Stage 4 Lung Cancer: Symptoms, Diagnosis, Treatment, Outlook, and More
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What Is Stage 4 Lung Cancer?

What Is Stage 4 Lung Cancer?
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Updated on June 23, 2025
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Stage 4 lung cancer means that lung cancer has spread, or metastasized, from the initial tumor to the other lung, the lining of the lungs, or to other organs outside of the lungs.

 It is also called metastatic or advanced lung cancer.
Stage 4 lung cancer has no cure, but it is treatable, and some people go on to live many years with a controlled level of the disease.

Stage 4 Lung Cancer Types

There are two main types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). SCLC is the lung cancer type that grows more quickly and is usually caused by smoking. NSCLC is the most predominant type of lung cancer, and it progresses more slowly. Typically, NSCLC tends to be diagnosed when it’s very advanced.

In everyday language, doctors and patients may use the phrase “stage 4 lung cancer” to refer to both types, even though SCLC is technically staged as “limited” or “extensive.”

Ian Bostock, MD, thoracic surgeon specializing in lung cancer at the Miami Cancer Institute in Florida, explains, “‘Stage 4’ applies to both types of lung cancer, but it is critical to make a distinction between the two because NSCLC and SCLC are treated in a very different way and the outcomes also differ significantly.”

This article primarily refers to the most prevalent type of lung cancer, NSCLC, although some information may also apply to SCLC.

Signs and Symptoms of Stage 4 Lung Cancer

The symptoms of stage 4 lung cancer tend to overlap with general lung cancer symptoms and may include:

  • Fatigue
  • Persistent cough
  • Spitting or coughing up blood
  • Chest pain
  • Trouble breathing
  • Loss of appetite
  • Unintentional weight loss
Depending on how advanced the illness is, you may experience more or fewer of these symptoms, more or less frequently, or severely. It’s important to note that lung cancer may cause no symptoms at all until it’s very advanced, and it’s also possible for a person with stage 4 lung cancer to have no symptoms.

When the cancer has spread to other organs, it can also cause the following symptoms:

  • Bone pain, including back pain or hip pain, when the cancer has spread to the bones
  • Headaches, weakness, or numbness in your limbs, when the cancer has spread to the brain
  • Dizziness, vertigo, and stroke-like symptoms when the cancer has spread to the brain

  • Yellowing of the skin and eyes (jaundice) occurs when the cancer has spread to the liver
  • Swollen lymph nodes in the neck or above the collarbone, when the cancer has spread there
Illustrative graphic titled Symptoms of Stage 4 Lung Cancer shows Headaches, Dizziness or Stroke-Like Symptoms, Swollen Lymph Nodes, Bone Pain, Weakness or Numbness of the Limbs, Jaundice. Everyday Health logo.
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Causes and Risk Factors of Stage 4 Lung Cancer

The typical causes and risk factors for stage 4 lung cancer are the same as those raising the risk of lung cancer in general, and they include:

  • Family history of lung cancer, especially in first-degree relatives
  • Tobacco smoking
  • Exposure to secondhand smoke
  • Exposure to radon gas, which sometimes seeps from the soil into basements through crevices in a home’s foundation
  • Occupational exposure to materials or chemicals like asbestos
  • Environmental exposure (such as air pollution)
  • Infections like HIV and tuberculosis

How Is Stage 4 Lung Cancer Diagnosed?

To reach a definitive diagnosis of stage 4 lung cancer, your healthcare provider will do a series of examinations and imaging tests. First, they will assess your medical history and perform a physical exam. Then, they may require a complete blood count (blood test) and the following imaging tests, in order:

  • Chest X-ray
  • Computed tomography (CT scan) if the X-ray has brought up suspicions of lung cancer
  • A biopsy, where a sample of tissue from the tumor is examined in the lab. This is the only way to know for sure if a person has lung cancer. A biopsy might be combined with imaging technology to aid in accessing the possible tumor tissue.
If your healthcare provider has been able to confirm a lung cancer diagnosis, they will likely perform the following tests to stage the cancer:

  • a CT scan of your chest, abdomen, and pelvis to see if the cancer has spread to other parts of the body.
  • a positron emission tomography (PET) scan to refine the cancer stage and determine appropriate treatment options.
  • A magnetic resonance imaging (MRI) scan of the brain to assess for brain metastasis
  • A bone scan to see if the cancer has infiltrated bone
After your initial diagnosis, your doctor might run biomarker testing, which uses a blood or tissue sample to detect changes in the DNA of the cancer cells. Some immunotherapies and targeted treatments are tailored for specific types of mutations in cancer cells, and this test might help determine your course of treatment.

