The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

What is stage 4 lung cancer?

Like other types of cancer, lung cancer is categorized by stages based on how widespread it is in the body. In general, the higher the stage, the more severe the cancer.

Stage 4 is the most advanced form of lung cancer and is metastatic—meaning the cancer has spread from the lung, where it originated, into other parts of the body.

Metastasis occurs when cancer cells separate from the original tumor and move through the body via the blood or lymph system. They often travel to the brain, bones, liver and adrenal glands. At that point, any metastatic tumors that develop in another area of the body are still considered lung cancer, because they are made up of lung cancer cells.

Stage 4 lung cancer symptoms

Sometimes, advanced lung cancer is discovered due to symptoms. The following lung cancer symptoms may accompany any stage, although they’re more likely to occur as the cancer progresses:

  • Persistent, worsening cough
  • Hemoptysis (coughing up blood)
  • Blood in spit
  • Chest pain that may be aggravated by deep breaths, coughing, laughing
  • Hoarse voice
  • Poor appetite
  • Unintentional weight loss
  • Shortness of breath
  • Fatigue or weakness
  • Wheezing
  • Frequent infections such as bronchitis and pneumonia

Other symptoms that may develop as a result of the cancer metastasizing to other parts of the body include:

  • Headaches, weakness or numbness in a limb, dizziness, balance issues or seizures (if the cancer has spread to the brain)
  • Jaundice (if the cancer has spread to the liver)
  • Pain in the bones of the back or hips
  • Swollen lymph nodes in the neck     

These symptoms may be caused by a less serious condition. Still, it’s important to visit your doctor if you’re experiencing these symptoms, because many are serious, and your doctor may help you determine what is causing them.

Metastatic lung (stage 4) cancer testing

Doctors use various tests, procedures and scans to look for lung cancer. They can be used to detect cancer signs, verify a diagnosis if cancer is suspected or determine the cancer's stage.

Advanced or metastatic lung cancer may be diagnosed through these procedures:

  • Magnetic resonance imaging (MRI) scans create detailed images of inside the body and help determine whether lung cancer has spread to the brain or spinal cord.
  • Computed tomography (CT) scans are similar to MRI scans in that they show images of the inside the body. They may help discover whether lung cancer has spread to the lymph nodes, adrenal glands, liver, brain or other organs.
  • Positron emission tomography (PET) scans may show where cancer cells are located in the body. Before a PET scan, patients receive a small injection of a substance (radioactive sugar) that’s meant to travel throughout the body. The substance would settle in any area(s) with cancer cells, indicating the presence and location of the cancer.
  • Bone scans help detect whether lung cancer has reached the bones. These tests are similar to PET scans in that they require an injection of a radioactive substance that will become concentrated in bones that contain cancer cells.

Stage 4 non-small cell lung cancer (NSCLC)

Non-small cell lung cancer (NSCLC) is one of two major types of lung cancer, and the more common.


NSCLC stages, which range from stage 1 to stage 4, are determined based on several factors, including the main lung tumor’s size and whether the cancer has spread to lymph nodes near the lungs or metastasized farther away in the body.


In stage 4, NSCLC is metastatic, meaning that it has spread beyond the lung where it began. Depending on how extensively it has spread, stage 4 NSCLC is further divided into two substages: 4A and 4B.


In stage 4A, the tumor may vary in size, and it may or may not have spread to the lymph nodes. One (or more) of these may also be the case:

  • Cancer has only spread to one other location, such as the second lung (where the cancer did not start) or another distant organ such as the brain, liver, adrenal gland or kidney.
  • It has spread to the lining or fluid around the lungs or heart.
  • Additional tumors are in the lung, not including the primary tumor.

In stage 4B, the cancer is widespread, in multiple places or organs far away from the lung.

While cancers that fall into either of these substages may be referred to as stage 4, they may require different treatments. Stage 4B is more common, but it’s generally more difficult to treat and has a lower chance of survival.

Stage 4 small cell lung cancer (SCLC)

The second most-common type of lung cancer after NSCLC is small cell lung cancer (SCLC). SCLC is not typically grouped into numbered stages. Instead, it’s identified as limited stage or extensive stage.

  • With limited-stage SCLC, the cancer is present in one lung and may have spread to lymph nodes near that lung, but it’s contained to one side of the chest. If the lung has multiple tumors, the cancer may not be in the limited stage.
  • Extensive-stage SCLC is similar to stage 4 NSCLC in that it is metastatic. SCLC is considered extensive if it has spread throughout the original lung, into the other lung or faraway lymph nodes, or to any other areas of the body.

