What Is Advanced Lung Cancer?

Lung cancer starts in your lungs, but there’s a strong possibility that it will spread (metastasize) beyond the lungs and surrounding lymph nodes to other parts of the body if it isn’t brought into remission early. Doctors may refer to metastatic lung cancer as advanced lung cancer. The condition is considered inoperable, but it may be helpful to know that treatments that can help halt further spread and potentially extend life are improving every day.

Types of Advanced Lung Cancer

Approximately 85% of all lung cancers are non-small cell lung cancers. Small cell lung cancer accounts for the remaining percentage of cases.

Among advanced non-small cell lung cancers, there are additional subtypes that include:

Lung adenocarcinoma: Formerly known as bronchoalveolar carcinoma (BAC), this type of cancer accounts for approximately 40% of non-small cell lung cancer tumors. Adenocarcinoma is the most common type of lung cancer to affect women, non-smokers, and young adults.
Squamous cell carcinoma: This type of cancer begins in the tissues lining the lung’s air passages. Around 30% of non-small cell lung cancer is this type, which is also known as epidermoid carcinoma.
Large cell carcinoma: These tumors, which begin in the central part of the lungs, are often associated with smoking. They account for 10% of non-small cell lung cancers.

Making up the remaining cases of advanced non-small cell lung cancer are rarer forms of cancer, and, in some cases, tumors that have characteristics of more than one of the common types (these are defined as “other”).

Stages

Advanced lung cancer is a term usually applied to cancer that has reached stage 3B or 4. About 17.6% of non-small cell lung cancers are already at stage 3B when they are diagnosed, and 40% are at stage 4. Advanced lung cancer can also result from the growth of stage 1, 2, or 3A tumors.

Stage 3B: Stage 3B non-small cell lung cancers are tumors of any size that have traveled to lymph nodes on the other side of the chest, spread near the collarbone, or have invaded other structures in the chest such as the heart or esophagus.
Stage 3C: In stage 3C, the tumors may be any size and have spread to lymph nodes above the collarbone on the same side of the chest as the primary tumor or to any lymph nodes on the opposite side of the chest as the primary tumor. In addition, there is spread to specific tissues in and around the chest cavity.
Stage 4: Stage 4 non-small cell lung cancers are tumors that have spread to the space between the layers lining the lungs (malignant pleural effusion) or to another region of the body. Lung cancer most commonly spreads to the bones, the liver, the brain, or the adrenal glands.

Illustration by James Bascara, Verywell

What Do the Different Stages of Lung Cancer Mean?

Advanced Lung Cancer Symptoms

The symptoms of advanced lung cancer may be related to the presence of cancer in the lungs, or they may be caused by tumors invading other organs and metastasizing to other regions of the body.

Common lung-related symptoms may include:

Chronic cough
Coughing up blood
Chest pain
Shortness of breath
Wheezing
Hoarseness
Recurrent infections such as bronchitis and pneumonia

When tumors spread or grow larger, advanced lung cancer symptoms and signs may occur, such as:

Fatigue
Unintended weight loss
Loss of appetite

Specific symptoms related to common areas of metastasis include:

Abdominal pain and jaundice (with liver metastases)
Headaches, speech difficulties, memory loss, and weakness (with brain metastases)
Pain in the back, shoulders, and chest (with bone metastases)

Diagnosis

Advanced lung cancer may be initially found on an X-ray or computed tomography (CT) scan, but further testing with a lung biopsy is necessary to determine whether or not an abnormality really is cancer and, if so, what type.

For advanced non-small cell lung cancers, genetic testing (sometimes called molecular profiling) is usually recommended because it allows the doctor to identify genetic traits in the cancer cells, which can then be targeted by specific types of treatments.

Traditionally, a tissue sample, or biopsy, would be surgically taken from the cancer site. But doctors are increasingly using a liquid biopsy test to identify DNA from the tumor circulating in your plasma.

Treatment

Lung cancer continues to be the leading cause of cancer deaths. But over the past two decades, the introduction of new medications has helped raise the overall survival rate for advanced cancer—including stage 4.

There were more new treatments approved for advanced lung cancer in the period between 2011 and 2015 than during the four decades prior to 2011. Keep this progress in mind whenever you look at research on this subject, since it often includes statistics from less recent time periods. Most importantly, keep your focus on the fact that things continue to improve.