Treatment and Medication Options for Stage 4 Lung Cancer

Nowadays, there are more lung cancer treatments than ever, and new therapies are constantly being tested in clinical trials.

For stage 4 specifically, treatment options include chemotherapy, immunotherapy, radiotherapy, and targeted therapies. The choice of treatment will depend on the type of cancer you have, how advanced it is, your overall condition, and how capable you are of withstanding side effects. Stage 4 lung cancer treatment is aimed at controlling the cancer, such as by slowing its growth, and minimizing symptoms.

Chemotherapy

Stage 4 lung cancer will typically require one or more chemotherapy drugs, either alone or in combination with targeted therapies or immunotherapies. You may also require chemotherapy as maintenance therapy — treatment that you receive to keep the cancer from spreading further.

Chemotherapy is usually administered through an IV; this way, the medication reaches the cancer cells that have spread throughout the body. Chemotherapy drugs commonly used in stage 4 lung cancer include:

If your doctor recommends a combination of chemo drugs, this will likely consist of cisplatin or carboplatin and one other drug.

 But the choice of chemo drugs depends on many factors, including your overall health and whether you’ve taken the drug before.

Chemotherapy can cause significant side effects, including:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea
  • Vomiting
  • Unintentional weight loss
  • Diarrhea
  • Constipation
  • Increased likelihood of infections
  • Easy bruising
  • Bleeding
  • Fatigue

Immunotherapy

Immunotherapy is a biological therapy (a therapy that uses compounds made from living organisms) to help your immune system better fight off cancer. Different immunotherapy drugs help the immune system in different ways, be it by enabling it to better identify cancer cells, bind to specific targets on the surface of cancer cells, or mount a stronger response against them.

Immunotherapy drugs typically used to treat stage 4 lung cancer include:

The choice of immunotherapy drug for you and your type of cancer will depend on very specific factors, like the proteins your type of cancer makes, or what genetic mutations it has.

For example, pembrolizumab (Keytruda), blocks the PD-1 receptor, allowing your healthy cells to fight the cancer better. Overexpressing this protein causes your immune system to essentially put the brakes on its cancer-fighting abilities, but the immunotherapy takes these brakes off.

Immunotherapy drugs for lung cancer are usually taken intravenously (through an IV), but some can be injected under the skin (subcutaneously).

Side effects of immunotherapy can range from flu-like symptoms (such as fatigue, fever, and chills) to musculoskeletal pain to heart palpitations. The side effects are often a result of the immunotherapy reactivating the immune system to act against the cancer, but at the same time, attacking healthy cells and tissues in the body.

Targeted Therapy

Targeted therapies get their name from targeting specific proteins that help tumors grow. Some targeted therapies interrupt the chemical signaling that helps the cancer spread, others suppress the hormones that cancer needs to grow, while others yet deliver cancer-killing compounds to cancer cells.

Some targeted therapies boost your immune system’s cancer-fighting abilities, so in that sense, they are also immunotherapies.

 “Targeted therapies and immunotherapy have been groundbreaking for people with stage 4 lung cancer,” says Dr. Bostock.
To find out which targeted therapy is most suited for your type of cancer, you’ll need to undergo biomarker testing, which may require a biopsy. This is to find out what genes, proteins, or other molecules characterize your cancer (and thus determine the best way to destroy it).

There are many targeted therapies approved for lung cancer. The ones most commonly used for stage 4 in particular include:

The most common side effects of targeted therapies include diarrhea and liver problems.

Surgery

Typically, stage 4 lung cancer isn’t treated with lung surgery, as the tumor has spread beyond the lung. Also, people with advanced lung cancer may not feel well enough to withstand the risks and physical toll of surgical intervention.

Sometimes, though, surgery is effective for stage 4 NSCLC that has spread to the adrenal glands, brain, or liver, by removing tumors that have clustered together in those areas.

Radiotherapy

Radiation therapy, or radiotherapy, is sometimes used to alleviate lung cancer symptoms, or instead of chemo or surgery for people who aren’t well enough for these other interventions.

