Metastatic Non-Small Cell Lung Cancer: Symptoms, Diagnosis, Treatment, and Prevention
Lung CancerMetastatic NSCLC: Finding Care

When Non-Small Cell Lung Cancer Spreads: What to Expect

When Non-Small Cell Lung Cancer Spreads: What to Expect
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Updated on June 6, 2025
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Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 80 to 85 percent of all cases.

 It’s referred to as metastatic NSCLC when it has spread from the lungs to other parts of the body.

There are several subtypes of NSCLC, depending on which type of cell the cancer originated in. But they’re usually grouped together, because the treatment approach and prognosis are often similar. These subtypes include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Once NSCLC has metastasized, it is no longer considered curable, but there are treatments available to provide comfort and slow the cancer’s progression.

Recognizing the Symptoms of Metastatic NSCLC

Many cases of NSCLC are not discovered until the cancer is in an advanced stage, often because people either don’t experience symptoms, or attribute their symptoms to another condition, such as an infection. Most NSCLC is diagnosed when a tumor grows and begins to make breathing more difficult or causes problems in parts of the body near the lungs.

Symptoms of NSCLC include:

  • A cough that does not go away
  • Chest pain that gets worse with deep breathing or laughing
  • Coughing up blood
  • Weight loss, loss of appetite, shortness of breath, and fatigue
Because these symptoms often mirror those of other conditions, NSCLC diagnosis may be delayed. This makes screening vital, particularly for those at high risk, because the cancer can quickly spread, or metastasize, to other organs.

As with many other cancers, the danger increases when NSCLC spreads. Tumor cells can break away in the lungs and travel through the bloodstream to other parts of the body. Metastatic NSCLC cells are most likely to spread to lymph nodes in the middle of the chest, liver, adrenal glands, bones, and possibly brain, says David Graham, MD, a hematologist and medical oncologist at Atrium Health Levine Cancer Institute in Charlotte, North Carolina.

Symptoms of metastatic NSCLC depend on where in the body the cancer has spread:

  • Bones: Bone pain in the back or hips
  • Brain: Headaches, weakness, numbness of an arm or leg, dizziness, seizures
  • Liver: Yellowing of the skin and eyes
  • Skin or lymph nodes: Lumps or swelling near the surface of the skin
  • Adrenal glands: Often no symptoms, but possible dizziness, weakness, or fatigue

How Metastatic NSCLC Is Diagnosed

A number of tests are used to diagnose NSCLC, see if it has spread, and look for signs that the cancer might be recurring after treatment.

 Your doctor will likely start with a chest X-ray. If there are any suspicious masses, they may follow up with a CT (computerized tomography) scan, MRI (magnetic resonance imaging), or PET (positron emission tomography) scan, which can help your doctor tell if the cancer has spread to the bones, brain, liver, other organs, or spinal cord.

Once a doctor determines there is reason to suspect lung cancer, the actual diagnosis is made by conducting a biopsy (a procedure in which cells, tissue, or fluids are removed to be examined in a lab). Sample cells can be collected by a syringe needle, surgery, or fluid removal from the area around the lungs. Your doctors may also use mucus samples to conduct tests.

Interventional radiology (IR) guided biopsy is where a radiologist uses imaging techniques, such as CT, to help guide the needle through the skin to the area of concern. A secondary needle passes through the first needle and takes the biopsy samples.

Additional procedures to diagnose NSCLC include:

  • Bronchoscopy A lighted flexible or rigid tube with a camera is inserted through the nose or mouth to help doctors see inside the airways and collect samples for testing.
  • Mediastinoscopy An endoscope (a thin tube with a light and camera) is inserted through a small surgical opening in the chest to look behind the breastbone (the sternum) and take tissue samples from the lymph nodes along the windpipe and major bronchial tube areas.
  • Mediastinotomy When lymph nodes can’t be reached using mediastinoscopy, a surgeon may use this, which is the same procedure but with a slightly larger incision between the ribs, next to the breastbone.
  • Thoracoscopy A thin, flexible tube with a camera and light, called a thorascope, is inserted through an incision near the lower end of the shoulder blade, between the ribs, to allow doctors to examine that area.
NSCLC is categorized in four stages:

  • Stage 1 It is nonmetastatic and only affects the lungs.
  • Stage 2 The cancer has spread to nearby lymph nodes in the lung.
  • Stage 3 It has spread to the lymph nodes in the center of the chest, the mediastinum, or is a very large tumor.
  • Stage 4 Cancer has spread to other organs.

