Table of ContentsView AllTable of ContentsStagingSymptomsTreatmentsPrognosisCopingFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Staging
Symptoms
Treatments
Prognosis
Coping
Frequently Asked Questions
Stage 4non-small cell lung cancer(NSCLC), also calledmetastatic lung cancer, is the mostadvanced stageof this disease. It refers to any size andtype of NSCLC(adenocarcinoma, squamous cell carcinoma, large cell carcinoma) that has spread from one lung to the other lung, to another region of the body, or to the fluid around the lung or heart. Stage 4 NSCLC is not curable but it is treatable.
Nearly 40% of people who learn they have lung cancer are already at stage 4 of the disease when they’renewly diagnosed.Thankfully, in recent years, several advances in treatments have significantly improved survival.
Caiaimage/Martin Barraud/OJO +/Getty Images
The first step in diagnosing stage 4 cancer is an X-ray orcomputed tomography (CT) scan, but alung biopsyis usually necessary to make a clear determination.
To determine what stage your cancer is, healthcare providers use a standard system from the American Joint Committee on Cancer (AJCC). It is called theTNMsystem, with each letter in the acronym standing for a different observable characteristic of the cancer.
Numbers or letters are used after the T, N, and M notations to indicate how advanced the tumor,lymph node progression, and metastases are.
Stage 4 cancer is broken into two groups: 4A and 4B (with 4B being the most advanced).
Of note,small-cell lung cancer(which is different and rarer than NSCLC) involves only two stages: limited and extensive.
Stage 4 NSCLC Symptoms
Stage 4 NSCLC symptoms may vary based on the location of tumors and how far the cancer has spread.
Problems due to the presence of a tumor in the lungs include:
As cancer metastasizes, symptoms are related to the area where the cancer has spread. For example:
The Symptoms of Lung Cancer
Because stage 4 NSCLC has spread beyond the lungs, it is considered inoperable. It cannot be cured, but it is treatable. New medications have helped people live longer, fuller lives while managing this disease.
Targeted Therapies
Using in-depthgenetic testing (molecular profiling)of your tumors, healthcare providers are able to identify genetic mutations in cancer cells. Based on this data, they can plan a personalized approach to your care and incorporatetargeted therapies—medications that act on these genes to halt the disease’s progression.
Your healthcare provider will probably recommend that you undergo genetic testing before you begin any other treatment. If these biomarker tests reveal that tumors show DNA changes, there may be medications that you can take that will target those mutations.
For instance, if there is anEGFR mutation, it means that cancer cells are carrying out cell division at an excessive rate. You may then be given tyrosine kinase inhibitors (TKIs), targeted therapy drugs that send signals to the cells to stop that growth.
These TKIs don’t work for all EFGR mutations, though. In May 2021, the Food and Drug Administration (FDA) approved the use of Rybrevant (amivantamab-vmjw) for people who have the third-most common kind of EGFR mutations, calledEGFR exon 20 insertion mutations. This different kind of targeted therapymay help people with this mutation when cancer has progressed during or after platinum-based chemotherapy treatments.
Initially, BRAF mutations were found in people with metastatic melanoma but are now discovered in approximately 4% of people with NSCLC.
Researchers have found that people with different cancer types harboring BRAF mutations often respond to treatment with BRAF inhibitors (usually in combination with a MEK inhibitor). Examples include the BRAF inhibitor Tafinlar (dabrafenib) combined with the MEK inhibitor Mekinist (trametinib) and Braftovi (encorafenib) combined with Mektovi (binimetinib).
What Is a Genetic Mutation in Cancer Cells?
Chemotherapy
Historically,chemotherapywas the main option available to advanced lung cancer patients. These medications kill cancer cells, but they also have difficult-to-manage side effects that not all people are able to tolerate. With new chemotherapy drugs, side effects are less severe and there is the benefit of long survival with treatment.
If genetic testing shows no treatable genomic alterations, chemotherapy will likely be recommended, often along with immunotherapy.Chemo may also be used alone aspalliative carefor those with very advanced cancer who want to ease their symptoms.
Immunotherapy
Immunotherapyis another newer type of treatment for lung cancer that stimulates your own immune system to recognize and fight cancer cells.People who have tumors that are PD-L1 positive and/or have a high number of mutations (called a high tumor mutational burden) may respond best to these medications. Those who have genomic alterations, such as EGFR mutations, tend not to respond as well.
While they don’t work for everyone, some people with advanced non-small cell lung cancer have experienced long-term control of their disease with these drugs.
Radiation Therapy
Radiation therapy, such asstereotactic body radiotherapy (SBRT), delivers high doses of radiation directly to a tumor to kill it. This won’t stop aggressive stage 4 non-small cell lung cancer that has spread, but it may be recommended as palliative therapy.
While surgery may be used to remove cancer in an effort to ease symptoms, it does not offer a chance for a cure.
Clinical Trials
Treatments for lung cancer are continually being researched and improved upon. The National Cancer Institute (NCI) runs clinical trials that test new treatments for advanced non-small cell lung cancer.
You can use theironline databaseto search for trials seeking participants.
The overall 5-yearsurvival ratefor stage 4 non-small cell lung cancer is approximately only 4% but can be much higher in certain populations. The mediansurvival time(time at which 50% of patients are alive and 50% have died) is about eight months.
Understanding Lung Cancer Survival Rates
Healthcare providers often say that learning what you can about yourlung cancercan improve your quality of life and possibly even your outcome. Ask questions. Learn about clinical trials. Consider joining asupport group.
Many people hesitate to talk aboutend-of-life issues, but discussing these with your healthcare provider and your family is associated with fewer feelings of loneliness and a better quality of life. Never lose hope. Even if you have chosen not to pursue further treatment, you can hope forquality time with loved onesand good control of your symptoms.
Frequently Asked QuestionsA diagnosis of stage 4 NSCLC means that the cancer has spread to one or more locations in the body. This makes it more difficult to treat, and even less likely that treatment will cure you. Therapies, though, can help relieve symptoms, make you feel better, and improve your quality of life.A variety of factors, including treatment type, contribute to the survival rate of stage 4 NSCLC. While a third of patients have a short prognosis (less than three months), 10 to 15 percent of patients who survive more than three months can live with the disease for two or more years.
A diagnosis of stage 4 NSCLC means that the cancer has spread to one or more locations in the body. This makes it more difficult to treat, and even less likely that treatment will cure you. Therapies, though, can help relieve symptoms, make you feel better, and improve your quality of life.
A variety of factors, including treatment type, contribute to the survival rate of stage 4 NSCLC. While a third of patients have a short prognosis (less than three months), 10 to 15 percent of patients who survive more than three months can live with the disease for two or more years.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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