Lung Cancer

Metastatic Disease

Lung cancer that has spread beyond the lung is called metastatic, advanced or Stage IV lung cancer. Some patients have advanced disease at the time cancer is diagnosed. For others, metastasis may be discovered during follow-up appointments or as a result of symptoms, such as a persistent headache or bone pain. When lung cancer metastasizes, it typically spreads to the adrenal glands, bone, brain, liver or the other lung. It is important to note that when lung cancer spreads to another part of the body, it is still considered lung cancer and is treated as such.

Treatment Options

Treatment for metastatic lung cancer is lifelong. As a result, the goals of treatment are to control the growth of the cancer or to relieve symptoms caused by it and to find the treatment that works best for you.

Metastatic lung cancer may be treated with systemic therapies, which involve the use of substances that travel through the bloodstream, reaching and affecting cells all over the body. These therapies include chemotherapy, biologic therapy, targeted therapy, hormone therapy, or a combination of these treatments.

Recent advancements have provided new, personalized lung cancer treatment options. These targeted therapy treatments focus on the tumor’s molecular abnormalities, also called molecular drivers. The abnormalities fuel the growth of some types of lung cancer, and the targeted therapy drugs use tyrosine kinase inhibitors to attack them. To determine if you are a candidate for this type of treatment, your tumor must be tested. Talk with your doctor to see if this is an option for you.

Radiation therapy is often used to relieve symptoms of metastatic lung cancer such as pain, bleeding, trouble swallowing, cough, or problems caused by spread to other organs such as the brain.

Researchers are testing new treatments for metastatic lung cancer in clinical trials. Clinical trials offer a unique opportunity to gain access to state-of-the art cancer treatment. Ask your doctor if your type of lung cancer is eligible for a clinical trial.

Monitoring Your Cancer

With metastatic lung cancer, tracking how your disease responds to treatment is an important part of your overall care plan. To monitor your cancer, your doctor will order routine testing. Several types of tests can help monitor the cancer’s response to treatment, including imaging studies, tumor marker testing and blood tests. Often, more than one test is needed. To have a baseline for comparison with later studies, your doctor will perform one or more of these studies before treatment.

You will have routine visits with your doctor during treatment. Use the visits to tell your doctor about any new or changing symptoms. Depending on the sites of metastasis, your doctor may be able to tell if treatment is working by performing a physical exam. For example, if a lymph node is a site of metastasis, your doctor may be able to feel that the node has gotten smaller, which means that the metastasis has shrunk.

Together, your input and the results of ongoing, specific testing can tell you and your doctor how well your treatment is working. If your treatment is not slowing or stopping the growth of your cancer, you and your treatment team should discuss other treatment options. Ask about second and third-line therapies that may be appropriate for you, as well as any clinical trials that may be available for your tumor type.

Choosing the Right Path for Yourself

Undergoing continuous treatment can take a toll on you. You may reach a point where you feel you need a break from your chemotherapy or other treatments. Talk with your doctor to ensure you understand what taking a break from treatment means for your treatment plan and discuss your reasons for wanting a break. Keep in mind that the treatment you choose initially may need to be adjusted depending on how your body responds and the progression of the disease. Changing your treatment dosage or intensifying the management of your side effects may be appropriate alternatives to stopping treatment.

If you have tried multiple treatment options that are no longer working, you may reach a time when you choose to stop treatment altogether. Talk with your doctor about your feelings. If you make that difficult decision, you are strongly encouraged to investigate hospice care, where efforts are focused on managing symptoms and supporting the patient and family without using cancer therapies. Hospice care can take place at home or in a hospice center and offers physical, emotional and spiritual support for you and your loved ones.


Palliative Care

Palliative care is a treatment strategy focused on improving the quality of life for patients by treating or preventing the side effects and symptoms of the disease. Palliative care, also called supportive care, may be given with primary treatment for the lung cancer or by itself, which may be the case for more advanced disease.

Individuals with lung cancer often suffer from shortness of breath. This symptom can be caused by a number of factors, such as fluid buildup in the area surrounding the lungs or a tumor that restricts an airway. Fluid that builds up in the chest surrounding the lungs is called pleural effusion. Your doctor may recommend thoracentesis (a procedure to drain the fluid) or pleurodesis, which involves draining the fluid and then injecting a substance that causes the lining of the chest wall and lung to stick together, preventing any further fluid buildup. Another option may be to place a catheter into the chest to allow the doctor to regularly drain fluid buildup. If the shortness of breath is caused by an airway restriction, laser therapy may be used to destroy the tumor, or a stent (silicone or metal tube) may be placed inside the airway to keep it open.

Lung tumors that have spread to the area around the heart can cause fluid buildup that affects its function. This may be treated using pericardiocentesis (a procedure to drain the fluid) or by creating a pericardial window, which prevents future fluid buildup by removing a piece of the sac around the heart to allow for drainage into the chest or abdomen.

Always tell your doctor about any new or worsening symptoms so they can be addressed immediately. Working to alleviate discomfort is an important part of managing your disease.


Additional Resources


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