The severity of lung cancer is described by its stage ranging from stage 1, which is early-stage, to the most advanced stage, which is stage 4. Although five-year survival rates are not as long for advanced lung cancer compared to earlier stages, it is still treatable for most patients.
New therapies have become available in the past 5-10 years that can dramatically change the prognosis for patients. These breakthrough treatments plus healthier lifestyle choices are making it possible for patients to live longer than ever before with advanced-stage lung cancer.
How Do You Know If It's Stage 4 Lung Cancer?
Stage 4 means the lung cancer has spread beyond its original location. It may have spread to both lungs, the area around the lungs, lymph nodes, and distant organs such as the brain, liver, bones, or lining of the heart. Some patients do not start out at stage 4, but over time the cancer can metastasize to other areas of the body.
Establishing the specific stage of your cancer helps the oncologist determine which treatments are most likely to work best for you and the order they should be given. This will be done through imaging and other testing that is needed to gather the data for treatment planning.
Your treatment plan is also impacted by whether this is your first time to receive lung cancer treatment or if this is a recurrent lung cancer and different treatments may be needed.
How is Stage 4 Lung Cancer Different from Earlier Stages?
Stage 4 lung cancer is different from earlier stages in several other key ways, including:
- In earlier stages of lung cancer, the cancer remains in the lungs and has not spread to lymph nodes, other tissues, or organs.
- Treatment goals for earlier stages of lung cancer focus on curing the cancer. Stage 4 lung cancer treatment focuses on slowing cancer’s progression, treating symptoms and side effects, and improving the patient’s quality of life.
- Different treatment options may be available compared to earlier-stage lung cancers. Participation in clinical trials or experimental life-extending treatments can be an important option for patients who want to pursue all opportunities for a cure.
- You may feel more of the symptoms of the cancer at stage 4 compared to patients at an earlier stage when symptoms are less obvious. Symptoms include extreme fatigue, pain, difficulty breathing, coughing, bleeding, loss of appetite, and emotional changes such as depression and anxiety. Later stages can include bone pain or fractures, headaches, seizures, vision changes, or jaundice.
- Stage 4 cancer presents unique emotional and psychological challenges for patients. Your life will change dramatically as you focus your energy and emotional strength on extending your life as long as possible.
- Palliative care becomes essential for stage 4 patients. It provides extra care and support in implementing your care plan and focuses on symptom relief and quality of life.
How Long Can You Survive with Late-Stage Lung Cancer?
Non-small cell lung cancer, the more common type, has a slightly better five-year survival rate of 9% compared to small cell lung cancer’s 5-year survival rate of 3% when diagnosed at a late stage.
These general survival rates are based on those who receive an initial lung cancer diagnosis at stage 4. This doesn’t apply to lung cancer that has returned.
While no one can know the exact answers about your life expectancy, we do know stage 4 lung cancer patients are living longer now than ever before due to the new targeted therapies that are available.
Many factors influence your outcome, including:
- Your overall health, which affects how you tolerate life-extending treatments.
- Having other chronic health conditions that can complicate your treatment.
- Your ability to self-care and live independently (performance status), which correlates to longer survival.
- Your age, as younger patients have much better survival rates compared to those over age 65.
- Your gender – women live longer after diagnosis compared to men.
- Smoking cessation before chemotherapy, as this can increase survival time by up to six months.
- Your race, which tends to be a factor in who gets an early diagnosis, has access to treatment, and death rate statistics.
- How your body responds to treatment, which affects the length of survival.
- How aggressive your cancer is, meaning how far it’s spread and how fast it’s growing.
- The location of the cancer.
- If you have a cancer with a genetic mutation that can be treated with targeted drug therapy – this increases survival time.
- Your emotional strength and positive attitude toward survival – these are some of the most powerful influences on survival times and quality of life.
What Are My Treatment Options for Stage 4 Lung Cancer?
