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Treating Stage 4 Lung Cancer

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Your Guide to Stage 4 Lung Cancer

Medically Reviewed By Adithya Cattamanchi, M.D.
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Stage 4 lung cancer is the most advanced stage of this disease. It means that the cancer may have spread to other areas. The two major types of lung cancer are non-small cell cancer and small cell cancer. Your doctor may diagnose lung cancer using imaging tests. They may also recommend chemotherapy or radiation for treatment. 

This article will give an overview of what stage 4 lung cancer means. It will also discuss the symptoms, causes, and treatments of stage 4 lung cancer.

What does stage 4 lung cancer mean?

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Cancer happens when the cells in a certain part of your body divide quickly and uncontrollably. Without treatment, cancerous cells can spread to other parts of your body.

“Metastasizing” is the term used to describe cancer when it spreads. When cancerous cells spread, they use all the resources in an area of the body. This means healthy cells cannot receive the nutrients they need to function.

When cancer starts in your lung tissue, it is called lung cancer.

Categorizing lung cancer into stages helps your healthcare team describe it. When staging your cancer, they will consider the size of the tumor and whether it has spread to any other parts of your body, such as another organ or your lymph nodes. 

The stages of cancer are numbered from 0 to 4 to indicate the spread and characteristics of your cancer. Stage 4 represents the most advanced stage of the disease and can be type 4A or 4B. 

During stage 4A lung cancer, you will typically experience one of the following findings:

  • There is at least one tumor in both lungs.
  • Cancer has spread to the areas around the heart and lungs.
  • Cancer has spread to another distant area of the body.

With stage 4B lung cancer, the cancerous cells have spread to multiple other places besides the lungs. During this stage, cancer may be in the:

  • brain
  • liver
  • bone
  • other distant areas

Types of lung cancer

The two most common types of lung cancer are non-small cell cancer and small cell cancer.

According to the American Cancer Society (ACS), 80–85% of lung cancers are non-small cell lung cancer. Adenocarcinoma, squamous cell carcinoma, and large cell carcinoma are the three subtypes of non-small cell lung cancer. Smoking is a major cause of this type of cancer, per the National Cancer Institute

The ACS believes that 10–15% of lung cancers are small cell lung cancer. Small cell lung cancer grows faster and spreads farther than non-small cell lung cancer. Because it spreads quickly, small cell lung cancer has typically metastasized by the time most people receive a diagnosis. 

What are the symptoms of stage 4 lung cancer?

During stage 4 lung cancer, healthcare professionals consider the cancer to be advanced. You may experience the symptoms of lung cancer, along with those caused by spreading cancer cells. 

Respiratory symptoms of stage 4 lung cancer include:

  • coughing that is persistent
  • coughing up blood
  • difficulty breathing and shortness of breath
  • wheezing

If your respiratory symptoms worsen, it may indicate that cancer has spread to both lungs. 

You may notice the following symptoms as cancer spreads:

  • bone pain
  • yellowing of the skin
  • swelling of your lymph nodes
  • seizures
  • headache
  • problems balancing 

The symptoms you experience during stage 4 lung cancer vary, depending on where the cancer has spread.

Bone pain indicates that the lung cancer may have settled in your bones. Yellowing of the skin suggests liver involvement. If you notice swollen lymph nodes, the cancer has likely spread to that area. If cancer spreads to the brain, it may cause seizures, headaches, and difficulty maintaining balance. 

What causes stage 4 lung cancer?

Smoking is a major cause of stage 4 lung cancer. According to the ACS, experts believe that around 80% of all lung cancer deaths result from smoking.

If you do not smoke, being around people who smoke may increase your risk of developing this type of cancer. Second-hand smoke is considered a major risk factor.

If you do smoke, you can dramatically decrease your chances of developing stage 4 lung cancer by quitting smoking. A healthcare professional can help you come up with a smoking cessation plan. 

According to the ACS, radon is the second leading cause of lung cancer. Radon is a radioactive gas found in the soil. When you are outside, it does not pose a large risk. Indoors, it can quickly build up to dangerous levels.

You cannot smell, taste, or see radon, so it is important to test your home regularly for gas. 

Asbestos is another carcinogen, or cancer-causing agent. You are more likely to develop stage 4 lung cancer if you work with asbestos or other carcinogens. This mineral is in insulation, older buildings, and industrial locations. Asbestos is usually harmless unless it is disturbed and enters the air. 

Where you work can also increase your risks of developing stage 4 lung cancer. Regular exposure to workplace carcinogens is more serious than occasional exposure. Uranium, arsenic, silica, and mustard gas can all cause lung cancer. Diesel smoke is another major chemical that can increase your risk. 

How do doctors diagnose stage 4 lung cancer?

Your healthcare team will diagnose stage 4 lung cancer based on your symptoms and some additional tests. If your doctor believes your symptoms may indicate stage 4 lung cancer, they will request imaging tests.

They may order a PET scan to find out where your cancer has spread. A CT scan is another imaging test used to learn if cancer has spread to the lymph nodes, brain, or other organs.

Your healthcare team may perform a CT-guided needle biopsy. During this procedure, they will take a section of your tissue to test for cancer.

Bone scans can determine whether the cancer is in your bones. A chest X-ray will indicate which part of your chest cavity is affected.

What are the treatments for stage 4 lung cancer?

Your doctor will cater your treatment plan to where your cancer has spread. During stage 4A, your cancer may have spread to another area, or it may be just in your lungs. If this is the case, your doctor may recommend surgery. 

During surgery, your healthcare team may remove the tumors. This works best on tumors that have not spread throughout multiple areas of the body. Your healthcare team may follow your surgery with chemotherapy or radiation. 

If your doctor suggests radiation, they may recommend systemic radiation. During this type of radiation, the radiation will travel through your body. Its goal is to shrink any tumors and reduce the number of cancer cells in your body. 

Chemotherapy is a type of medication that works to reduce the growth of cells. It works on healthy cells and cancerous cells, so you may experience some side effects. Mouth sores, hair loss, and fatigue are common symptoms. 

Your doctor may treat your stage 4B lung cancer with targeted gene therapy. Your healthcare team will test your tumor to identify which gene mutations are present in the cancerous cells. Then, your doctor will recommend a therapy that targets the gene causing the tumor. 

Another treatment option your doctor may recommend is immunotherapy. This treatment uses medications to help your own immune system recognize and clear cancer cells more efficiently, according to the ACS.

Side effects of immunotherapy may include fatigue, nausea, and loss of appetite.


Of the major stages of lung cancer, stage 4 is the most serious. It means the cancer may have spread to other areas of your body.

By using an imaging test, your healthcare team may discover that the cancer is now in your bones, lymph nodes, or other organs. You may notice a persistent cough or have a hard time breathing.

If your brain is affected, you may experience seizures or headaches. Bone pain, yellowing of your skin, and swelling in your lymph nodes indicate further spread. 

The two major types of lung cancer are non-small cell cancer and small cell cancer. Most lung cancer is non-small lung cancer. Small cell lung cancer makes up a smaller percentage of lung cancer, but it is more aggressive. 

Your doctor will create an individualized treatment plan to treat your stage 4 lung cancer. They may use a combination of surgery, chemotherapy, or radiation to manage your advanced cancer. Targeted gene therapy allows your doctor to further individualize your treatment by focusing on which gene mutations are causing the cancerous growth. 



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Medical Reviewer: Adithya Cattamanchi, M.D.
Last Review Date: 2022 Sep 7
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