Stage 4 lung cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on September 12, 2022.

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.

What is stage 4 lung cancer?

Stage 4 lung cancer, also called metastatic lung cancer, is an advanced disease. In stage 4 lung cancer, the cancer has spread from the lung, where it originated, to 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. The cancer cells often travel from the lung to the brain, bones, liver and adrenal glands where they may form new metastatic tumors. 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.

This article will cover:

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 lung 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 a doctor to evaluate these symptoms, because many are serious, and a doctor may help determine what is causing them.

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    Metastatic (stage 4) lung 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.
    • Biopsy is the only way to truly confirm a cancer diagnosis. The procedure involves removing a sample of cells or tissue and having a pathologist examine them under a microscope for signs of cancer.

    Non-small cell lung cancer stage 4


    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.


    Non-small cell lung cancer stage 4A: 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.

    Non-small cell lung cancer stage 4B: 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.

    Small cell lung cancer stage 4


    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 a patient has advanced lung cancer, he or she should ask a doctor what to expect from treatment.
    • Patients may even want to seek a second opinion from another doctor to ensure that the treatment plan is satisfactory.
    • The care team will weigh the benefits of treatment with the potential side effects and how these may impact 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 a patient's health is quickly declining, standard treatments may be too taxing on the body and lead to debilitating side effects. If this is true, ask a doctor about lowering the treatment doses or receiving palliative care on its own.

    Stage 4 lung cancer survival rate and quality of life

    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.

    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. The rate includes the life expectancy of patients who are still in treatment and those who have finished treatment and have no further evidence of disease.

    • Patients with metastatic (stage 4) non-small cell lung cancer that’s spread to distant organs or regions of the body have a five-year relative survival rate of 8 percent, according to ACS. Stage 4 non-small cell lung cancer that has spread regionally has a five-year relative survival rate of 37 percent.
    • For metastatic (stage 4) small cell lung cancer that’s widespread in the body, the five-year relative survival rate is 3 percent. For patients with stage 4 small cell lung cancer that has spread regionally, the five-year relative survival rate is 18 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.

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    Show references
    • National Cancer Institute (2020, May 21). Small Cell Lung Cancer Treatment (PDQ®)– Patient Version.
    • American Society of Clinical Oncology (2019, March). [Updated July 2022] What Is Metastasis?
    • American Cancer Society (2019, Oct. 1). What Is Lung Cancer?
    • American Cancer Society (2017, June 26) [Updated 8/15/2022]. Understanding Your Pathology Report: Lung Cancer.
    • American Cancer Society (2019, Oct. 1). Non-Small Cell Lung Cancer Stages.
    • National Cancer Institute. Stage IV Non-Small Cell Lung Cancer.
    • American Cancer Society (2020, Dec. 22) [Updated 3/14/2022]. Treatment Choices for Non-Small Cell Lung Cancer, by Stage.
    • American Cancer Society (2019, October 1). Small Cell Lung Cancer Stages.
    • American Cancer Society (2020, May 11) [Updated 8/15/2022]. Tests for Lung Cancer.
    • American Cancer Society (2019, Oct. 1). Signs and Symptoms of Lung Cancer.
    • American Cancer Society (2022, March 2). Lung Cancer Survival Rates.
    • American Society of Clinical Oncology (2020, May) [Updated November 2021]. Lung Cancer – Non-Small Cell: Types of Treatment.
    • American Cancer Society (2020, Sept. 10) [Updated 6/16/2021]. Managing Advanced Cancer.
    • American Cancer Society (2021, Jan. 4) [Updated 3/3/2021]. Treatment Choices for Small Cell Lung Cancer, by Stage.

    Our lung cancer centers

    At City of Hope, 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

    Stage 4 lung cancer is a complex disease. At City of Hope, 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.

    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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