Key Takeaways

  • A diagnosis of stage 4 NSCLC means that the cancer has spread from the lung to other areas of the body, requiring treatments like chemotherapy, immunotherapy, surgery, and radiotherapy.
  • Symptoms of stage 4 NSCLC may include a persistent cough, shortness of breath, and chest pain, as well as symptoms related to where the cancer has spread, such as headaches or jaundice (yellowing of the skin or eyes).
  • Although stage 4 NSCLC is advanced, treatments are improving, leading to increased survival rates and better quality of life for those living with the condition.

At stage 4, NSCLC is no longer isolated in one lung. It has spread to either your other lung or other organs and tissues elsewhere in your body.

Living with stage 4 NSCLC can feel scary. However, encouraging treatment developments are helping people live longer and enjoy a better quality of life.

A 2020 research review even states that new treatments are “turning lung cancer from an incurable disease into a chronic disease.”

This article takes a closer look at stage 4 NSCLC, including symptoms, treatment, and outlook.

The symptoms of stage 4 NSCLC go beyond the coughing and congestion that come with earlier stages of NSCLC. It’s often the severity of these symptoms that leads people to get a lung cancer screening.

The symptoms of stage 4 NSCLC include:

  • nagging cough
  • shortness of breath
  • chest pain
  • hoarse voice
  • coughing up blood
  • blood-tinged mucus

Metastatic cancer symptoms

If the cancer has metastasized, meaning it has spread to other parts of your body, you may have other symptoms. Some of them may include:

  • headache
  • aches and pains, especially in your bones
  • jaundice (a yellowing of your skin and eyes)
  • swollen lymph nodes, particularly those near your neck or collarbone
  • conditions related to your nervous system, such as dizziness, balance problems, muscle weakness, or tingling in your limbs

Moffitt Cancer Center specialists note that some symptoms may be more likely to develop based on where the cancer has spread. For example, headaches are more strongly associated with brain metastasis, while jaundice suggests liver metastasis.

The National Cancer Institute reports that 40% of new NSCLC diagnoses are already at stage 4.

If you have lung cancer symptoms or a history of smoking or exposure to airborne toxins, your doctor may recommend that you have some imaging tests to diagnose or rule out lung cancer.

The first test may be a simple chest X-ray, which could reveal a suspicious nodule or mass. For more precision and to find lesions that may be missed on an X-ray, a CT scan might be ordered instead of or in addition to a lung X-ray.

Lung function tests may also be performed after a diagnosis to determine whether your lungs can withstand the removal of cancerous tissue.

Bronchoscopy

If you are coughing up mucus, a lab test may reveal the presence of cancer cells. Your doctor may also perform a bronchoscopy. In this procedure, they insert a thin, flexible tube with a camera attached down your throat and into a lung.

This provides a close-up view of lung tissue and any abnormal masses or nodules. A bronchoscopy may also include a biopsy.

Lymph node testing

If your doctor suspects the cancer has traveled to your nearby lymph nodes or other parts of your body, further tests may be appropriate. These may include:

  • endobronchial ultrasound
  • endoscopic esophageal ultrasound
  • mediastinoscopy
  • mediastinotomy
  • thoracoscopy

The treatment timeline for NSCLC can vary significantly based on the type of treatment you’re receiving and how your body and the cancer respond to various treatments.

Chemotherapy

In stage 4 NSCLC, treatment is usually indefinite. Chemotherapy and immunotherapy can last longer than months.

Chemotherapy generally starts killing cancer cells and reducing tumor size within a few weeks, whereas immunotherapy takes longer, at least a couple of months.

Surgery

When NSCLC has reached stage 4, surgery to remove cancerous tissue may not be an option. This is because the cancer may have spread to multiple sites, including organs and bones, and it may be inoperable.

In some cases of stage 4A, when the cancer has spread to one other site, surgery may be an option. It may be combined with radiation therapy and chemotherapy.

Immunotherapy

Another treatment producing encouraging results in recent years is immunotherapy. This treatment involves the use of medications that help your immune system destroy cancer cells.

A 2020 review states that immunotherapy medications prove to be effective in treating people living with advanced NSCLC. Some medications include:

Radiotherapy

A 2018 review found that radiotherapy, when combined with immunotherapy and chemotherapy, may be especially helpful in repressing the tumor’s growth and providing systemic control over the condition.

The outlook for people living with stage 4 NSCLC can be a hopeful one, particularly if your body and the cancer respond well to treatment. In fact, the National Cancer Institute reported in 2020 that NSCLC mortality rates are falling in the United States due to remarkable advances in treatment.

A cancer outlook is often presented as a 5-year relative survival rate. People with the same type of cancer at the same stage are compared with people in the larger population. For stage 4 NSCLC, the 5-year relative survival rate is about 9%.

While coping with stage 4 NSCLC is certainly a challenge, know that there are plenty of people living and maintaining a strong quality of life with the condition.

Living with NSCLC means more than treating symptoms and side effects — it also means handling the emotional weight of the condition. Managing the emotional aspect of a serious condition like NSCLC is important and shouldn’t be ignored as you focus on the cancer treatment itself.

Some of the important steps you can take include:

  • Find support: Emotional assistance can make a big difference, whether from friends, family, or a cancer support group. Lean on people close to you, and don’t feel embarrassed about asking for help or feeling anxious about the future.
  • Make small lifestyle adjustments: Follow your doctor’s suggestions about a nutritious diet, regular exercise, sleep, and other facets of everyday life that support good health.
  • Explore spirituality: If you have strong spiritual beliefs or even questions about spirituality, consider spending time contemplating those feelings and ideas and conversing with others who may share your beliefs.

NSCLC support organizations

The following organizations provide support and resources for people with stage 4 NSCLC as well as their families and caregivers:

  • The American Lung Association oversees an online community of lung cancer survivors and helps you find support groups in your community. It also operates the Better Breathers Club, which educates people about breathing techniques, exercise, and news on treatment.
  • The American Cancer Society offers information and inspiration for people living with lung cancer. It answers questions about treatment and life after treatment and explores other topics related to lung cancer testing and caregiving.
  • The Foundation for Lung Cancer provides a wealth of information about lung cancer. It also offers free personalized help for people seeking resources and assistance as well as opportunities to volunteer or otherwise help people in their community or around the country.

Stage 4 NSCLC is the most advanced form of the condition and can be the most challenging to treat. That said, new treatments are available that can slow the progression of the disease and improve your quality of life.

According to the American Cancer Society, the 5-year relative survival rate for stage 4 NSCLC is 9%. This survival rate is based on people who received a diagnosis of NSCLC between 2012 and 2018.

It’s worth noting that treatments for NSCLC have improved since then. In addition, survival rates are only estimates, and everyone responds to the disease and its treatments differently.

NSCLC may spread at different rates. The average time for a tumor to double in size is 7 months. However, this is different for everyone.

Factors that may influence the progression of NSCLC include the type of NSCLC, its stage at diagnosis, and how a person and the cancer respond to treatment.

While there is no cure for stage 4 NSCLC, some people may live for many years after receiving a diagnosis. Advances in treatments are helping people live longer and improving their quality of life.

Advancements in the treatment of stage 4 NSCLC are making it possible for people to live longer and enjoy more comfortable lives.

If you or someone you know has stage 4 NSCLC, the best thing you can do is become educated about the condition and treatment options. The more you know, the better you can discuss these topics with your doctors and make decisions about your care.