In this stage, the cancer has spread beyond the edges of the lung tissue into nearby areas in the chest. The cancer may have also spread to the lungs’ other airways or into organs such as the liver and brain. In the United States, most people who are diagnosed with non small cell lung cancer in this stage live for about 2 years. Survival rates depend on many factors, including the type and stage of the cancer and a person’s age and overall health.
In some cases, the doctor may be able to completely remove the cancer from the lungs by surgery or from other parts of the body such as the bones. This is called surgical cure. In most cases, however, doctors can only cure the cancer by giving chemotherapy or other drugs that attack the cells and keep them from growing. The types and doses of chemotherapy used depend on the type of cancer.
Stage IV cancer is the most advanced stage of non small cell lung cancer, and it means that the cancer has spread to other parts of the chest or to other organs. It can be hard to treat because the cancer can grow in the lungs or in the fluid that surrounds the lungs and heart (the pericardial sac). The cancer can also grow into blood vessels in the lungs or other parts of the body. Often, the treatment plan involves systemic therapy, which is when the medicine is taken by mouth or vein.
If the cancer has spread to other parts of the lungs, the doctor can try to slow the growth of the cancer by treating the area where it is found with radiation or with chemotherapy. The doctor can also try to kill the cancer by removing the part of the lung where the cancer is growing or using a special machine that treats only the area with cancer.
The doctor will also ask about a person’s smoking history and perform a physical exam. The doctor will also want to know about any other medical conditions the patient has. A CT scan of the chest and upper abdomen is often done. A PET-CT or MRI scan of the brain may also be done. In some cases, a doctor will test lymph nodes in the neck for signs of cancer.
Some people with stage III NSCLC are treated with immunotherapy and a combination of chemotherapy. Immunotherapy is a treatment that uses the body’s natural defenses to fight the cancer. It can improve the response to chemotherapy or other treatments in some patients.
Researchers have made significant advances in understanding the genetic changes that occur in cancer and in developing therapies to target these alterations. In 2017, updated ASCO guidelines recommended that doctors use immunotherapy to treat some patients with stage IV NSCLC who have certain driver alterations, such as EGFR mutations or ALK fusions. However, at the time of this writing, there is insufficient evidence to recommend systemic therapy for patients with stage IV NSCLC who do not have these alterations.
