Lung and bronchus cancer is the third most commonly diagnosed cancer, behind breast cancer and prostate cancer. It’s the leading cause of cancer deaths.

It represents about 12.4% of all new cancer cases, the National Cancer Institute (NCI) reports, with about 236,740 new cases estimated for 2022 in the United States.

Stage 4 lung cancer is the most advanced stage of lung cancer. In stage 4, the cancer has spread, or metastasized, to both lungs, the area around the lungs, or distant organs.

If you or a loved one has received a stage 4 lung cancer diagnosis, you’ll want to know what to expect so you can get the best possible treatment.

Expect a rush of emotions

Along with communicating with family and friends, consider joining a support group or seeking out a therapist or counselor.

Expect to take charge of your healthcare decisions

Many people are motivated to research available information from trusted resources. Then, they might discuss their findings with their healthcare team.

One area to research could be available clinical trials. These might give you access to new treatments that could improve your outlook.

Expect to make lifestyle changes

Many people support their treatment by stopping behaviors that are harmful to their health, like smoking. You might also adopt healthy habits, such as staying physically active and incorporating healthy food choices into your diet as much as possible.

Expect some relationships to change

You might find that people start treating you differently than you hoped or predicted. Or you might find yourself needing something different from certain relationships.

Be honest about your needs and seek the support of friends and family you trust.

Expect palliative care

Many lung cancer treatments have uncomfortable or concerning side effects. Advancing cancer can also cause unpleasant symptoms, including pain and fatigue.

Typically, your healthcare team can recommend a palliative care specialist. This is someone who adds extra support to your care plan by focusing on symptom relief and quality of life rather than treating the lung cancer itself.

Expect checkups

Even when you’re done with initial treatment, there will be follow-up visits, including testing to monitor your recovery.

If you’ve received a diagnosis of stage 4 lung cancer, many factors will affect your outlook, including:

  • Overall health: Commonly, if you’re healthy when you receive your diagnosis, it’s an indication that you might have a better ability to tolerate life-extending treatments.
  • Age: Although data regarding the outcomes of older people with lung cancer is limited, a small 2013 study found older age was associated with poorer lung cancer survival.
  • Sex: Women tend to live longer after being diagnosed with lung cancer compared with men, according to some research.
  • Race and ethnicity: Black Americans, Latinx Americans, Asian Americans and Pacific Islanders, and Indigenous Americans are less likely to be diagnosed with lung cancer early and more likely to die sooner than white Americans, per a 2021 report from the American Lung Association. This is largely due to lack of access to healthcare.
  • Response to treatment: If your body responds well to cancer treatment, you’ll likely have a higher chance of survival.
  • Genetic mutations: According to 2015 research, an epidermal growth factor receptor (EGFR) gene mutation is more common in women and nonsmokers with lung cancer. Targeted drug therapies can treat EGFR and other gene mutations, increasing survival rates.
  • Lung cancer type and tumor location: Some subtypes of lung cancer, such as large cell lung carcinoma, are more aggressive than others. A tumor located in the alveoli instead of the lung cells, called a bronchioloalveolar adenocarcinoma, may result in a better survival chance, according to a 2011 study.
  • Smoking: A small 2018 study found that people with stage 4 lung cancer who quit smoking cigarettes before starting chemotherapy increased their survival time by as much as 6 months.
  • Ability to perform daily activities: Based on the Eastern Cooperative Oncology Group (ECOG) Performance Status score, people with lung cancer who are able to perform everyday functions may survive longer than those with lung cancer who are confined to a bed or chair more than 50% of the time.

Stage 4 lung cancer may be categorized as either:

  • non-small cell lung cancer
  • small cell lung cancer

The outlook differs somewhat between the two types. However, treatment is similar at stage 4 and focuses on slowing the progression of the disease and improving symptoms.

Non-small cell lung cancer is the more common type. According to the American Cancer Society (ACS), about 13% of lung cancers are small cell lung cancers. Small cell lung cancers are more aggressive and may spread quickly.

Substages

Stage 4 lung cancer is divided into two substages:

  • Stage 4a is where the cancer has spread within the lungs or to one area outside the lungs.
  • Stage 4b is where the cancer has spread to several places in one or more organs that aren’t close to the lungs, such as the brain, liver, or bones.

At stage 4, your healthcare team is focused on palliative care as opposed to curative care.

Late stage 4a lung cancer can cause symptoms such as:

  • Fatigue: This can include extreme physical, emotional, and mental tiredness.
  • Emotional changes: Some people find that they become less interested in things that used to interest them.
  • Pain: Severe pain and discomfort can occur, but your healthcare team can help you manage the pain to improve your quality of life.
  • Difficulty breathing: Shortness of breath and trouble breathing are not uncommon. You can learn techniques that help, and your healthcare team can recommend medication to help relax your breathing and reduce anxiety.
  • Coughing: A persistent cough can be caused by a tumor blocking an airway. Your healthcare team can create a treatment plan to help alleviate and manage the coughing.
  • Bleeding: If a tumor spreads into a major airway, it may cause bleeding. Your doctor may suggest treatment with radiation or another procedure.
  • Changes in appetite: Fatigue, discomfort, and certain medications can lower appetite. You may find that food is no longer as appetizing and that you seem to become full more quickly.