There are several different types of treatments available for stage 4 lung cancer including radiation, chemotherapy, targeted drug therapy, and immunotherapy. Surgery may be used to remove large tumors that have not spread beyond the lungs and are causing pain or restricting your breathing.
Some patients choose not to have active treatment. Their health may be too poor, or they believe the side effects of treatment are worse than potential benefits. If that’s your decision, your care team will focus on alleviating your symptoms, such as pain or shortness of breath. Palliative care becomes your treatment focus.
The best treatment plan will depend on how far your cancer has spread, your age and overall health, your preferences, and if there are gene mutations that can be treated with targeted therapy drugs.
Chemotherapy and/or radiation can be used to shrink larger tumors before surgery or after surgery to kill remaining cancer cells. Chemotherapy and radiation can relieve pain or other symptoms. Radiation is used in patients who cannot have chemotherapy.
Immunotherapy boosts your immune system to recognize and attack lung cancer cells.
Targeted therapy focuses on specific gene mutations in lung cancer cells. Before treatment begins, stage 4 patients are usually tested for genetic mutations. If a mutation is found, targeted therapy drugs will be your first treatment method to slow tumor growth. In a 2019 study on targeted therapy drugs, patients averaged a survival time of almost seven years.
How Will the Oncologist Know if There is a Targeted Therapy that Will Work for Me?
Decisions about treatment for stage 4 lung cancer are increasingly relying on personalized medicine that includes genetic profiling of tumors. This is done through biomarker testing on tissue gathered during a biopsy or surgery.
The tests will determine if there is a specific gene that has mutated, causing the cancer to grow. These are not inherited genetic mutations, but rather mutations caused through environmental exposure, such as the chemicals in smoke.
Biomarker testing has become a routine part of diagnosis and staging for non-small cell lung cancer patients. Since 2021, clinical practice guidelines have included biomarker testing as part of an individualized treatment plan.
Other Types of Treatments That Help Patients with Stage 4 Lung Cancer
Palliative care and symptom management are usually included in stage 4 treatment plans. A study of patients who started palliative care when diagnosed lived three months longer than those who opted to continue treatment with chemotherapy and radiation. Palliative care patients also reported an improved quality of life.
Complementary therapy methods cannot cure cancer but are used to relieve symptoms of stage 4 lung cancer. They include:
- Acupuncture to relieve pain, nausea, and vomiting
- Hypnosis can reduce anxiety, nausea, and pain
- Massage relieves anxiety and pain
- Meditation can reduce stress and improve quality of life
- Yoga can help improve sleep
New Lung Cancer Treatments Made Possible Through Clinical Research
Research to find new and better treatment methods for lung cancer is ongoing. Immunotherapy is a major area of research. Clinical trials are testing new combinations of immune therapies, with and without chemotherapy. Several new immunotherapy treatments have been approved for advanced lung cancers. Research is also being done to determine which patients can benefit from immunotherapies.
Targeted therapies are becoming more widely used, and new ones are being developed.
Researching how to provide a better and earlier diagnosis, more accurate surgeries with robot-assisted surgery, and better imaging techniques are just a few of the diverse projects that are improving stage 4 lung cancer cure rates and extending lives.
A key part of developing new treatments is the work of clinical trials where new drugs and methods are tested on actual patients. This is one of the steps required before new treatments can gain approval and become widely available. Patients who want to pursue every opportunity for a cure should ask their oncologists about participating in clinical trials.
The Latest Treatments & Trials for Lung Cancer Are Available through Rocky Mountain Cancer Centers
The lung cancer specialists at RMCC make all of the latest treatments available to patients with lung cancer, including the latest targeted therapies for NSCLC and lung cancer clinical trials. Whether this is your first lung cancer diagnosis or the cancer has recurred, our team is available to review your specific situation and make a treatment plan recommendation. We are also available for second opinions.
Request an appointment at one of our locations in the Denver area, Colorado Springs, Boulder, and throughout the Front Range.