Treatment Options for Metastatic NSCLC

Current treatments don’t cure metastatic NSCLC for most people. But they can ease your symptoms and help you live longer and feel better, according to Taofeek Owonikoko, MD, a thoracic medical oncologist and executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore.

Treatment options depend on many factors, including where the cancer has spread and the characteristics of the cancer. “We want to find the specific alterations in the cancer cell,” says Dr. Owonikoko. “If there are mutations, the particular treatment would be dictated by that.”

Targeted Therapy

Doctors commonly order biomarker testing (also called molecular or genomic testing), which looks for changes in the tumor’s DNA. Biomarker testing can be done on tissue samples, blood, or other bodily fluids, such as urine or sputum (known as a liquid biopsy). This can help doctors plan personalized treatment based on genetic mutations and your likely response to immunotherapy. The test looks for DNA from dead tumor cells present in the bloodstream to determine whether the cancer cells have mutations in specific genes (including EGFR, ALK, ROS1, RET, and BRAF).

“We have targeted therapies that will take advantage of changes associated with those genetic markers,” says Dr. Graham. “They offer a treatment opportunity we wouldn’t have otherwise.” Each of those genes is associated with a pathway in the cells that spurs cancer growth. Targeted therapies can home in on certain gene mutations with drugs to block the pathways and slow the growth and spread of cancer cells.

Such treatments are known as targeted therapies because they are directed at specific types of cancer cells and cause less damage to healthy cells.

Immunotherapy

Your tumor may also be tested for a protein called PD-L1. High levels indicate that the cancer may respond better to immunotherapy drugs, one of the most important advances in the treatment of metastatic NSCLC (and other cancers) and now a standard treatment for most patients with advanced lung cancer.

Cancer cells have devised all kinds of clever biological tricks to hide from the body’s immune system, which would otherwise attack them. Immunotherapy — using drugs called checkpoint inhibitors — makes the cancer cells visible to the immune system, which is then mobilized.

Treatment of lung cancer, as well as cancer that’s spread to the bones, brain, liver, or elsewhere, might require conventional cancer treatments, such as radiation therapy or chemotherapy. In some cases, surgery may be done to remove tumors that have spread to the brain.

Prevention of Metastatic NSCLC

Early detection is key for preventing NSCLC from metastasizing. Avoid smoking (or exposure to secondhand smoke), which is the most common cause of lung cancer, but also be aware of exposure to chemicals in the workplace or at home.

 Using personal protective equipment can help minimize this risk. Having been exposed to radiation near the lungs (such as for prior cancer treatment) also increases your risk.

If you have a family history of lung cancer, your doctor may choose to monitor your lung health more closely, and possibly recommend genetic testing.

The Outlook for Metastatic NSCLC

How long you’ll live — and what kind of life you’ll have — are related to the particular mutations present in your tumor cells, which treatments are available, and how well you respond to those treatments.

Treatment of metastatic NSCLC has improved dramatically in the past decade or so, says Graham. Just a decade or two ago, “The chances of living two years with metastatic NSCLC were pretty small,” he says. Thanks to advancements in treatment, the outlook is “definitely a lot better than it was,” Graham says.

Because of advancements in treatment, survival rates for people with metastatic NSCLC are improving. If you respond to treatment, you could live four or five years, says Owonikoko. “Overall, the prognosis has improved,” he says, “but it’s still not where we want it to be.”

The five-year survival rate is 9 percent, although this can vary, and these statistics don’t predict how long you’ll live. If the cancer has only spread to the lymph nodes or nearby tissues (regional NSCLC), the five-year survival rate is 37 percent.

Clinical trials are constantly being conducted to find ways to improve treatments and quality of life for people with metastatic NSCLC. Ask your doctor whether you may be a candidate for such a trial, which you can find at www.clinicaltrials.gov.

Research and Statistics: Who Has Metastatic NSCLC?

The most common risk factor for NSCLC is smoking, but nonsmokers can still develop NSCLC, too.