External beam radiation requires specialized equipment, and you won’t feel a thing while receiving the actual radiation beam. But the treatment can cause side effects, such as fatigue, nausea, breathlessness, hair loss, and appetite loss.

Complementary and Integrative Therapies

During lung cancer treatment, complementary and integrative therapies can help improve comfort, alleviate symptoms, or help a person cope with side effects.

It’s important to remember that complementary therapies don’t cure cancer and they are not alternatives to standard treatments, but they can be beneficial to your physical and mental health.

These complementary therapies may bring you some comfort and relief or help improve your overall health:

  • Meditation, mindfulness, and breathing techniques can all help to quiet the mind and manage stress.
  • Yoga and tai chi can help balance your mind and body, as well as improve your physical mobility.
  • Acupuncture may help relieve the side effects of chemo, such as nausea and vomiting.
  • Vitamins, herbs, and dietary supplements may help strengthen your body in the fight against cancer, improve your mood, or ease insomnia or depression.
  • Massage therapy, chiropractic care, and reflexology can help ease body pain.
Be mindful that some supplements (like St. John’s wort) or even fruit (like grapefruit and Seville oranges) can interfere with medications or treatments because they contain enzymes that can affect how well your body absorbs the drug.

Always consult your healthcare provider before deciding to try any complementary or integrative therapies.

Lifestyle Changes for Stage 4 Lung Cancer

If you’ve received a stage 4 lung cancer diagnosis, “it’s important to remain healthy and active,” says Bostock. Studies have shown that improved muscle strength and cardiorespiratory fitness can help prolong life for people with many forms of cancer, including advanced lung cancer.

Tailored exercise programs to target individual needs were found to possibly reduce cancer-related mortality.

 Speak to your healthcare provider about a personalized exercise program that’s tailored to your needs and abilities.
Furthermore, “Lots of walking, deep breathing exercises, and healthy nutrition go a long way in stage 4 lung cancer,” Bostock adds. “Additionally, it is imperative that patients quit smoking or at least dramatically reduce the intake of tobacco.”

Outlook for Stage 4 Lung Cancer

“Statistics for stage 4 lung cancer can be tricky to interpret,” says Bostock.

“There are many factors that affect survival, and it is important to have all of these details in order to fully evaluate each case,” he says. “It is crucial that patients are seen by providers who practice in a multidisciplinary setting, that they get professional opinions from different providers, and ensure that the biopsies or fragments of the tumor used for the diagnosis are sent for molecular or biomarker testing.”

“Biomarker testing can open many different avenues of therapy that can be life-changing,” Bostock notes.

Finally, he adds, “defining ‘cure’ has become more nuanced nowadays. Some patients with stage 4 lung cancer can have excellent responses to treatment and in many ways move toward a stage of ‘chronic disease’ or ‘disease stability’ for years.”

Complications of Stage 4 Lung Cancer

Stage 4 lung cancer can raise the risk of several complications, both from the cancer itself and from the treatment you receive. Managing or preventing these complications is an important part of your lung cancer treatment journey.

Cancer and cancer treatment-related complications include:

  • A higher risk of infection and sepsis: Chemotherapy and other cancer therapies weaken your immune system, reducing its ability to fight off infections. Cancer also puts a strain on your immunity. Combined, this can sometimes lead to infection and, if untreated, sepsis, which is a life-threatening complication that needs prompt intervention.

  • Higher risk of deep vein thrombosis (DVT) or blood clots: Chemotherapy delivered through a catheter inserted into a central blood vessel raises the risk of DVT.

  • Superior vena cava syndrome (SVCS): This is a complication that can develop when lung cancer tumors press on the superior vena cava, a large vein that runs from your head and chest all the way to the heart. Symptoms include swelling in the face, neck, or arms, problems breathing, headaches, dizziness, and personality changes if the syndrome affects the brain. SVCS can become life-threatening and require immediate medical attention.

  • Anxiety or depression: A diagnosis of advanced lung cancer is daunting, and coping with treatment side effects can be overwhelming as well. Speak to a mental healthcare professional if you’re struggling and remember that your doctor is there to help your emotional just as much as your physical health.

Research and Statistics: How Many People Have Stage 4 Lung Cancer?

Worldwide, the number of new stage 4 NSCLC cases each year is almost one million. Research indicates that 60 to 70 percent of all new cases of NSCLC are diagnosed at stage 4.

