Written By: Devin Golden

Stage 4 Lung Cancer

Stage 4 lung cancer is the most advanced or metastatic lung cancer stage. Patients in this stage may not be a candidate for surgery because of the extent of the tumor size and spread of the cancer beyond the lung. Support options are available to help them cope with cancer.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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Important Facts About Stage 4 Lung Cancer

  • Stage 4 lung cancer has a poor survival rate. Less than 10% of patients with stage 4 lung cancer live for five years.
  • Stage 4 is split into two sub-stages: stage 4A and stage 4B. Stage 4A has a slightly better prognosis and life expectancy.
  • Stage 4 asbestos lung cancer can be a common diagnosis because asbestos lung cancer is often diagnosed too late to still be in earlier stages. Asbestos lung cancer has a latency period of at least 10 years, and patients often misinterpret serious side effects.
  • The symptoms of lung cancer worsen in stage 4 as the respiratory system is more affected by the presence of tumors.
  • Treatment for stage 4 lung cancer includes chemotherapy, immunotherapy, and in some cases, surgery.

What Is Stage 4 Lung Cancer?

Stage 4 is the most advanced of the stages of lung cancer. Patients in this stage typically focus more on quality of life and comfort measures rather than aggressive treatments. Although, some patients still want to fight to extend time with their family.

There are two types of lung cancer: non-small cell and small cell. According to the National Cancer Institute, around 40% of patients with non-small cell lung cancer are diagnosed in stage 4. Close to 66% of patients with small cell lung cancer are diagnosed in stage 4. Fortunately, most people have non-small cell lung cancer.

Stage 4 non-small cell lung cancer and stage 4 small cell lung cancer are split into two sub-stages:

  • Stage 4A
  • Stage 4B

Stage 4A non-small cell lung cancer and small cell lung cancer is defined by a tumor of any size and reaching the lymph nodes in the lung cavity. Additionally, there are:

  • Multiple tumors present in one lung aside from the main tumor
  • Cancer spreads to the lining and/or fluid around the lung (pleura) or heart (pericardium)
  • Cancer cells found in a distant organ (brain, liver or kidneys)

Stage 4B is defined by:

  • Disease spread throughout the original lung
  • Cancer has spread beyond the lung to multiple distant organs
  • Multiple spots in one distant organ

Stage 4 Asbestos Lung Cancer

Asbestos lung cancer forms when asbestos enters the body and aggravates tissue with the pointy ends of an asbestos fiber. An asbestos disease means the lung cancer was caused by sharp fibers irritating lung tissue. The cancer doesn’t begin growing for at least 10 years, and sometimes up to 40 years. Once it does start spreading, it spreads fast from stage 1 to stage 4.

Patients often mistake symptoms for other diseases, especially if they never smoked cigarettes or had a family history of lung cancer. This can lead to them misdiagnosing themselves – or even their physician misdiagnosing the symptoms. A misdiagnosis can delay treatment and often result in a diagnosis of cancer in a late stage. 

This is why asbestos lung cancer may have a greater risk of being diagnosed in stage 4.

What to Do If You’re in Stage 4 Asbestos Lung Cancer?

If your doctor says you have stage 4 lung cancer, you should keep fighting but also begin preparing your will and other legal documents. You should also consider your family by handling any lingering tasks to ease their adjustment if you pass away.

One of the tasks you can start after a lung cancer diagnosis is filing a lawsuit if it was caused by asbestos. Companies profited off asbestos as a key component to building houses, offices, entertainment venues and other buildings. Asbestos was also used to make automobiles, military ships and airplanes.

Many of the people who ran these companies knew asbestos was dangerous, even cancerous. Yet, they continued using the mineral and exposing their workers, customers and other innocent people to the toxin.

You’re eligible to file a lawsuit due to the exposure to asbestos and its link to your stage 4 lung cancer. Contact a lawyer to begin the legal process, either filing a lawsuit or seeking an asbestos trust fund payout. If you’re in stage 4 and haven’t started looking for an asbestos attorney, this is the time to do it so your family can be compensated for the many challenges they’ve already faced and are going to face soon.

What Are the Symptoms of Stage 4 Lung Cancer?

