What Is Stage IV of Non-Small-Cell Lung Cancer?

Medically Reviewed by Paul Boyce, MD on November 04, 2023
4 min read

If you're in stage IV of non-small-cell lung cancer, it means the disease has spread from the lungs to distant areas of your body, such as the liver, brain, or bones. Although it usually can't be cured, there are a variety of treatments that can slow the cancer's growth and help you manage its symptoms.

The symptoms you had in earlier stages of the disease may continue or get worse. Some problems you may have are:

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 (jaundice). You may feel pain at the sites of the tumor.

Imaging tests. Your doctor may use X-rays, CT scans, or PET scans to see if new tumors have formed in your body and check how large they are. High-resolution CT and PET scans are good at finding tiny tumors that might not show up on an X-ray.

Tissue biopsy. If your doctor suspects your lung cancer has spread to other organs, you may get a biopsy to confirm or rule out cancer in those areas. Your doctor may use a hollow needle to remove a small sample of tissue from your lymph nodes or liver, for instance. A specialist called a pathologist will look at it under a microscope to see if there are cancer cells. Genetic tests on the tissue can also identify specific features of the cancer.

Your doctor will likely use a combination of treatments when you're in stage IV. Your plan may include:

Chemotherapy. Although it's not likely to cure you at this stage, chemotherapy can shrink the tumors you have or slow their growth.

Targeted drugs. If your tumor cells have certain genetic mutations (changes), your doctor may suggest a targeted drug to destroy those specific cancer cells. For example, some tumor cells grow quickly because they make too much of a protein called EGFR. Drugs called EGFR inhibitors, like amivantamab-vmiw (Rybrevant), erlotinib (Tarceva) and osimertinib (Tagrisso), block signals from this protein so the tumor cells don't grow as fast.

Immunotherapy. This type of medicine activates your immune system to find and destroy cancer cells. Your doctor may suggest drugs called immune checkpoint inhibitors, like nivolumab (Opdivo) and pembrolizumab​​​​​​​ (Keytruda).

Laser therapy. Doctors sometimes use laser procedures to treat small tumors that block your airways. You may find it easier to breathe once these tumors are removed.

Radiation. This therapy, which uses high-energy beams to kill tumor cells, can shrink your tumors' size and ease pain. Newer radiation methods precisely target tumor cells to lessen side effects.

Fluid drainage. As lung cancer advances, fluid buildup in some parts of your body, especially around the lung and inside the sac that surrounds the heart, can cause discomfort and breathing problems. If this happens, your doctor can drain the fluid with a special needle. This procedure may need to be repeated every so often. If your fluid buildup is severe enough, your doctor might put in a device called a chest catheter. It attaches to a fluid drainage bottle that you can empty on a regular basis.

It's important to reach out to friends and family to get backing for the swirl of emotions you may have. You may want to create a supportive care plan with your doctor to make sure your quality of life is as high as possible. This plan could include counseling to help you manage emotions, medications to boost your appetite, and nutritional supplements to keep your weight up.

You may also wish to talk to your doctors, friends, and family about end-of-life care options. This can be a tough topic to discuss, but when you do, you'll be able to make sure that you and your care team are on the same page.

Many patients with stage IV lung cancer report pain severe enough to interfere with daily life. If this is true for you, talk to your doctor about a pain medication plan that eases your discomfort and allows you to take part in activities you most enjoy.