Stage 4 lung cancer

The stage of a cancer tells you how big it is and whether it has spread. Knowing the stage helps your doctor decide which treatment you need.

Stage 4 is part of the number staging system. It uses the TNM system to divide cancers into stages. There are 4 stages of lung cancer, numbered from 1 to 4. Stage 4 can be divided into 4A and 4B.

Stage 4 non small cell lung cancer is also called metastatic (advanced) lung cancer.

Stage 4A

There are 2 possible stages for stage 4A:

Stage 4A can mean the following:

• the cancer can be any size and might have grown into nearby structures (any T)
• it might have spread to nearby lymph nodes (any N)
• it has spread to the other lung
• it is in the layers covering the lung (the pleura) or the heart (pericardium)
• there are cancer cells in the fluid between the two layers covering the lung (pleural effusion) or the heart (pericardial effusion)

Or stage 4A can mean the following:

• the cancer can be any size and might have grown into nearby structures (any T)
• it might have spread to nearby lymph nodes (any N)
• there is a single area of cancer that has spread outside the chest to a distant lymph node or to an organ such as the liver, bones or the brain

Stage 4B

Stage 4B can mean the following:

• the cancer can be any size and might have grown into nearby structures (any T)
• it might have spread to nearby lymph nodes (any N)
• it has spread to several areas outside the chest such as distant lymph nodes or other organs, or both

TNM stages

TNM stands for Tumour (T), Node (N) and Metastasis (M). The staging is different depending on the type of cancer you have.

The information below is an overview of the TNM staging for all types of cancer.

• T describes the size of the tumour (cancer)
• N describes whether there are any cancer cells in the nearby lymph nodes
• M describes whether the cancer has spread to parts of the body further away from where the cancer started

The doctor gives each factor (T, N and M) a number. The number depends on how far the cancer has grown or spread.

So, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1 N0 M0.

A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3 N1 M1.

In the TNM staging system, stage 4 is the same as one of the following:

• Any T, Any N, M1a
• Any T, Any N, M1b
• Any T, Any N, M1c

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

• your type of cancer (the type of cells the cancer started in)
• where the cancer is
• other health conditions that you have

The treatment for small cell lung cancer is different to the treatment for non small cell lung cancer.

Non small cell lung cancer

Treatment aims to control the cancer for as long as possible and help to reduce symptoms.

If you are well enough you might have:

• targeted cancer drugs
• immunotherapy
• chemotherapy with immunotherapy
• chemotherapy
• stereotactic radiosurgery (SRS) on any cancer left behind (residual disease)
• brain SRS or whole brain radiotherapy for brain metastases

To control symptoms you might also have one or more of these treatments:

• external radiotherapy
• internal radiotherapy (brachytherapy)
• laser treatment
• freezing the tumour (cryotherapy)
• a rigid tube (called a stent) to keep the airway open
• a rigid tube (called a stent) to keep a big vein called the superior vena cava open

Small cell lung cancer

Treatment aims to control the cancer for as long as possible and help to reduce symptoms.

If you are well enough you usually have chemotherapy with or without immunotherapy.

If your cancer responded well to chemotherapy with or without immunotherapy, you might have radiotherapy to your chest.

After you finish treatment, you might have radiotherapy to your head if your cancer has responded well to treatment. This treatment is called prophylactic cranial radiotherapy (PCR). You have this because it is common for small cell lung cancer to spread to the brain. The radiotherapy aims to kill any cancer cells that may have already spread to the brain but are still too small to see on scans.

You might have prophylactic cranial radiotherapy if:

• your chemotherapy or radiotherapy treatment has stopped your cancer growing
• you are well enough

To control symptoms you might also have one or more of these treatments:

• radiotherapy
• internal radiotherapy (brachytherapy)
• laser treatment
• freezing the tumour (cryotherapy)
• a rigid tube (called a stent) to keep the airway open
• stereotactic ablative body radiotherapy (SABR) for cancer that has spread to one or a few distant sites, also called oligometastatic disease
• a rigid tube (called a stent) to keep a big vein called the superior vena cava open

Other stages