a CT scan or PET (positron emission tomography) scan to find the location of the tumours and check how large they are. They may also take a biopsy of the tumours to see what type they are. The cancer cells can be tested to see if they respond to certain medicines or if they have specific genetic mutations.
If the cancer has spread to the adrenal gland, brain or liver, surgery might be used. This is only recommended if there are just one or a few areas of cancer found close together, and it depends on your general health.
Some people with stage 4 cancer may be offered chemotherapy with or without radiation to the chest (palliative radiotherapy). This might be given before surgery or after other treatments. It might be given before a biopsy of the brain to try to kill any cancer cells that have already spread to the brain. It might also be given before surgery to reduce the chance of the cancer spreading to the brain (prophylactic cranial radiotherapy).
Chemotherapy may cause side effects, such as fatigue and nausea. Your doctor might give you a medicine to make you feel better during treatment. It is important to tell your care team if you have these symptoms.
Immunotherapy uses your own immune system to fight the cancer cells. Your cancer cells might have changes in a gene called BRAF, which sends signals for cell growth. If the cancer has changes in this gene, you might be treated with a drug called vemurafenib (Tafinlar).
Some types of immunotherapy are used with or instead of surgery for lung cancer at stage 4. These include medicines called checkpoint inhibitors. These include pembrolizumab and atezolizumab. These are used to treat people whose cancer has the PD-L1 protein. This is a cancer cell surface marker that helps the body recognize and attack cancer cells.
Symptoms
In stage 4, cancer cells have spread beyond the lung where it first formed. It may have spread to lymph nodes in the chest, other parts of the lungs, the area around the lungs and distant organs, including the brain, liver and bones. This stage of cancer is sometimes called metastatic cancer or advanced lung cancer.
During this stage, treatment is designed to control symptoms and help people live longer. Symptoms vary depending on where the cancer has spread and the type of lung cancer. It’s important to tell your doctor if you have any new or unusual symptoms so they can evaluate them and make sure they are not caused by another health condition.
Lung cancer that has spread to the lungs can cause a buildup of fluid that makes it hard to breathe, causing shortness of breath (dyspnea). It also can cause pain and coughing up blood, which is called hemoptysis. In some cases, cancer that has spread to other parts of the body can cause symptoms such as bloating, weight loss or jaundice, which causes yellowing of the skin and eyes.
Even though this is the most advanced stage of lung cancer, there are still treatments that can help prolong life and improve quality of life. Some people with stage 4 lung cancer can achieve remission or no evidence of disease (NED) for five years or more. But even when cancer has gone into remission, there is always a risk that it could return.
The best way to prevent lung cancer is not to smoke or be around smokers. It’s also important to get regular screenings for cancer with your healthcare provider. If you have a family history of cancer, it’s especially important to talk with your doctors about your risk factors. Talk with your children about the dangers of smoking so they understand how to avoid it. This is the only way to decrease the number of people who die from lung cancer. If you’re diagnosed with lung cancer, it’s important to stay positive and find ways to feel hopeful. Support groups, clinical trials and a palliative care specialist can all help you navigate this difficult time.
Prevention
If you have a history of smoking or exposure to tobacco smoke, or have other health conditions like heart disease or lung diseases, you are at a higher risk for developing lung cancer. You can help lower your risk by not smoking, avoiding people who smoke and working in environments with low air pollution. You can also be proactive about getting regular screenings. Early detection may mean a quicker diagnosis, which can lead to more treatment options.
Lung cancer is divided into stages based on the size of the tumor and whether it has spread beyond the lungs. Stage 4 lung cancer (also known as metastatic lung cancer) is any type of non-small cell lung cancer that has spread to other parts of the body, such as the lining around the lungs or the fluid in the chest. This is the most advanced stage of lung cancer and is not curable, but it can be managed with a combination of treatments.
A cancer diagnosis can be emotionally and psychologically challenging for anyone, especially at later stages. However, new treatments have increased survival rates for those with stage 4 lung cancer. The overall survival rate for this stage depends on a variety of factors, including your general health, how well you tolerate life-extending treatments and your age when diagnosed.
When you are diagnosed with stage 4 lung cancer, your provider will start by listening to your symptoms, doing a physical exam and taking a blood sample to check for certain signs of cancer, such as a cough that won’t go away or pain in the lungs or chest. You may also have a CT scan or PET scan to see if the cancer has spread to other areas of the body and a biopsy to test for cancerous tissue.
If your doctor determines you are in stage 4, they will develop a treatment plan that includes palliative care. This will include symptom management, such as easing pain and discomfort, as well as a discussion about your quality of life. This can be done in a hospice setting or at home, depending on your preference.
Support
A cancer diagnosis is difficult to handle at any stage. But it’s particularly challenging when the disease has advanced to stage 4. Unlike patients diagnosed with lung cancer in an earlier stage, these people don’t have as many treatment options.
At this stage, the cancer has spread to areas beyond the lungs, including the area around the lungs and lymph nodes, or to distant organs like the brain, liver, bones, or lining of the heart. In addition, the cancer may have formed a fluid collection in the pleural space (called malignant pleural effusion), which can cause pain and make breathing more difficult.
Because of these factors, general survival rates for this stage of lung cancer are lower than those for an earlier stage. However, research to improve diagnostic methods and develop new and better treatments is ongoing. New targeted therapies that target specific gene mutations in tumor cells are one example of this work. Another is immunotherapy, which boosts the immune system to attack cancer cells.
Surgery is usually not an option for this stage of the disease. This is because cancer that has spread to these areas is likely to grow into or block vital structures in the chest, such as major blood vessels or the main air passages leading to the lungs. However, if the tumors are small and have not yet reached these areas, surgery may be an option for some patients.
For patients who decide not to have active treatment, palliative care is an important part of their care. This involves helping patients manage pain and other symptoms, such as fatigue, and provides emotional support. This type of treatment can be provided at home or in a hospice or care home.
As scientists learn more about the biology and genetics of lung cancer, they are developing ways to personalize treatment. For example, a recent study found that patients with a specific genetic mutation, called ALK, responded well to an immunotherapy drug combination. This is just one example of how medical advances are improving survival rates and quality of life for stage 4 lung cancer patients.
