Metastatic Lung Cancer

Metastatic lung cancer occurs when cancer that started in the lungs has spread to other parts of the body. While this advanced stage cannot usually be cured, modern treatments can help control the disease, manage symptoms, and improve quality of life for some time.

Table of contents

• What is metastatic lung cancer?
• Where lung cancer commonly spreads
• Symptoms
• How doctors diagnose metastatic lung cancer
• Treatment options
• Coping and emotional support
• Taking care of yourself during treatment

What is metastatic lung cancer?

Metastatic lung cancer means that cancer has spread from where it started in the lung to other parts of the body. It is also called advanced or secondary cancer, and sometimes referred to as stage 4 lung cancer^[1][6]. The name of the cancer does not change when the disease affects a new area. For example, lung cancer that spreads to the liver is called metastatic lung cancer, not liver cancer^[3].

Metastatic lung cancer can happen in two ways. A cancer might be advanced when it is first diagnosed. Or it may come back some time after you were first treated, which is called recurrent cancer^[1]. According to research, in approximately 30 to 40 percent of people with non-small cell lung cancer, the cancer had already spread by the time it was diagnosed^[3].

Unfortunately, advanced cancer cannot usually be cured. But treatment might control it, help with symptoms, and improve your quality of life for some time^[1]. Thanks to advances in targeted drugs, immunotherapies, improved radiation technologies, and less invasive surgeries, patients with metastatic lung cancer are now living longer than they did in the past^[6].

It’s important to understand that metastatic lung cancer is different from locally advanced lung cancer. Locally advanced cancer has spread into tissues around the lungs and might have spread into nearby lymph nodes (small bean-shaped organs that are part of the body’s defense system), but has not spread to distant parts of the body^[1].

Where lung cancer commonly spreads

Not all lung cancers will spread. But if the cancer does spread, there are certain parts of the body that it is more likely to go to^[1]. The most common areas for lung cancer to spread include nearby lymph nodes or a single distant lymph node, the brain, bones, the liver, the adrenal glands (small organs located near the kidneys), and other parts of the lung or the other lung^[1][6].

Cancer spreads to different parts of the body through specific routes. Hematogenous spread occurs through the bloodstream and is seen in tumors with venous drainage into the lungs, such as head and neck cancers, thyroid, adrenals, kidneys, testes, melanoma, and bone cancers. Lymphatic spread can happen in two ways: through forward invasion through the diaphragm or pleural surfaces, or backward spread from lymph node deposits near the center of the chest. Examples include cancers of the lung, stomach, breast, pancreas, uterus, rectum, and prostate^[4].

Some metastatic cancers are called oligometastatic cancers, which means the cancer has spread to only a limited number of sites, typically five or fewer. Research has shown that these cancers can sometimes be controlled for longer periods with more aggressive treatment approaches, and in rare cases, they can even be cured^[6].

Symptoms

Lung cancer often has no symptoms in its early stages. The lungs do not have pain receptors, which means many people have no symptoms when lung cancer is limited to the lungs. As a result, many lung cancer patients are diagnosed after the disease has already spread to another area of the body^[6].

Symptoms of metastatic lung cancer depend on where the disease has spread^[6]. Common symptoms that may occur with metastatic lung cancer include:

• A cough that doesn’t go away
• Shortness of breath
• Chest pain
• Coughing up blood, even a small amount
• Frequent chest infections
• Hoarseness
• Wheezing
• Losing weight without trying
• Loss of appetite

When lung cancer spreads to other parts of the body, additional symptoms may appear. Bone pain, such as hip pain, is common if lung cancer spreads to the bones. When cancer spreads to the brain, symptoms might include headache, vision changes, dizziness, or weakness in an arm or leg^[6][14]. The lymph nodes, such as those in the neck, may also be swollen when lung cancer spreads^[6].

Other possible symptoms include a swollen face or neck, which might happen because the tumor is blocking a large vein in the chest. This is called superior vena cava obstruction. Other symptoms of this condition include swollen veins in the neck, breathlessness, headaches, and dizziness^[14].

How doctors diagnose metastatic lung cancer

Diagnosis is the process of finding out the cause of a health problem. Your doctor will start by taking your health history and asking about your symptoms. They will also do a physical exam, which may include listening to your lungs^[2].

Blood tests are usually done to check your general health and find out how some organs are working. These tests may reveal if cancer has spread to organs other than the lungs. A complete blood count checks your general health and how well the bone marrow is working. Other blood tests can measure substances in the blood that help doctors understand how the kidneys and liver are functioning. Tumour marker tests measure the amount of a specific protein in the body and may be done if you have had cancer before^[2].

Imaging tests are an important part of diagnosing metastatic lung cancer. A chest x-ray is usually the first test done to try to find out what is causing symptoms like a cough and shortness of breath^[2]. A CT scan (computed tomography scan) of the chest is a common test used to check for lung spread because it provides more detailed images^[2]. Other imaging tests that may be used include MRI scans (magnetic resonance imaging), PET scans (positron emission tomography), and bone scans to see if cancer has spread to other parts of the body.

A biopsy, which involves taking a small sample of tissue to examine under a microscope, may be performed to confirm the diagnosis. A specialist called a pathologist can see whether the cells have the same features as the original lung cancer cells^[3].

