Non-Small Cell Lung Cancer Stage IV

Stage IV non-small cell lung cancer means the disease has spread from the lungs to distant areas of the body. Although it usually can’t be cured, a variety of treatments can slow the cancer’s growth and help manage symptoms.

Table of contents

• What Is Stage IV Non-Small Cell Lung Cancer?
• Signs and Symptoms
• How Doctors Diagnose the Disease
• Treatment Options

What Is Stage IV Non-Small Cell Lung Cancer?

Stage IV non-small cell lung cancer, also called metastatic or advanced lung cancer, means the disease has spread from the lungs to distant areas of your body^[2]. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 80% to 85% of all lung cancer cases^[6].

Stage 4 can be divided into 4A and 4B. In stage 4A, the cancer may have spread to the other lung, the space between the lungs, the layers covering the lung or heart, or there may be a single area of cancer that has spread outside the chest to a distant lymph node or organ such as the liver, bones, or brain^[5]. Stage 4B means the cancer has spread to several areas outside the chest, such as distant lymph nodes or other organs, or both^[5].

Common places where stage IV non-small cell lung cancer may spread include the liver, brain, bones, adrenal glands, and lymph nodes^[2][6].

Signs and Symptoms

The symptoms you had in earlier stages of the disease may continue or get worse^[2]. Some problems you may experience include:

• Cough that won’t go away
• Chest pain that gets worse when you breathe or cough
• Fatigue
• Shortness of breath
• Loss of appetite and weight loss
• Coughing up blood
• Wheezing
• Hoarseness

Other symptoms may appear as lung cancer spreads to different parts of your body^[2]. If it moves into the brain or spinal cord, you may feel dizzy, get headaches, or have trouble keeping your balance^[2]. If it spreads to the liver, your skin and eyes may turn yellow, a condition called jaundice^[2]. You may feel pain at the sites of the tumor^[2].

How Doctors Diagnose the Disease

Your doctor may use several tests to check if non-small cell lung cancer has spread to stage IV^[2].

Imaging tests make pictures of the body and can show the location and size of the lung cancer^[2]. Your doctor may use X-rays, CT scans, or PET scans to see if new tumors have formed in your body and check how large they are^[2]. High-resolution CT and PET scans are good at finding tiny tumors that might not show up on an X-ray^[2].

A biopsy is a procedure to remove a sample of tissue for testing in a lab^[2]. If your doctor suspects your lung cancer has spread to other organs, you may get a biopsy to confirm or rule out cancer in those areas^[2]. Your doctor may use a hollow needle to remove a small sample of tissue from your lymph nodes or liver, for instance^[2]. A specialist called a pathologist will look at it under a microscope to see if there are cancer cells^[2]. Genetic tests on the tissue can also identify specific features of the cancer^[2].

Treatment Options

Your doctor will likely use a combination of treatments when you’re in stage IV^[2]. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan^[3]. The aim of treatment is to control the cancer and help to reduce symptoms^[5]. Your plan may include:

Chemotherapy may be offered for stage 4 non-small cell lung cancer if there are no genetic changes that can be identified in the lung cancer tumors using cell and tissue studies^[3]. Although it’s not likely to cure you at this stage, chemotherapy can shrink the tumors you have or slow their growth^[2]. The most common chemotherapy drug combination used to treat stage 4 non-small cell lung cancer is cisplatin or carboplatin with gemcitabine^[3]. Other combinations may be used depending on your specific situation^[3].

Targeted therapy may be offered instead of chemotherapy for stage 4 non-small cell lung cancer if there are genetic changes to the lung cancer cells^[3]. If your tumor cells have certain genetic mutations (changes), your doctor may suggest a targeted drug to destroy those specific cancer cells^[2]. For example, some tumor cells grow quickly because they make too much of a protein called EGFR (epidermal growth factor receptor)^[2]. Drugs called EGFR inhibitors, like erlotinib, gefitinib, and osimertinib, can be used if your cancer has this mutation^[3]. The type of targeted therapy given will depend on the type of genetic mutation that was identified using cell and tissue studies^[3].

Immunotherapy is a type of medicine that activates your immune system to find and destroy cancer cells^[2]. Your doctor may suggest drugs called immune checkpoint inhibitors, like nivolumab and pembrolizumab^[2].

Radiation therapy uses high-energy beams to kill tumor cells. This therapy can shrink your tumors’ size and ease pain^[2]. Newer radiation methods precisely target tumor cells to lessen side effects^[2]. Stereotactic radiosurgery (SRS) may be used on any cancer left behind or for brain metastases^[5].

Laser therapy is sometimes used to treat small tumors that block your airways^[2]. You may find it easier to breathe once these tumors are removed^[2].

Fluid drainage may be needed because as lung cancer advances, fluid buildup in some parts of your body, especially around the lung and inside the sac that surrounds the heart, can cause discomfort and breathing problems^[2]. If this happens, your doctor can drain the fluid with a special needle^[2].

Additional supportive therapies may help improve the quality of life for people with stage 4 lung cancer^[13]. These focus on relieving chest pain, addressing shortness of breath, removing blockages from airways, and treating fluid buildup^[13].