What Is Stage IV (4) Lung Cancer?

When this disease has reached stage IV (4), it’s the most advanced. Most patients are diagnosed at stages 3 and 4. Treatment options are much fewer when cancer has advanced this far. At stage IV, tumors have metastasized (spread) from the originating lung to the second lung, to space around the heart, lungs (pericardium), chest, lymph nodes, or other areas.

At this level, symptoms that develop vary based on the region in the body where the tumors have spread. This differs slightly for every patient at every stage. At stage IV lung cancer, cancer could have made its way to the bones, at which point symptoms would consist of bone pain or easy breaks. If tumors have metastasized to the liver, a patient could experience nausea, fatigue, bloating, or swelling in the fingers and toes. When cancer makes its way to the brain, it could cause neurological issues like recurring headaches, difficulty with vision, trouble talking, or seizures. More common symptoms of stage 4 include:

  • Back or abdominal pain
  • Excessive coughing or coughing up blood
  • Feeling fatigued or weak
  • Growth in the neck or collarbone area
  • Issues with breathing and loss of breath
  • Lack of a desire to eat

Talk to a doctor for more details if you have recurring symptoms for an extended period.

Non-Small Cell Lung Cancer

Non-small lung cell cancer (NSCLC) grows slower than small-cell lung cancer (SCLC). Approximately 90% of lung cancer diagnoses are NSCLC. It’s separated into two sub-sections based on tumor size and location.

This is an image representing Stage IVA in Lung Cancer Stage.

Stage IVA

Cancer cells have metastasized to the second lung, into the space holding the fluid around the lungs (known as malignant pleural effusion), or fluid around the heart (or malignant pericardial effusion). Tumors can be any size and have made their way to nearby regions. One lymph node on the second lung or chest has been affected. The liver, bones, or brain may be compromised.

This is an image representing Stage IVB in Lung Cancer Stage.

Stage IVB

Tumors can be of any size. More than one tumor has metastasized outside the chest, distant lymph nodes, or other organs such as the liver or brain.

Small Cell Lung Cancer

Classified differently than NSCLC, SCLC is referred to as either limited or extended when attributing the growth of tumors.

This is an image representing Stage IV - Extended in Lung Cancer Stage.

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.

Prognosis and Survival Rates

When your oncologist makes a prognosis, they’re predicting how they think the disease will develop and how you’ll react to it. This involves symptoms and side effects you may experience while you’re sick and undergoing treatment. This time also includes how you may respond to treatments and what will happen post-treatment. Your doctor may recommend diet and exercise changes to help you potentially improve your prognosis.

A patient’s survival rate refers to the percentage of patients at a similar stage of the same disease still alive five years after their diagnosis. Compared to stage I and stage II lung cancers, survival rates are at their lowest, averaging at 4.7%. Remember that survival rates do not reflect recent technologies and emerging treatments that may be more efficient at fighting tumors.


Stage IV cancer treatment options are sometimes beyond curative measures. At this point, doctors may develop a palliative treatment plan, designed to help the patient manage their symptoms, pain, and side effects to be more comfortable. Doctors may utilize one or a combination of chemotherapy, radiation, surgery, or targeted therapies.

At such a developed point in the disease, a patient may consider being a part of a clinical trial. Clinical trials are where scientists, doctors, and researchers develop and test new treatments and therapies on patients that sign up. The patient could gain access to new therapies not yet approved by the Food and Drug Administration that are otherwise unavailable.

Talk to your oncologist if this is something you may be interested in. They can recommend some clinical trials in your area or nearby that may suit you.

Next Steps

If you experience lung cancer symptoms, go to a doctor for a diagnosis. Did your doctor determine the cause of the illness was negligent exposure to a carcinogen? You could have a legal case against the companies responsible. The monetary compensation you receive from this legal action could help pay for treatment or support your family during these difficult times.