Treatment options

A team of health care professionals will discuss your treatment options and decide what treatment you might need. The type of treatment you have depends on several factors, including what type of lung cancer you have, how big it is, where it has spread, and your general health^[9].

Treatment for metastatic lung cancer has advanced dramatically in recent decades. There are new targeted drugs and immunotherapies, improved radiation technologies, and less invasive surgeries^[6]. While eliminating metastatic lung cancer can be difficult, treatments like chemotherapy, radiation, and targeted therapies can help control the cancer’s growth, relieve symptoms, and potentially extend a person’s life^[3].

Chemotherapy uses anti-cancer drugs to destroy cancer cells. You might have chemotherapy alone or combined with other treatments^[9]. Chemoradiotherapy means having chemotherapy and radiotherapy treatment together^[9].

Radiotherapy uses radiation from a machine to destroy cancer cells. It is a common treatment for lung cancer and can help shrink tumors that are causing symptoms^[9][14].

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Immunotherapy drugs help the immune system to attack cancer. These treatments are increasingly used for lung cancer^[9].

For oligometastatic lung cancer, doctors may use targeted radiation or surgery in addition to drug therapies to control the spread of cancer^[6].

Other treatments may be used to help manage specific symptoms. Laser therapy uses a focused beam of light to destroy tissue. Photodynamic therapy kills cancer cells using a combination of a light-sensitizing drug and bright light. Cryotherapy freezes cancer cells. A stent, which is a hollow tube, may be placed in your airway to keep it open and help you breathe^[9].

Coping and emotional support

Finding out that you have metastatic lung cancer can be distressing and may come as a shock. It’s common to feel uncertain and anxious. It’s normal to not be able to think about anything else^[1]. You might have a number of different feelings, including feeling shocked, upset, numb, frightened, confused, angry, guilty, or sad. You may have some or all of these feelings, or you might feel totally different^[21].

Everyone reacts in their own way, and there is no right way to feel^[1][21]. Some people find it helpful to find out more about their cancer and the treatments they might have. Many people find that knowing more about their situation can make it easier to cope. You might feel that you don’t want to know much information straight away, and that’s okay. You can always ask for more information when you are ready^[1][21].

Talking to your friends and relatives about your cancer can help and support you. Help your family and friends by letting them know if you would like to talk about what’s happening and how you feel^[21]. You might find it easier to talk to someone other than your own friends and family. Your specialist nurse or doctor may be able to arrange for you to see a counselor. There are also support groups where you can meet other people who have been diagnosed with lung cancer^[21].

A lung cancer nurse specialist can support you and provide information about other sources of advice and support. They will also have a contact number so you can call them if you have any questions^[1].

If you have feelings of depression, talk to your doctor so they can provide you with advice and support^[1].

Taking care of yourself during treatment

Lung cancer treatment can cause side effects, but there are steps you can take to support your mental and physical well-being during treatment.

Nutrition and hydration: There’s no special diet that treats lung cancer, but eating well can help you feel your best. Focus on vegetables, fruits, lean proteins, and whole grains. Stay away from processed foods or choices that are high in sugar or fat. If your treatment affects your taste, smell, or appetite, a nutritionist can help you find ways to keep your calories up^[13]. Drinking plenty of water, broth, or other healthy fluids can help make the side effects from your treatment less severe^[13].

Physical activity: If you’re having trouble breathing, exercise may feel like a challenge. But physical activity, even light movement, can boost your mood, help you feel less tired, strengthen your heart and muscles, and lower your chance of other cancers. Talk to your doctor about how you can get moving safely^[13][19]. Gentle exercises like yoga can be particularly helpful as it improves breathing and can be done while going through treatment^[13].

Managing symptoms: Tell your doctor or nurse about your symptoms so they can help you. Pain can affect your quality of life in a big way. Don’t hesitate to get in touch with your doctor if you have discomfort. There may be medications or other tools that can bring you relief^[13]. Breathlessness can often be improved with simple measures such as breathing slowly through your nose and out through your mouth, making daily activities easier, using a fan to direct cool air toward your face, and eating smaller and more frequent meals^[1].

Rest and stress management: Listen to your body and take it easy when it tells you to. Rest helps you fight fatigue. Don’t overload your schedule and leave space in your day to nap or just sit^[13]. Meditation helps you focus on the moment and can help ease feelings of anxiety and worry^[13]. Deep breathing exercises, where you sit with your eyes closed and take in air slowly through your nose and exhale through your mouth, can also be helpful^[13].

Staying engaged: Dealing with cancer doesn’t have to mean cutting fun out of your life. Laughter and feelings of joy help ease stress. Watch your favorite TV show, spend time with people you enjoy, or get reacquainted with your favorite hobby^[13]. Some patients may find a sense of calm and meaning in continuing their daily activities such as work, while others may find strength in nature^[17].

Palliative care: Palliative care doesn’t mean end-of-life care. Your team can help get you the resources and support you need to ease the physical and emotional symptoms you feel. They can also help you better understand your condition and treatments^[13].

If you smoke, consider quitting. Quitting smoking can help protect your lungs and take off unnecessary pressure during lung cancer treatment. It will also help you heal once treatment is over^[19].