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Stage 4

Find out what stage 4 lung cancer means and about treatments.

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 means that the cancer has spread. It is divided into stage 4A and 4B. It is also called advanced lung cancer.

Stage 4A can mean any of the following:

  • there is cancer in both lungs
  • the cancer is in the covering of the lung (the pleura) or the covering of the heart (pericardium)
  • or there is fluid around the lungs or the heart that contains cancer cells
Diagram 1 of 3 showing stage 4 lung cancer

Or it can mean that there is a single area of cancer that has spread outside the chest to a lymph node or to an organ such as the liver or bone.

Diagram 2 of 3 showing stage 4 lung cancer

Stage 4B means that the cancer has spread to several areas in one or more organs.

Diagram 3 of 3 showing stage 4 lung cancer

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

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:

  • chemotherapy
  • targeted cancer drugs

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
  • light therapy (photodynamic therapy – PDT)

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.

If the chemotherapy works well, you might have radiotherapy to your chest after chemotherapy.

After you finish treatment, you might have radiotherapy to your head. This treatment is called prophylactic cranial radiotherapy (PCR). You have this because it is quite 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 have 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
  • light therapy (photodynamic therapy – PDT)

Other stages

Last reviewed: 
01 Aug 2017
  • TNM Classification of Malignant Tumours (8th edition)
    International Union Against Cancer   
    John Wiley and Sons, 2016

  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2016

  • Lung cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2011

  • Management of lung cancer
    Scottish Intercollegiate Guideline Network, 2014

  • The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer
    Peter Goldstraw and others for the Study of Lung Cancer Staging and Prognostic Factors Committee
    Journal of Thoracic Oncology, 2015, vol.11, No.1:39-51

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