Symptoms, Treatment, and Prognosis
Stage 4 non-small cell lung cancer (metastatic lung cancer) is the most advanced stage of lung cancer and refers to any lung cancer of any size that has spread (metastasized) to another region of the body, to another lobe of the lungs, or is accompanied by a malignant pleural effusion. Nearly 40 percent of people newly diagnosed with lung cancer already have stage 4 disease. Causes include smoking, radon exposure, asbestos exposure, and more, and it’s important to note that people who have never smoked can develop lung cancer. The diagnosis may be suspected based on findings on a chest CT scan, but a biopsy is usually required to make the diagnosis. This stage of lung cancer is not curable, but it is treatable. Several advances in recent years in treatments such as targeted therapies and immunotherapy have improved survival significantly. While the prognosis is still not what we would hope, there are people who have survived for years or even decades while being treated.
These may include:
- Persistent cough
- Coughing up blood (hemoptysis)
- Shortness of breath
- Pain the chest, back, shoulder or arms
- Repeated episodes of pneumonia or bronchitis
- Pain in the back, hips, or ribs if the tumor has spread to bone
- Difficulty swallowing due to a tumor being near or invading the esophagus
- Headaches, vision changes, weakness, or seizures if a tumor spreads to the brain
- Jaundice (a yellowing of the skin) from tumor that has spread to the liver
- Unintentional weight loss
- Loss of appetite
Because stage 4 lung cancer has spread beyond the lungs it is considered inoperable, that is, surgery would be unable to remove all of the tumor and offer a chance for a cure. But stage 4 lung cancer istreatable. In those that are able to tolerate chemotherapy, traditional chemotherapy, immunotherapy, and/or the newer targeted therapies may improve survival and help with the symptoms of lung cancer. Many clinical trials are in progress looking at new targeted therapies, combinations of chemotherapy and targeted therapies and also immunotherapy.”
Radiation therapy may be recommended as a palliative therapy — therapy that is done to control symptoms but does not result in a cure. This can be helpful for some people to control bone pain (due to tumors spreading to bone), bleeding from the lungs, tumors that are obstructing the airways and causing shortness of breath, or brain metastases that are causing significant symptoms, such as headaches or weakness.
It’s now recommended that all patients with advanced lung adenocarcinoma and some people with squamous cell carcinoma of the lungs should have genetic testing (molecular profiling) done on their tumor. For a subset of people with EGFR mutations, ALK rearrangements, or ROS1 rearrangements medications are available that can increase progression-free survival.
Immunotherapy is another newer type of treatment for lung cancer, with the first medication in this category having been approved for lung cancer in 2015. While these drugs do not work for everyone, some people with advanced lung cancer have experienced long-term control of their disease with these drugs.
It is important to discuss any treatment you are considering with your doctor and your loved ones, so you can carefully weigh the risks and benefits of treatment.
The overall 5-year survival rate for stage 4 lung cancer is sadly only around 1 percent. The median survival time (time at which 50 percent of patients are alive and 50 percent have passed away) is about 8 months.
What Can I Do to Help Myself?
Studies suggest that learning what you can about your lung cancer can improve your quality of life, and possibly even your outcome. Ask questions. Learn about clinical trials. Consider joining a support group. Many of us hesitate to talk about end-of-life issues, but discussing these with your doctor and your family — even if all of you are hoping for a cure — 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. Hope for quality time with loved ones, with good control of your symptoms. Hope for the future of your loved ones who will remain, with memories of you in their hearts.