What to Expect with Stage 4 Lung Cancer

Symptoms of stage 4 lung cancer may include:

• fatigue
• new, persistent cough
• recurring chest infections
• swollen lymph nodes
• difficulty breathing
• clubbing of your fingers and toes
• unintentional weight loss
• coughing up blood
• changes in appetite
• joint pain or swelling
• bone pain or fractures if cancer has spread to your bones
• headaches, vision issues, or seizures if cancer has spread to your brain
• nausea, bloating, or jaundice if cancer has spread to your liver

Here are a few things to expect and ways to help you cope.

Rush of emotions

Receiving a diagnosis of stage 4 lung cancer can be difficult. It may cause a surge of emotions, such as:

• shock
• panic
• anxiety
• fear
• anger
• guilt

To help you manage your emotions, you can speak with loved ones. You can also join a lung cancer support group, such as LUNGevity, or speak with a therapist.

Relationship changes

You might find that people start treating you differently or that you need something different from certain relationships. Be honest about your needs. Seek the support of friends and family you trust.

Lifestyle changes

You may have to stop certain lifestyle behaviors that are harmful to your health, such as smoking.

You might also find that you can no longer do things you once did. In some cases, this can make it difficult to manage your daily tasks, such as your finances and household chores.

Talk with family members and friends for support. You can also contact healthcare professionals for ways to manage lifestyle changes and address your quality of life concerns.

Regular checkups

After receiving a diagnosis of stage 4 lung cancer, you may have regular clinic visits with a healthcare professional, including an oncologist and other members of an oncology team. This is to monitor the cancer’s spread.

Take these opportunities to tell your healthcare team how you’re feeling. Ask for any support you may need, such as palliative care. Palliative care can severe as an extra layer of support for individuals with advanced cancer.

These clinic visits may be overwhelming. It could help to have someone come with you for support.

After your initial treatment, there will also be follow-up visits, including testing to monitor your recovery.

There are two types of lung cancer, which may have different outlooks and survival rates.

Non-small cell lung cancer (NSCLC)

Non-small cell lung cancer (NSCLC) accounts for 80–85% of lung cancer diagnoses.

Healthcare professionals use a staging system from 0–4 to classify NSCLC, with 0 being the earliest and 4 being the most advanced. This helps determine the size of the tumor and where and how far it has grown.

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.

Small cell lung cancer (SCLC)

Small cell lung cancer (SLCLC) accounts for 10–15% of lung cancer diagnoses. It’s typically more aggressive and spreads more quickly than NSCLC.

Healthcare professionals use a two-stage system to classify SCLC:

• Limited: Cancer affects only one side of your body, such as the lung, chest, and lymph nodes.
• Extensive: Cancer has spread to nearby tissues, lymph nodes, or distant organs.

Stage 4 SCLC is when it’s extensive.

Survival rates for lung cancer are expressed using a 5-year relative survival rate. This rate compares the number of people living with a type and stage of cancer to the larger population. It showcases the likelihood of still being alive after the first diagnosis.

The American Cancer Society calculates the 5-year relative survival rate based on statistics from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program database.

SEER uses different stages to classify lung cancers:

• Localized: The cancer has not spread beyond the lung.
• Regional: Cancer has spread to nearby lymph nodes and tissues.
• Distant: Cancer has spread to distant parts of the body, such as organs.

Stage 4 cancer is when your cancer has spread to a distant part of your body.

Here are the 5-year relative survival rates based on people who received a diagnosis of NSCLC and SCLC between 2012 and 2018:

Survival rates are only estimates. Everyone’s body responds to the disease and its treatments differently.

Several factors may affect your outlook after receiving a diagnosis of stage 4 lung cancer.

Age

A 2019 study found that older age was associated with poorer lung cancer survival.

Sex

A 2022 study found that females live longer than males after a lung cancer diagnosis.

Race and ethnicity

According to a 2022 report from the American Lung Association, Black Americans, Latino Americans, Asian Americans, Pacific Islanders, and Indigenous Americans are more likely to die from lung cancer sooner than white Americans. This is largely due to racial disparities in healthcare coverage and access.

Genetic mutations

A 2015 study found that an epidermal growth factor receptor (EGFR) gene mutation is more common in females and nonsmokers with lung cancer. Targeted drug therapies that treat EGFR may increase survival rates.

Lung cancer subtype

A 2021 study found that people with adenocarcinoma lung cancer had a better 5-year relative survival rate than those with squamous cell carcinoma. People with SCLC had the lowest survival rate of all lung cancers.

Tumor location

A 2011 study found that a tumor in the alveoli instead of the lung cells, called a bronchioloalveolar adenocarcinoma, may result in a better survival chance.

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 can do everyday functions may survive longer than people who cannot and need to stay in a bed or chair for more than 50% of the time.

Your overall health and response to treatment may also affect your outlook.

Treatment options during stage 4 lung cancer aim to reduce symptom severity and improve quality of life. Your treatment plan will depend on several factors, including:

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

Some treatment options include:

• chemotherapy
• radiation therapy
• targeted therapy
• immunotherapy
• photodynamic therapy
• surgery
• clinical trials

It’s rare that these treatment options will cure stage 4 lung cancer. However, they may help manage cancer symptoms.

Learn more about taking care of yourself during stage 4 lung cancer treatment.

Palliative care, or supportive care, can be received alongside other lung cancer treatments to help improve your quality of life. The aim is to help ease your symptoms of cancer and medication side effects as well as provide emotional support.

Some possible palliative care services may include:

• evidence-based treatments to help suppress coughing, improve breathing, and increase hunger
• counseling for emotional support
• dietary support
• stress-reducing therapies, such as massage and mindfulness

You can receive palliative care at home or in other places like a hospital, hospice, or care home.

Remember, it’s never too early or late to ask for palliative care.

As a caregiver for someone living with stage 4 cancer, you can expect to see them experiencing many of the symptoms and changes listed above.

They may also experience spiritual changes, whether they’re religious or not. The National Cancer Institute 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 and the best possible health outcomes.

However, caregiving is often emotionally and physically exhausting. This can lead to feeling overwhelmed and overburdened, a condition called caregiver burnout.

Learn more about preparation for NSCLC caregivers.

Below are frequently asked questions relating to stage 4 lung cancer.

How long can you live with stage 4 lung cancer?

A person’s outlook with stage 4 lung cancer can depend on the extent of the disease, their health, and several other factors. However, the estimated 5-year relative survival rate for stage 4 NSCLC is 9%. For stage 4 SCLC, it’s 3%.

Can you survive stage 4 lung cancer?

Stage 4 lung cancer is incurable. While treatments are advancing, it’s still difficult to treat. Your outlook depends on several factors, such as the cancer’s stage at diagnosis and treatment.

Does stage 4 cancer mean terminal?

Stage 4 lung cancer is the most advanced. Although the 5-year relative survival rate is very low, it’s not necessarily terminal. No treatments currently exist to cure stage 4 NSCLC. However, treatments may help reduce your symptoms and improve your quality of life.

Stage 4 lung cancer is the most advanced stage.

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 prepared to make decisions that maximize your quality of life and wellbeing.