What Are The Symptoms
The symptoms you had in earlier stages of the disease may continue or get worse. Some problems you may have are:
- Cough that won’t go away
- Chest pain that gets worse when you breathe or cough
- Shortness of breath
- Loss of appetite and weight loss
Other symptoms may appear as lung cancer spreads to different parts of your body. If it moves into the brain or spinal cord, you may feel dizzy, get headaches, or have trouble keeping your balance. If it spreads to the liver, your skin and eyes may turn yellow . You may feel pain at the sites of the tumor.
Talk With Others Who Understand
MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.
Are you living with stage 4 lung cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Nsclc That Has Spread To Only One Other Site
Cancer that is limited in the lungs and has only spread to one other site is not common, but it can sometimes be treated with surgery and/or radiation therapy to treat the area of cancer spread, followed by treatment of the cancer in the lung. For example, a single tumor in the brain may be treated with surgery or stereotactic radiation, or surgery followed by radiation to the whole brain. Treatment for the lung tumor is then based on its T and N stages, and may include surgery, chemo, radiation, or some of these in combination.
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Treatment Options For Resected/resectable Stage Iiia Nsclc
Treatment options for resected/resectable disease include the following:
Despite careful preoperative staging, some patients will be found to have metastases to mediastinal N2 lymph nodes at thoracotomy.
The preponderance of evidence indicates that postoperative cisplatin combination chemotherapy provides a significant survival advantage to patients with resected NSCLC with occult N2 disease discovered at surgery. The optimal sequence of surgery and chemotherapy and the benefits and risks of postoperative radiation therapy in patients with resectable NSCLC are yet to be determined.
If complete resection of tumor and lymph nodes is possible, such patients may benefit from surgery followed by postoperative chemotherapy. Current evidence suggests that lung cancer resection combined with complete ipsilateral mediastinal lymph node dissection is not associated with improvement in survival compared with lung cancer resection combined with systematic sampling of mediastinal lymph nodes in patients with stage I, II, or IIIA NSCLC.
The addition of surgery to chemoradiation therapy for patients with stage IIIA NSCLC did not result in improved OS in a phase III trial but did improve progression-free survival and local control.
How Asbestos Leads To Lung Cancer
Asbestos is a fibrous mineral common in building materials, and it is a known cause of serious lung ailments such as:
- Mesothelioma, a form of lung cancer for which the only known cause is breathing asbestos
- Forms of lung cancer aside from mesothelioma
Asbestos is highly effective in suppressing fire and preventing corrosion in buildings, but it is a known carcinogen. Some of the places where asbestos is found include:
- In insulation, which may be in walls, attics, around pipes, and around heat-emitting appliances such as furnaces and stoves
- In vinyl flooring
- In certain textured paints
- In certain roofing materials including shingles
Because of asbestos prevalence in building materials, certain segments of the population are at a heightened risk of developing asbestos-induced lung cancer. These groups include but are not limited to:
- A demolition crew member
- Someone who regularly works near insulation
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Treatment Options For Unresectable Stage Iiia Nsclc
Treatment options for patients with unresectable stage IIIA NSCLC include the following:
The addition of sequential and concurrent chemotherapy to radiation therapy has been evaluated in prospective randomized trials and meta-analyses. Overall, concurrent treatment may provide the greatest benefit in survival with an increase in toxic effects.
Concomitant platinum-based radiation chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.
Concurrent versus sequential chemoradiation therapy
Important Facts About Stage 4 Lung Cancer
- Stage 4 lung cancer has a poor survival rate. Less than 10% of patients 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.
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Re: My Husband Has Stage 4 Lung Cancer
Hello, so sorry about your husband having cancer. I know its such a hard time for you and your whole family. I had lymphoma last year and the treatment was very challenging but it has worked. It was the love and support of my family and friends that got me through. I hope the medical team can be successful in treating your husband. Sending you lots of prayers and love. Linda G
Use Of Vascular Endothelial Growth Factor Inhibitors
PICO 3: Is bevacizumab with chemotherapy safer for patients with advanced stage IV NSCLC and treated brain metastases, anticoagulation, or a poor PS than chemotherapy alone?
Bevacizumab, an anti-vascular endothelial growth factor humanized monoclonal antibody, already approved for the treatment of advanced colorectal cancer, was evaluated in a large, randomized, phase 3 trial conducted by the ECOG and referred to as ECOG 4599.10 This trial randomly assigned patients with advanced NSCLC, without squamous histology, to carboplatin-paclitaxel with or without bevacizumab. Other exclusion criteria were a history of hemoptysis, a history of brain metastases, a history of bleeding or thrombotic disorders, or a need for full anticoagulation. The ECOG 4599 trial enrolled 855 eligible patients with a PS of 0 to 1. All efficacy end points, including response rate and PFS and OS, were significantly better in the bevacizumab arm. Among 420 patients who were treated with bevacizumab, toxicity was in general tolerable, except for five deaths secondary to hemoptysis. This trial was discussed in the 2007 ACCP guidelines and led to the recommendation to add bevacizumab to carboplatin and paclitaxel in this select patient group .4
Remark: No recommendation can be given about the use of bevacizumab in patients receiving therapeutic anticoagulation or with an ECOG PS of 2.
Lung Cancer Biomarker Testing
Biomarker testing is one of the first steps in developing a treatment for stage 4 lung cancer. The way this works is you take a sample from your tumor or do a blood test and identify if there are any genetic mutations alterations or changes in the genes or proteins that have developed your cancer.
