Stage 4 non-small cell lung cancer (NSCLC) is the most advanced form of the condition and can be the most challenging to treat.

At stage 4, the cancer is no longer isolated in one lung. It has spread to either of the following areas:

  • your other lung
  • nearby tissue and lymph nodes in your chest
  • other organs and tissue elsewhere in your body

Living with stage 4 NSCLC can feel scary. But there are encouraging treatment developments that are helping people live longer, and enjoy a better quality of life.

A 2020 research review even said that new treatments are “turning lung cancer from an incurable disease into a chronic disease.”

In this article, we’ll go over the basics of stage 4 NSCLC, including symptoms, treatment, and outlook.

The symptoms of stage 4 NSCLC go beyond the coughing and congestion that comes with earlier stages of NSCLC. It’s often the severity of symptoms that leads people to get a lung cancer screening.

The symptoms for stage 4 NSCLC include those for most cases of lung cancer:

  • nagging cough
  • shortness of breath
  • chest pain
  • hoarse voice
  • coughing up blood
  • blood-tinged mucus

Metastatic cancer symptoms

If the cancer has metastasized, meaning it has spread to other parts of your body, you may have assorted other symptoms. Some of them may include:

  • headache
  • aches and pains, especially in your bones
  • jaundice (a yellowing of your skin and eyes)
  • swollen lymph nodes, particularly those near your neck or collarbone
  • conditions related to your nervous system, such as dizziness, balance problems, muscle weakness or tingling in your limbs

Moffitt Cancer Center specialists note that some symptoms may be more likely to develop based on where the cancer has spread. Headaches are more strongly associated with brain metastasis, while jaundice suggests liver metastasis.

The National Cancer Institute reports that about 40 percent of people newly diagnosed with NSCLC are already at stage 4 of the condition.

If you have lung cancer symptoms, or you have a history of smoking or exposure to airborne toxins, your doctor may recommend that you have some imaging tests to diagnose or rule out lung cancer.

The first test may be a simple chest X-ray, which could reveal a suspicious nodule or mass. For more precision and to find lesions that may be missed on an X-ray, a CT scan might be ordered instead of or in addition to a lung X-ray.

Lung function tests may also be done after a diagnosis is made to determine whether your lungs could withstand the removal of cancerous tissue.

Bronchoscopy

If you are coughing up mucus, a lab test may reveal the presence of cancer cells. Your doctor may also perform a bronchoscopy, in which a thin, flexible tube with a camera attached is inserted down your throat and into a lung.

This provides a close-up view of lung tissue and any abnormal masses or nodules. A bronchoscopy may also include a biopsy.

Lymph node testing

If your doctor suspects the cancer has traveled to your nearby lymph nodes or other parts of your body, further tests may be appropriate. These may include:

  • endobronchial ultrasound
  • endoscopic esophageal ultrasound
  • mediastinoscopy
  • mediastinotomy
  • thoracoscopy

The treatment timeline for NSCLC can vary significantly, based on the type of treatment you’re receiving and how your body responds to various treatments.

In many of these cases, chemotherapy is primary treatment, according to the American Cancer Society. Chemotherapy can take several months, while radiation therapy and immunotherapy often take several weeks to complete.

Surgery

When NSCLC has reached stage 4, surgery to remove cancerous tissue may not be an option. This is because the cancer may have spread to multiple sites, including organs and bones, and it may be inoperable.

In some cases of stage 4A, when the cancer has spread to one other site, surgery may be an option. It may be combined with radiation therapy, as well as chemotherapy.

Immunotherapy

Another treatment that is producing encouraging results in recent years is immunotherapy, which involves the use of medications that help an individual’s own immune system destroy cancer cells.

One 2020 study found that immunotherapy medications proved to be effective in treating people living with advanced NSCLC. Some medications include:

  • nivolumab
  • pembrolizumab
  • atezolizumab

Radiotherapy

One 2018 study found that radiotherapy, when combined with immunotherapy and chemotherapy, may be especially helpful in repressing the growth of the tumor and providing systemic control over the condition.

The outlook for people living with stage 4 NSCLC can be a hopeful one, particularly if your body responds well to treatment. In fact, the National Cancer Institute reported in 2020 that NSCLC mortality rates are falling in the United States due to remarkable advances in treatment.

A cancer outlook is often presented as a 5-year relative survival rate. People with the same type of cancer at the same stage are compared to people in the general population. For stage 4 NSCLC, the 5-year relative survival rate is about 7 percent.

While coping with stage 4 NSCLC is certainly a challenge, know that there are plenty of people living and maintaining a strong quality of life even with the condition.

Living with NSCLC means more than treating symptoms and side effects — it also means dealing with the emotional weight of the condition. Managing the emotional aspect of a serious condition like NSCLC is important, and shouldn’t be ignored as you focus on the cancer treatment itself.

Some of the important steps you can take include:

  • Find support. Whether it’s from friends, family or a cancer support group, emotional assistance can make a big difference. Lean on people close to you, and don’t feel embarrassed about asking for help or feeling anxious about the future.
  • Make small lifestyle adjustments. Follow your doctor’s suggestions about a nutritious diet, regular exercise, sleep and other facets of everyday life that support good health.
  • Explore spirituality. If you have strong spiritual beliefs or even questions about spirituality, consider spending time contemplating those feelings and ideas and conversing with others who may share your beliefs.

Advancements in the treatment of stage 4 NSCLC are making it possible for people to live with this condition without letting it stand in their way. These major steps forward have helped people enjoy longer, more comfortable lives.

If you or someone you know has stage 4 NSCLC, the best thing you can do is become educated about the condition and treatment options. The more you know, the more comfortable you’ll be discussing these topics with your doctors and making decisions about your care.