Stage 4 Lung Cancer: What Families Should Know
What does stage 4 lung cancer mean?
Stage 4 lung cancer means the cancer has spread beyond the lung where it started. It may have reached the other lung, the lining around the lungs or heart, or organs further away such as the brain, bones, liver or adrenal glands. Stage 4 is also called metastatic or advanced lung cancer.
For families, the diagnosis often comes as a shock. Becky Slootheer's illness started with a cough that would not go away. In July 2012 it turned out to be stage four lung cancer, and her husband Roy, an ER nurse, suddenly found himself on the other side of the hospital bed.
Can stage 4 lung cancer be treated?
Yes. Stage 4 lung cancer is usually not curable, but it can often be treated. The goal of treatment is to slow the cancer down, relieve symptoms and give the patient as much good time as possible. Treatment has changed a lot in recent years, and some people now live considerably longer than they would have in the past.
Which treatments are used for stage 4 lung cancer?
Targeted therapy: medicines aimed at specific changes (mutations) in the cancer cells, such as EGFR, ALK or ROS1. This is why biomarker testing of the tumor is so important.
Immunotherapy: medicines that help the immune system recognize and attack the cancer.
Chemotherapy: often combined with immunotherapy.
Radiation: to treat specific spots or relieve pain and other symptoms.
Palliative care: care focused on comfort and quality of life, which can start alongside treatment and is not the same as hospice.
Which options fit depends on the type of lung cancer, the biomarker results and the patient's overall health. The oncologist is the right person to explain this for your situation.
What should families know in the first weeks?
Ask about biomarker testing. The results can open the door to targeted treatment.
Ask for palliative care early. It helps with pain, breathlessness, fatigue and the emotional side, for the patient and the family.
Bring someone to appointments and take notes. A lot of information comes at once.
Keep one folder with test results, medication lists and contact numbers.
Be careful with survival statistics. They describe large groups of people, often treated years ago, and they cannot predict what will happen to one person.
Talk to your children in a way that fits their age. Honest information usually helps more than silence.
What symptoms should you watch for at home?
Call the care team when you notice new or worsening shortness of breath, coughing up blood, new pain, confusion, fever during treatment, or when the patient cannot eat or drink. In an emergency, call 911.
Frequently asked questions
Is stage 4 lung cancer always terminal?
It is usually not curable, but many people live with it for a period of time while on treatment. How long differs a lot from person to person.
Can non-smokers get stage 4 lung cancer?
Yes. Lung cancer also occurs in people who have never smoked.
What is the difference between palliative care and hospice?
Palliative care can start at diagnosis and go alongside treatment. Hospice is care for the last phase of life, when treatment aimed at the cancer has stopped.
Roy shares what he learned as a nurse and as a husband. This is personal experience, not medical advice. Always talk to your own care team about your situation.
Read Broken Glass
In Broken Glass Roy describes what stage four lung cancer meant for Becky, for him and for their two sons. Order a signed copy or read a chapter for free.
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