Broadly speaking, men are twice as likely to be diagnosed with lung cancer or die from it than women. But, there is great variation in the male-to-female ratio of cancer cases across the globe. In many countries in Europe and North America, lung cancer is becoming just as prevalent in women as it is in men.

The average age at diagnosis for lung cancer in general is 70 years.

 For stage 4 lung cancer specifically, some studies have found an average age at diagnosis of 64 years old.

Disparities and Inequities in Stage 4 Lung Cancer

There are many disparities and health inequities in lung cancer in general. Overall, research shows that in the United States, Black Americans have the highest lung cancer mortality of all racial or ethnic groups and the poorest outcomes.

Black men in the United States are also more likely to be diagnosed at stage 4 than their white counterparts (52 percent vs. 43 percent).

There are also large disparities in treatment and access to good-quality care. For example, Black Americans are less likely to receive surgery or any treatment for their lung cancer than white Americans.

The reasons for these disparities are likely to be many and nuanced. Many studies attempt to take into account socioeconomic status and everything that involves (such as health insurance), but this is a difficult task. Additionally, biomarker testing shows that different racial groups are more likely to carry specific gene mutations. For example, Asian people with lung cancer tend to have more EFGR mutations.

Knowing the genetics behind some of these differences could lead to better tailored treatment programs and outlook in the future.

Related Conditions

Up to 88 percent of people with lung cancer have at least one other condition, or comorbidity, with an average of two comorbidities per person. Additional medical conditions can significantly affect outlook and how well a person responds to treatment.

The most common conditions found in people with lung cancer, including advanced lung cancer, are:

The Takeaway

  • Stage 4 lung cancer may cause various symptoms, including a persistent cough, bloody sputum, or weight loss. If the cancer has spread further, it can cause additional symptoms, but many people with stage 4 lung cancer experience no symptoms at all.
  • There are a wide range of treatments available for stage 4 lung cancer. The best choice of treatment will depend on many factors, including but not limited to your age, overall health, and type of cancer.
  • Modern treatments for stage 4 lung cancer, such as immunotherapy and targeted therapy, have yielded excellent results for many.
  • If you’ve received a stage 4 lung cancer diagnosis, get a second opinion, weigh all your options, discuss with healthcare providers, and make the best decision for your own unique circumstances. Remember that everyone is different, and healthcare professionals are there to help your physical health as well as your emotional one.

Common Questions & Answers

What is the life expectancy of a person with stage 4 lung cancer?
Some studies of newer therapies found that up to 25 percent of people with stage 4 lung cancer went on to live for five years or more. That said, life expectancy statistics vary greatly and depend on many factors.
Yes, newer treatment options are creating a better prognosis. Advocate for yourself and consider all your treatment options to find the best treatment for you.
People have recovered, with no evidence of disease, and many more continue to live long, full lives while living with cancer. Newer therapies like immunotherapy and targeted therapies have proven revolutionary for some people with stage 4 lung cancer.

Resources We Trust

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.
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Tingting Tan, MD, PhD

Medical Reviewer

Tingting Tan, MD, PhD, is a medical oncologist at City of Hope National Medical Center.

Dr. Tan's research has been published in multiple medical and scientific journals, including Oncologists, Cancer Cell, and Genes and Development.

A graduate of the Beijing Medical University, Tan holds an M.D. from Peking University Health Science Center and a Ph.D. from Rutgers University. Her training includes fellowships at the University of California San Francisco Cancer Research Institute and the Fox Chase Cancer Center at Temple University.

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Ana Sandoiu

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Ana is a freelance medical copywriter, editor, and health journalist with a decade of experience in content creation. She loves to dive deep into the research and emerge with engaging and informative content everyone can understand. Her strength is combining scientific rigor with empathy and sensitivity, using conscious, people-first language without compromising accuracy.

Previously, she worked as a news editor for Medical News Today and Healthline Media. Her work as a health journalist has reached millions of readers, and her in-depth reporting has been cited in multiple peer-reviewed journals. As a medical copywriter, Ana has worked with award-winning digital agencies to implement marketing strategies for high-profile stakeholders. She’s passionate about health equity journalism, having conceived, written, and edited features that expose health disparities related to race, gender, and other social determinants of health.

Outside of work, she loves dancing, taking analog photos, and binge-watching all the RuPaul’s Drag Race franchises.

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