 Men are more likely than women to develop lung cancer, and Black men are 12 percent more likely to develop lung cancer than white men.

One older study found that approximately 47 percent of NSCLC diagnoses occur after metastasis, although they note that previous research found these statistics to be slightly lower (30 to 40 percent). No newer research is available.

Support for People With Metastatic NSCLC

LUNGevity

LUNGevity is a nonprofit that has information both for patients and their caregivers or partners, ranging from cancer screenings and cancer care to survivor resources. They also provide a lung cancer hotline, as well as a mentorship program that pairs cancer patients with mentors who had similar experiences.

American Lung Association

The American Lung Association has a variety of mental health support groups and resources, as well as a free HelpLine to chat with healthcare professionals. They also offer a variety of educational resources about lung cancer.

CancerCare

CancerCare provides support groups, specialized programs, information, financial assistance, education, and counseling to people affected by cancer.

American Cancer Society

The American Cancer Society provides information, programs, resources, and assistance in finding additional free or low-cost programs to cancer patients.

The Takeaway

  • NSCLC is often diagnosed after it has spread, as it often mimics the symptoms of other health conditions, or you may have no symptoms at all.
  • Although metastatic NSCLC is unlikely to be cured, there are treatment options that can improve your quality of life, and possibly slow the spread of cancer.
  • Targeted therapies and immunotherapies are commonly used to treat metastatic NSCLC, in addition to more conventional cancer treatments.
  • Early detection is key to preventing the spread of cancer.

Common Questions & Answers

I’ve never smoked and avoid secondhand smoke. Can I still have metastatic NSCLC?
Yes, although metastatic NSCLC is most commonly caused by smoking, it can also be inherited or caused by other environmental or genetic factors.
Targeted therapies for specific gene mutations and immunotherapies are commonly used to treat metastatic NSCLC. These may be combined with more conventional cancer treatments, such as chemotherapy or radiation.
Discuss this with your doctor, as many factors impact life expectancy. Where your cancer has spread, the type of mutation, and medical history can all affect life expectancy. New treatments and research improve the outlook for metastatic NSCLC.

Resources We Trust

Additional reporting by Colleen de Bellefonds.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. What is Lung Cancer? American Cancer Society. January 29, 2024.
  2. Lung Cancer Diagnosis. Moffitt Cancer Center.
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  5. Interventional Radiology Lung Biopsy. UCLA Health.
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Conor Steuer, MD

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Castle Connolly Top Doctor

Conor E. Steuer, MD, is medical oncologist specializing in the care of aerodigestive cancers, mesothelioma, and thymic malignancies and an assistant professor in the department of hematology and medical oncology at the Emory University School of Medicine in Atlanta. He joined the clinical staff at Emory's Winship Cancer Institute as a practicing physician in July 2015. He currently serves as chair of the Lung and Aerodigestive Malignancies Working Group and is a member of the Discovery and Developmental Therapeutics Research Program at Winship.

Dr. Steuer received his medical degree from the New York University School of Medicine in 2009. He completed his postdoctoral training as a fellow in the department of hematology and medical oncology at the Emory University School of Medicine, where he was chief fellow in his final year.

He has been active in research including in clinical trial development, database analyses, and investigation of molecular biomarkers. He is interested in investigating the molecular biology and genomics of thoracic and head and neck tumors in order to be able to further the care of these patient populations. Additionally, he has taken an interest in utilizing national databases to perform clinical outcomes research, as well as further investigate rare forms of thoracic cancers.

Steuer's work has been published in many leading journals, such as Cancer, the Journal of Thoracic Oncology, and Lung Cancer, and has been presented at multiple international conferences.

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Paul Raeburn was a journalist and blogger, and the author of five books, including, most recently, The Game Theorist’s Guide to Parenting, in 2016, and Do Fathers Matter?, in 2014, both published by Scientific American/FSG. He died in April 2024 from Parkinson's disease.

He was the author of more than 150 freelance articles for Discover, The Huffington Post, The New York Times Magazine, Scientific American, National Public Radio, and Psychology Today, among many others. He was a past president of the National Association of Science Writers. In addition, he was a media critic for the Knight Science Journalism Tracker from 2009 to 2012 and the chief media critic from 2012 to 2014.

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