There are two basic categories of treatment: Systemic therapy and local therapy.

Systemic therapies include chemotherapy, immunotherapy, and targeted therapies. These are the preferred treatments for advanced lung cancer because they can work throughout your body to eradicate cancer cells that have spread beyond the original tumor site.

Local therapies may be used in some cases.

Targeted Therapies

Among the amazing developments in cancer treatment has been the ability to identify genetic mutations in cancer cells and use medications that act on these genes to make the cancer cells ineffective.

The first step in this therapy is to undergo genetic testing, which can pinpoint several chromosomal abnormalities and gene mutations in cancer cells that are “targetable.”

For instance, if you have an EGFR mutation, the cancer cells are carrying out cell division at an excessive rate. The drugs that target these cells, tyrosine kinase inhibitors, send signals to stop that cell growth.

Other mutations that medications now target include ALK and ROS1 mutations. Additional therapies have been approved and more are regularly being made available.

Chemotherapy

Chemotherapy is a mainstay for advanced lung cancer, and it has extended people’s lives for decades. There are many drug combinations used, but most of these include a “platinum” drug such as Platinol (cisplatin).

These drugs work to kill the malignant cells, but the goal is not to cure cancer with chemotherapy—especially in advanced lung cancer cases. Instead, the primary aim of chemotherapy with stage 3B and 4 cancer is to offer palliative care that eases symptoms and improves the quality of life.

Immunotherapy

Immunotherapy is a fairly recent approach to cancer treatment that uses medication to help your own immune system fight cancer. There are several ways immunotherapies fight cancer, including by:

Inhibiting immune checkpoints so that the immune system can work at full-strength without slowing down
Boosting the ability for T lymphocytes (T cells) that attack cancer to destroy the malignant cells
Tagging cancer cells (via man-made antibodies) so the immune system can locate and kill them
Building up your overall immunity through vaccines
Using immunoregulatory substances to enable the immune system to fight off invaders

How Does Immunotherapy and Work on Cancer?

Clinical Trials

Clinical trials are research studies that test new ways of preventing, screening, and treating diseases. Not everyone is a good fit for every type of trial, and there are some issues to consider before enrolling.

Learning how clinical trials work and weighing the risks and benefits is worthwhile when you keep in mind that every new drug now offered to cancer patients was only able to be approved after undergoing thorough clinical trials

The National Cancer Institute funds and oversees clinical trials that regularly investigate new treatments for advanced non-small cell lung cancer. You can use their online database to search for trials seeking participants.

Local Therapies

Treatment of lung cancer with metastases was essentially the same for everyone in the past, but that’s changing somewhat.

Local therapies, including radiation therapy and surgery, are more effective for early-stage cancers where the malignancy is still one area. But they may occasionally be used along with the systemic treatments in the treatment of advanced lung cancer.

Radiation

In cases where there are few lesions (or spots of spread) resulting from brain metastases, radiation treatment via stereotactic body radiotherapy (SBRT) has resulted in improved survival.

Surgery

Systemic treatments are sometimes used to decrease the size of stage 3B or stage 4 lung cancer tumors so that these tumors can be surgically removed. While it will not rid the body of all cancer, this type of surgery can improve the quality of life and extend survival.

It’s important to keep in mind, though, that the stress of surgery on top of systemic treatments may be too much for some people in advanced stages of lung cancer to tolerate.

Another path doctors have explored is using non-cancer drugs to help lung cancer patients. For example, drugs known as bisphosphonates that were originally used to treat osteoporosis may improve survival rates for people with bone metastases.

Prognosis

When looking at the statistics regarding survival rates for stage 3B and 4 non-small cell lung cancer, it’s important to consider that these numbers have been improving and the hope is they will continue to improve.

The current five-year survival for advanced lung cancer is just under 7%. That said, there are long-term survivors of advanced lung cancer, and that number is growing.

Coping and Support

What you’ll quickly learn after being diagnosed with advanced lung cancer is that lung cancer takes patience, persistence, and support.

The first thing to remember is that it’s important to learn how to be your own advocate in your cancer care, which means researching your condition, asking questions, and fighting for the treatment you think is best.

You’ll need to rely on others at some point as well, so reach out to family and friends.

You can also get support through in-person and online lung cancer communities where you can find people who understand what you’re facing and can support you on your journey.