Many of the symptoms from other lung cancer stages are the same in stage 4. However, they are more severe and can cause more discomfort and pain for patients. People with lung cancer should know the signs of stage 4.

For instance, chest pain is more severe in this stage. This is due to the main tumor getting thicker and larger, which causes pressure in the chest cavity. There is also less room for fluid in the pleura (lining of the lungs), and more fluid buildup against the chest.

The size of the cancer and main tumor also affects breathing more. The lungs aren’t able to expand or allow adequate oxygen exchange as much as they should. This causes shortness of breath.

Other possible stage 4 lung cancer symptoms include:

  • Jaundice (yellow skin)
  • Bone pain
  • Headaches
  • Seizures
  • Dizziness
  • Poor balance
  • Muscle weakness and numbness
  • Fatigue
  • Swollen lymph nodes around the neck or collarbone

Stage 4 Lung Cancer Treatment

The intent of stage 4 lung cancer treatment is to make the patient feel comfortable in their final weeks and months. Stage 4 is usually unrecoverable, but in some extraordinary cases treatment may help the patient beat the odds and survive their stage 4 lung cancer.

Treatment for stage 4 includes chemotherapy, radiation and immunotherapy. Many times options used to treat stage 4 lung cancer are limited to palliative therapy, which is low doses of chemotherapy and immunotherapy. These are usually for maintenance therapy to slow the disease as much as possible and reduce tumor pressure on the lungs and chest. Another palliative therapy to help with comfort is fluid drainage, such as a thoracentesis.

Some of the immunotherapy drugs approved for lung cancer are:

  • Opdivo (nivolumab)
  • Imfinzi (durvalumab)
  • Yervoy (ipilimumab)
  • Keytruda (pembrolizumab)

In some very specific cases, doctors may try a pneumonectomy surgery and remove one of the lungs entirely – and all tumors on that lung. This surgery is only performed if the lung cancer doctor believes the tumors on the other lung and in the distant regions can be addressed with smaller surgeries, chemotherapy or immunotherapy.

Life Expectancy for Stage 4 Lung Cancer

Stage 4 lung cancer survival rates are the poorest of the stages usually. The life expectancy for stage 4 lung cancer is less than one year. The 5-year survival rate is less than 10%. However, survival rates are only estimates and should not discourage patients with advanced lung cancer from fighting.

Stage 4A lung cancer still has chances of a turnaround with a response to treatment. Some patients begin making recoveries thanks to new therapies, such as immunotherapy drugs that strengthen their immune system. If the tumors shrink enough in stage 4A, patients might be able to have surgery.

Stage 4B has very little chance of a turnaround. The 5-year survival rate is nearly 0%. When cancer progresses to this sub-stage, patients usually live for just a few weeks.

Frequently Asked Questions About Stage 4 Lung Cancer

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What are my chances of surviving with stage 4 lung cancer?

The 5-year survival rate for stage 4 lung cancer is around 10%. It is nearly 0% for people with stage 4B, which is the more advanced type of stage 4 lung cancer. While turnarounds are rare, they do happen thanks to advancements in cancer treatment and medicine.

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What treatments and therapies are used for stage 4 lung cancer?

Immunotherapy, chemotherapy and radiation therapy are the most common therapies for stage 4 lung cancer. Surgery is risky and not recommended because the cancer is so widespread that surgery likely won’t be able to remove enough of the tumor. Some minor surgeries and procedures are done to relieve symptoms and make patients more comfortable in their final weeks and months.

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How many people are diagnosed with stage 4 lung cancer?

The majority of patients are diagnosed in earlier stages, which is a positive statistic. It means most patients have a better chance of survival and more therapeutic options to try. Asbestos lung cancer is more likely than non-asbestos lung cancer to be diagnosed in stage 4. This is because asbestos lung cancer has a long latency period and can start spreading after years of being dormant.

Sources & Author

  1. Stage 4 Lung Cancer. Moffitt Cancer Center. Retrieved from: https://moffitt.org/cancers/lung-cancer/diagnosis/stages/stage-4-lung-cancer/. Accessed: 08/21/2022.
Devin Golden

About the Writer, Devin Golden

Devin Golden is the senior content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.