Stage 4 lung cancer

About staging

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.

TNM stages

The TNM system describes:

• the size of the primary tumour (T)

• whether the cancer has spread to the lymph nodes (N)

• whether the cancer has spread to another part of the body (M)

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 T1mi-T1a N0 M0.

A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3-T4 N1 M1.

In the TNM staging system, stage 4A is the same as:

• Any T Any N M1a-M1b

Stage 4B is the same as:

• Any T Any N M1c1-M1c2

Stage 4A

Stage 4A (any T any N M1a-M1b) 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 a single area in one organ such as the liver, bones or the brain

Stage 4B

Stage 4B (any T any N M1c1-M1c2) 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)

• the cancer has spread outside the chest to more than one area in one organ, such as to several areas in a single bone, or to several organs

Treatment

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) for small amounts of cancer left behind (residual disease) or for small areas of cancer in the brain

• 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

Find out about these treatments

Small cell lung cancer

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

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

If your cancer responded well to chemotherapy with or without immunotherapy, and there is still cancer left behind, your doctor might suggest 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 irradiation​ (PCI). 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. Sometimes doctors may suggest regular MRI scans of the brain instead of PCI.

You might have prophylactic cranial irradiation 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 airway 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

Read about treatments for metastatic lung cancer

Other stages

• Stage 1

• Stage 2

• Stage 3

• Limited and extensive disease (small cell cancer)

• TNM staging