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Lung cancer

What is stage IV lung cancer?

Stage IV lung cancer is the most advanced stage of the disease. In this stage, the disease has spread, or metastasized, from the lung in which it originated to the other lung, the pericardium (membrane around the heart and lungs), chest and/or other areas of the body. Stage IV lung cancer, also called metastatic lung cancer, may be found in the lymph nodes and multiple organs, including the kidneys and the adrenal gland, but it most often spreads to the bones, liver and/or brain. Metastatic tumors, or metastases, are considered secondary tumors and are still considered lung cancer, even when found in other parts of the body. Stage IV lung cancer, which may also be referred to as extensive-stage cancer, spreads to other parts of the body through the lymph system or bloodstream.

Many patients are found to have stage IV lung cancer when they are first diagnosed with the disease. In fact, according to the National Cancer Institute, about 66 percent of patients diagnosed with small cell lung cancer and about 40 percent of patients diagnosed with non-small cell lung cancer have stage IV disease.

At Cancer Treatment Centers of America® (CTCA), we offer a variety of treatment options to patients with stage IV lung cancer, including immunotherapy, radiation therapy and chemotherapy. In some cases, treatments may be palliative, used to ease the symptoms associated with the disease and improve quality of life. Qualifying patients may also be candidates for clinical trials, which may offer treatments not otherwise available.

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Stage IV lung cancer symptoms

The symptoms of stage IV lung cancer may depend on where in the body the disease has spread. For instance:

Other symptoms of stage IV lung cancer include:

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Types of stage IV lung cancer

There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer. In most cases, patients first diagnosed with either type are found to have stage IV disease.

As their names suggests, these types of lung cancer are diagnosed when a pathologist identifies a specific type of diseased cell. Designating the type of lung cancer is a critical first step in understanding treatment options.

Small cell lung cancer

About 10 percent of all lung cancers are small cell lung cancers. This disease is often very aggressive and may spread quickly. There are two main subtypes of small cell lung cancer:

Non-small cell lung cancer

This is the most common type of lung cancer, accounting for 90 percent of all lung cancer diagnoses. Non-small lung cancers may grow more slowly than small cell lung cancers. There are three main types of non-small cell lung cancer:

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Substages of stage IV lung cancer

Stage IV lung cancer may be divided into stage IVA and stage IVB, depending on the where the disease has spread.

Stage IVA

In stage IVA lung cancer, the disease has spread to areas around the lung and/or one distant organ. Areas around the lung may include the lymph nodes and/or the previously healthy lung.

Stage IVB

In stage IVB lung cancer, the disease has spread to multiple places in one or more distant organs or bones.

Extensive stage

Advanced small cell lung cancer may also be referred to as extensive-stage small cell lung cancer. In this stage, the cancer has spread to other parts of the body such as the other lung, the bone and/or bone marrow, the brain or the fluid around the lungs. Most patients are found to have extensive-stage disease when first diagnosed with small cell lung cancer.

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Treatments of stage IV lung cancer

Treatment options for stage IV lung cancer may depend on where and how extensively the cancer has spread. In some cases, treatments may be considered palliative, offered to ease side effects and improve quality of life. Treatment options include:

Chemotherapy: Drugs may be given alone, in combination and/or with other treatments. Chemotherapy may not be an appropriate option to treat lung cancer metastases in the brain.

Radiation therapy: This treatment may be used to shrink tumors and ease disease-related side effects.

Immunotherapy: Drugs known as checkpoint inhibitors may be used to help the immune system better recognize and attack lung cancer cells.

Surgery: Surgery may be an option to remove tumors from the lungs and the chest cavity and to remove affected lymph nodes. This treatment may not an option if the cancer has spread to multiple organs, but it may be used to remove tumors that are causing pain or other side effects.

Targeted therapy:These drugs are designed to target specific receptors or proteins on cancer cells to slow tumor growth.

Photodynamic therapy: This palliative treatment uses light and light-sensitive agents to shrink tumors in the lung.

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Clinical trials for stage IV lung cancer

Clinical trials are a key testing ground for determining the effectiveness and safety of new treatments for many types and stages of cancer, including stage IV lung cancer. As part of our commitment to providing innovative treatment options to our patients, the doctors at CTCA® may recommend that stage IV lung cancer patients enroll in carefully selected clinical trials.

Clinical trials may offer treatment options before they are approved by the U.S. Food and Drug Administration and that may be otherwise unavailable. Talk to your doctor about whether a clinical trial is a good option for you and ask about the risks and various requirements involved.

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Integrative care for stage IV lung cancer

Stage IV lung cancer and treatments for the disease may also come with symptoms and side effects that may affect your quality of life. Depending on where the disease has spread, stage IV lung cancer may cause symptoms such as pain, fatigue or difficulty breathing. Likewise, treatments for stage IV lung cancer may cause loss of appetite, nausea, neuropathy and/or other side effects. At CTCA, our team of doctors and clinicians work closely with integrative care experts, including nutrition-therapy, naturopathic providers, physical therapists and mind-body therapists, to help you manage side effects and maintain your strength and stamina throughout treatment.

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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 IV 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 IV 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 IV lung cancer diagnosis, so you can make informed decisions about your care.

Patricia Rich - Medical Oncology Director, CTCA Lung Cancer Institute; Vice Chief of Staff

Patricia Rich

Medical Oncology Director, CTCA Lung Cancer Institute; Vice Chief of Staff, CTCA Atlanta

Bruce Gershenhorn - Medical Oncologist

Bruce Gershenhorn

Medical Director, Lung Cancer Center, CTCA Chicago

Shayma Master Kazmi - Hematologist-Oncologist & Medical Oncologist

Shayma Master Kazmi

Medical Oncologist & Hematologist, CTCA Philadelphia

Ashish Sangal - Medical Director of Lung Center, Medical Oncologist

Ashish Sangal

Medical Director of Lung Center, Medical Director of Medical Oncology, CTCA Phoenix

Peter Baik - Lung Cancer Institute Leader, Cancer Treatment Centers of America

Peter Baik

Thoracic Surgery Director, CTCA Lung Cancer Institute, Director of Osteopathic Education

"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."

Jane Elterman

Jane E.

Lung Cancer

MORE ABOUT JANE

More About JANE

Quality of care

At CTCA, we treat cancer patients the way we would want our own families to be treated. We call it the Mother Standard® of care. It’s the driving force in all we do—treating all patients with the compassion and respect they deserve.

Learn more about the Mother Standard of care