Treating metastatic (stage 4) lung cancer

Treating metastatic lung cancer is challenging. This stage of cancer may continue to spread, and small bits of the disease may linger in the body and cause a recurrence, even if the treatment appears successful. Therefore, treatment will typically focus on extending and bettering life by relieving symptoms and controlling the cancer's growth. A few things to consider:

  • If you have advanced lung cancer, ask your doctor what to expect from treatment.
  • You may even want to seek a second opinion from another doctor to ensure you’re satisfied with your treatment plan.
  • Your care team will weigh the benefits of treatment with the potential side effects and how these may impact your health and well-being.

Treatment options for metastatic lung cancer may vary depending on factors such as:

  • The type of cancer
  • The cancer’s spread and location
  • The presence of underlying gene changes (mutations), which may be fueling the cancer
  • The patient's symptoms and overall health
  • The patient's preferences

Treating stage 4 NSCLC

Stage 4 NSCLC treatment may include:

If the cancer has metastasized to one other site—particularly the brain—a typical course of treatment may begin with surgery and radiation therapy to target the area where the cancer spread. Then, the focus shifts to the lung, where treatment may include some combination of surgery, chemotherapy and radiation (depending on the specifics of the tumor).

More often, though, cancers at this stage may be too widespread and require systemic treatments that attack the cancer throughout the body.

The first consideration in choosing a systemic treatment is whether there are specific genetic changes in the primary lung tumor that may be targeted. If so, targeted therapy drugs designed to act on these gene changes would likely be the first choice. Chemotherapy, immunotherapy, or both, also may be options.

Treating extensive-stage SCLC

Because extensive-stage SCLC is cancer that has spread extensively in the body, systemic treatments (such as chemotherapy or immunotherapy) would be more useful than therapies (such as radiation therapy or surgery) that target a specific region of the body. As with stage 4 NSCLC, treatment would likely focus on blocking the cancer's growth, relieving symptoms and extending the patient's life. Chemotherapy and immunotherapy, or a combination of both, are typically the first line of treatment at this stage.

Palliative care options for stage 4 lung cancer

Patients with advanced lung cancer typically receive palliative care, whether alongside other treatments or on its own (if the patient has chosen not to pursue standard treatment).

Palliative care is intended to improve the quality of life for patients with serious conditions by focusing on treating emotional and physical symptoms. This approach emphasizes the patient and his or her needs over targeting the disease itself.

Palliative care is not the same thing as hospice, and may be beneficial for patients dealing with a severe illness—at any stage. Joining support groups or speaking with a counselor may also be helpful.

In some cases, if your health is quickly declining, standard treatments may be too taxing on your body and lead to debilitating side effects. If this is true, ask your doctor about lowering the treatment doses or receiving palliative care on its own.

Quality of life and survival rate for stage 4 lung cancer

Lung cancer becomes more serious and difficult to treat as it progresses. Advanced or metastatic lung cancers of any kind tend to have very low survival rates. However, the cancer's stage—or how advanced it is—is a significant factor in your prognosis.

One way to estimate life expectancy when battling cancer is to consider the five-year relative survival rate for that type of cancer. A five-year relative survival rate shows the likelihood that a person with a specific type and stage of cancer would live for at least five years after the diagnosis, compared with people who don't have cancer.

Patients with metastatic NSCLC that’s spread to distant organs or regions of the body have a five-year relative survival rate of 7 percent, according to ACS. For metastatic SCLC that’s widespread in the body, the five-year relative survival rate is 3 percent.

It's important to remember that these rates are based on patients who had advanced lung cancer at least five or more years ago, and the rates may not account for recent advances in treatment options. The rates also don't consider all factors specific to each individual, such as the type of cancer and the care he or she is receiving.

Our lung cancer centers

At CTCA, our lung cancer centers bring together multidisciplinary teams of doctors and other clinicians with the expertise to treat all stages of the disease, including stage 4 lung cancer. The experts at our lung cancer centers collaborate daily, delivering personalized treatments tailored to each patient’s needs and goals.

Meet our lung cancer center doctors

Stave 4 lung cancer is a complex disease. At CTCA, our lung cancer doctors and other clinicians are committed to helping you understand the challenges that come with a stage 4 lung cancer diagnosis, so you can make informed decisions about your care.

Jason Beland - Chair, CTCA Department of Radiology

Jason Beland

Chair, CTCA Department of Radiology

Christopher Parks - Interventional Pulmonologist

Christopher Parks

Interventional Pulmonologist, CTCA Atlanta

Marnee Spierer - Chief of Staff & Chief of Radiation Oncology

Marnee Spierer

Chief of Staff & Chief of Radiation Oncology, CTCA Phoenix

Jane Elterman

Jane E.

Lung Cancer

"When I was diagnosed, my niece was expecting her first child. Five years later, I was there to see this child start kindergarten. We’ve added more nieces and nephews to the family since then; I’ve seen graduations from college and high school; and my stepdaughter is expecting her first child. On top of all these blessings, I’m feeling great. I had forgotten how good I could feel."


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