Generally, a gene produces a protein thats responsible for a specific role inside the cell . Thus, when a mutation occurs, this protein is produced excessively in a way that makes a cancer cell stronger and able to spread faster. The goal of biomarker testing and targeted therapies is to identify these genes or proteins and give medications that specifically target these pathways. By providing this targeted therapy cancer cells may be killed while causing less damage to surrounding normal cells that do not express the same biomarkers.
This is whats called a lung cancer genetic test to test for the presence of a mutated or altered gene or protein that caused the cancer. There are multiple biomarkers that can be tested. Some of the more common biomarkers tested in lung cancer include the following:
- EGFR gene mutation
For each of these biomarkers, there is a specific available therapeutic drug targeting and inhibiting it.
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What Is The Tnm System
Lung cancer staging often uses the letters T, N, and M:
- T stands for your tumorâs size and where itâs located in your lungs or body.
- N stands for node involvement. This means whether or not your cancer has spread to your lymph nodes near your lungs.
- M stands for metastasis. This means whether or not your cancer has spread. Lung cancer can spread to your other lung or your liver, bones, brain, kidneys, adrenal glands, or other parts of your body.
Your doctor can stage your tumor with these letters, and then be more specific with the numbers 0-4.
Theyâll measure the size of your tumor in centimeters to give it a number. The higher the number, the more your tumor has grown or spread.
They might also use X as a number. This means the tumor canât be measured or itâs unclear how far it has spread.
If your doctor says your lung cancer is âunresectable,â that means that surgeons cannot remove it.
How Is The Stage Determined
The staging system most often used for NSCLC is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:
- The size and extent of the main tumor : How large is the tumor? Has it grown into nearby structures or organs?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
- The spread to distant sites : Has the cancer spread to distant organs such as the brain, bones, adrenal glands, liver, or the other lung?
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.
The system described below is the most recent version of the AJCC system, effective as of January 2018.
NSCLC is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests . If surgery is done, the pathologic stage is determined by examining tissue removed during the operation.
Staging for NSCLC can be complex, so ask your doctor to explain it to you in a way you understand.
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What Is Stage 4 Lung Cancer
Stage 4 lung cancer is an advanced disease. At this stage, the cancer is metastaticmeaning it 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 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:
- 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
- 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, its important to visit your doctor if youre experiencing these symptoms, because many are serious, and your doctor may help you determine what is causing them.
Treating Stage I Nsclc
If you have stage I NSCLC, surgery may be the only treatment you need. This may be done either by taking out the lobe of the lung that has the tumor or by taking out a smaller piece of the lung . At least some lymph nodes in the lung and in the space between the lungs will also be removed and checked for cancer.
Segmentectomy or wedge resection is generally an option only for very small stage I cancers and for patients with other health problems that make removing the entire lobe dangerous. Still, most surgeons believe it is better to do a lobectomy if the patient can tolerate it, as it offers the best chance for cure.
For people with stage I NSCLC that has a higher risk of coming back , adjuvant chemotherapy after surgery may lower the risk that cancer will return. But doctors arent always sure how to determine which people are likely to be helped by chemo. New lab tests that look at the patterns of certain genes in the cancer cells may help with this. Studies are now being done to see if these tests are accurate.
After surgery, the removed tissue is checked to see if there are cancer cells at the edges of the surgery specimen . This could mean that some cancer has been left behind, so a second surgery might be done to try to ensure that all the cancer has been removed. Another option might be to use radiation therapy after surgery.
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Nsclc That Progresses Or Recurs After Treatment
If cancer continues to grow during treatment or comes back , further treatment will depend on the location and extent of the cancer, what treatments have been used, and on the persons health and desire for more treatment. Its important to understand the goal of any further treatment if it is to try to cure the cancer, to slow its growth, or to help relieve symptoms . It is also important to understand the benefits and risks.
If cancer continues to grow during initial treatment such as radiation therapy, chemotherapy may be tried. If a cancer continues to grow during chemo as the first treatment, second-line treatment most often consists of a single chemo drug such as docetaxel or pemetrexed, or targeted therapy. If a targeted drug was the first treatment and is no longer working, another targeted drug or combination chemo might be tried. For some people with certain types of NSCLC, treatment with an immunotherapy drug such as nivolumab , sometimes along with ipilimumab pembrolizumab or atezolizumab might be an option.
Smaller cancers that recur locally in the lungs can sometimes be retreated with surgery or radiation therapy . Cancers that recur in the lymph nodes between the lungs are usually treated with chemo, possibly along with radiation if it hasnt been used before. For cancers that return at distant sites, chemo, targeted therapies, and/or immunotherapy are often the treatments of choice.
For more on dealing with a recurrence, see Understanding Recurrence.
Small Cell Lung Cancer
Classified differently than NSCLC, SCLC is referred to as either limited or extended when attributing the growth of tumors.
Stage IV Extended Stage
At stage IV, SCLC has already spread to other areas and may be classified as an extensive-stage small cell. Here, tumors may have metastasized to the other side of the chest, several lymph nodes, second lung, bone, brain, or bone marrow. Approximately two out of every three people diagnosed with SCLC are at the extensive stage.
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Lung Cancer Treatment Options
Some people who have stage 4 lung cancer may not need treatment right away, while others might need it right away depending on how much the tumor has grown and spread at diagnosis. The decision on whether to start treatment depends on many factors, including:
- The type of lung cancer you have for example, small cell carcinoma tends to spread quickly but be responsive to chemotherapy
- Your overall health condition for example: if you have other serious illnesses like heart disease or diabetes mellitus
- How well your body responds to certain types of treatment
Similarly, the treatment recommended will depend on several factors, including whether the cancer is a squamous cell or non-small cell, what biomarkers are present, your underlying health, and many other factors unique to each person.
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