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

The most common type of lung cancer is non-small cell lung cancer. According to the American Cancer Society, about 13 percent of lung cancers are small cell lung cancers, which are more aggressive and may spread quickly.

Stage 4 lung cancer is divided into two substages:

  • Stage 4a, where the cancer has spread within the lungs or to one area outside the lungs
  • Stage 4b, 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

According to the National Cancer Institute (NCI), 57 percent of lung and bronchus cancer is diagnosed at stage 4.

Lung and bronchus cancer is the second most commonly diagnosed cancer, behind breast cancer.

It represents about 12.7 percent of all new cancer cases, the NCI reports, with an estimate of about 229,000 new cases in the United States in 2020.

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 and then discuss 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 prognosis.

Expect to make lifestyle changes

Many people support their treatment by stopping behaviors that are harmful to their health like smoking and adopting healthy habits such as staying physically active and incorporating healthy food choices into their 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. Sometimes treatment can be adjusted.

Typically, your healthcare team can recommend a palliative care specialist who focuses on the management of side effects.

Expect checkups

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

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 6 percent means that people with stage 4 lung cancer are, an average, about 6 percent 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 (SEER) 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 for at least 5 years earlier. New treatments are being researched and improved 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 2009 and 2015.

Stage5-year survival rate
Distant (stage 4) non-small cell lung cancer7 percent
All stages combined for non-small cell lung cancer25 percent
Stage5-year survival rate
Distant (stage 4) small cell lung cancer3 percent
All stages combined for small cell lung cancer7 percent

The treatment options for late stage 4a or 4b lung cancer vary depending on factors such as how far the cancer has spread, whether any gene mutations have occurred, and your health in general.

Before treatment for stage 4 lung cancer starts, your tumor may be tested for genetic mutations, such as in the epidermal growth factor receptor (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.

ChemotherapyDrugs may be administered alone or in combination with other treatments, such as radiation therapy or immunotherapy.
Radiation therapy This 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 ALK inhibitors target certain gene mutations in lung cancer cells, helping to slow the growth of tumors.
ImmunotherapyMedications called checkpoint inhibitors may be taken 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.

If you’ve been diagnosed with stage 4 lung cancer, many factors will affect your outlook, including:

  • Overall health. Commonly, if you’re healthy when diagnosed with stage 4 lung cancer, it’s an indication that you might have a better ability to tolerate life-extending treatments.
  • Age. Although data regarding the outcome of older people with lung cancer is limited, a small 2013 study found older age was associated with poorer lung cancer survival.
  • Gender. According to the ACS, the chances of a woman developing lung cancer sometime in her life is about 1 in 17, while for a man the risk is about 1 in 15.
  • Race. The ACS also indicates that while black women are 14 percent less likely to develop lung cancer than white women, black men are about 15 percent more likely to develop lung cancer than white men, which may be the result of systemic environmental and healthcare-related factors.
  • Response to treatment. If your body responds well to cancer treatment, you’ll likely have a higher chance of survival.
  • Genetic mutations. An EGFR gene mutation is more common in women and nonsmokers with lung cancer. Targeted drug therapies can treat EGFR and other genetic 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 (bronchioloalveolar adenocarcinoma), instead of lung cells may result in a better survival chance, according to an early 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 percent of the time.

Often at this stage, 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 reduce 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 deliver person-centered, compassionate care that delivers an 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 as well and ask for support and guidance when needed.

By understanding stage 4 lung cancer prognosis, 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.