Late stage 4b lung cancer that has spread to other organs may also cause the following symptoms:

  • bone pain or fractures if it’s spread to your bones
  • headaches, vision issues, or seizures if it’s spread to your brain
  • nausea, bloating, or jaundice if it’s spread to your liver

As a caregiver, you can expect to see your loved one experiencing many of the symptoms and changes listed above, from reduced appetite to difficulty breathing to emotional changes.

Your loved one might also experience spiritual changes, whether they’re religious or not. The NCI recommends that caregivers support and respect loved ones who depend on spirituality to help them cope with cancer.

The goal is to give person-centered, compassionate care that delivers improved quality of life along with the best possible health outcomes.

Caregiving is often emotionally and physically exhausting. This can lead to feeling overwhelmed and overburdened, a condition referred to as caregiver burnout.

Physical signs and symptoms of burnout can include:

  • body aches and pains
  • fatigue
  • frequent headaches
  • increased or decreased appetite

Emotional signs and symptoms of burnout can include:

  • anxiety
  • depression
  • exhaustion
  • irritability
  • lack of energy

It’s important for caregivers to take care of their own health and ask for support and guidance when needed.

Stage 4 lung cancer survival rates measure how many people are living a certain number of years after they were diagnosed with stage 4 lung cancer.

For example, a 5-year survival rate of 8% means that people with stage 4 lung cancer are, on average, about 8% as likely to survive for at least 5 years as people who don’t have lung cancer.

Cancer survival rates are based on statistics from the NCI’s Surveillance, Epidemiology, and End Results Program database.

Keep in mind that survival rates are only estimates. Everyone’s body responds to the disease and its treatment differently.

Relative survival rates also don’t take into account recent improvements in treatment. They’re based on diagnosis and treatment from at least 5 years earlier. New treatments are being researched and improved on every day.

The following 5-year survival rates provided by the ACS are based on people who were diagnosed with stage 4 lung cancer between 2011 and 2017. Survival rates for stage 4 non-small cell lung cancer and small-cell lung cancer are broken out.

Stage5-year survival rate
distant (stage 4) non-small cell lung cancer8%
all stages combined for non-small cell lung cancer26%
Stage5-year survival rate
distant (stage 4) small cell lung cancer3%
all stages combined for small cell lung cancer7%

The treatment options for late stage 4a or 4b lung cancer vary depending on several factors, such as:

  • how far the cancer has spread
  • whether any gene mutations have occurred
  • your health in general

Before treatment for stage 4 lung cancer starts, your tumor may be tested for genetic mutations. According to a 2015 research review, one of these mutations is in the EGFR gene. If the gene is mutated in your cancer cells, you may receive a targeted therapy drug.

While the following common treatments aren’t likely to cure your lung cancer, they may help you feel better and live longer.

ChemotherapyYou may receive these drugs alone or in combination with other treatments, such as radiation therapy or immunotherapy.
Radiation therapyThis may be used to shrink tumors. It may be used to treat stage 4 lung cancer in people who can’t tolerate chemotherapy.
Targeted therapyDrugs such as EGFR inhibitors and anaplastic lymphoma kinase inhibitors target certain gene mutations in lung cancer cells, helping to slow the growth of tumors.
ImmunotherapyYou may take medications called checkpoint inhibitors to help your immune system recognize and attack lung cancer cells.
Photodynamic therapyLight and light-sensitive agents may be used to shrink tumors that haven’t spread beyond your lungs.
SurgeryTumors in your lungs or chest cavity and affected lymph nodes may be surgically removed if they cause pain.

Below we answer a few frequently asked questions about advanced non-small cell and small cell lung cancer.

Is non-small cell lung cancer always fatal?

Non-small cell lung cancer isn’t always fatal. The outlook depends a lot on the cancer’s stage at diagnosis.

Stage 4 is the most advanced form of non-small cell lung cancer. While this means it’s difficult to treat and survival rates are low — around 8% — these estimates can’t predict your individual situation.

It’s also worth noting that survival rates are based on data from years ago and don’t reflect today’s exact circumstances or newer treatments.

Can stage 4 non-small cell lung cancer be cured?

Currently, there aren’t any treatments that are likely to cure stage 4 non-small cell lung cancer. Treatment for stage 4 lung cancer aims to reduce your symptoms and help you live longer. However, research on new treatments is in progress every day.

Which spreads faster: small cell or non-small cell lung cancer?

Small cell lung cancer is generally more aggressive and spreads faster than non-small lung cancer.

Which has better survival rates: small cell or non-small cell lung cancer?

Survival rates tend to be better for non-small cell lung cancer than for small cell lung cancer. But your individual characteristics, tumor location, and overall health each play a role in survival, among other factors.

By understanding stage 4 lung cancer outlooks, you can anticipate what you’ll experience as you navigate the treatment process.

With preparation, you can be ready to make decisions that’ll maximize your treatment options and comfort.