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Stage 4 Lung Cancer
Lung cancer is a type of cancer that grows in your lung tissue. Stages of cancer span from 0-4, with stage 4 being the most advanced stage of lung cancer. Lung cancer is often diagnosed in the later stages because symptoms may be difficult to detect before stage 3 or 4. There are two main types of lung cancer—small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
Small cell lung cancer (SCLC) makes up about 10-15% of all lung cancer cases, and non-small cell lung cancer (NSCLC) makes up about 80-85% of lung cancer cases. SCLC tends to spread more rapidly beyond the lungs to other parts of the body.
Lung cancer is the leading cause of cancer-related death in the United States. However, more research is being done every day to advance treatment and detect lung cancer sooner. Your healthcare team will create a treatment plan based on how advanced your cancer is. Treatment options for stage 4 lung cancer include chemotherapy, radiation therapy, and immunotherapy.
An oncologist (a doctor who specializes in the diagnosis and treatment of cancer) will perform several tests to determine what stage, or how advanced, your cancer is. Knowing the stage of cancer helps them develop an effective treatment plan. The American Joint Committee on Cancer (AJCC) developed the TNM staging system to determine how advanced cancer is. The system is broken down into three factors: T for tumor: Measures the size and location of a cancerous tumor N for nodes: Determines if cancer cells have spread to the lymph nodes (a group of glands part of the immune system) M for metastasis: Assesses if cancer cells have spread (metastasized) beyond the lungs to other areas of the body The less advanced stages of lung cancer are stages 0-3. Stage 4 lung cancer means the cancer has spread to other parts of the body. There are two types of stage 4 lung cancer: stage 4A and stage 4B. Stage 4A usually means the cancer has spread to the chest, both lungs, the lining around your lungs (pleura), and the lining around your heart (pericardium). Stage 4B means the cancer has spread to one or more tumors outside of your chest or to other lymph nodes and organs. Both non-small cell lung cancer and small-cell lung cancer use the same staging system, though the system is generally not as important in SCLC. Instead, the cancer might be considered to be in a limited stage (cancer is only on one side of your chest) or an extensive stage (cancer has spread to other parts of your body). Stage 4 lung cancer develops when cancer cells from the lung spread to other parts of the body. The cancer cells can move in several ways, including growing into nearby tissue and passing through lymph node or blood vessel walls. Lung cancer is most commonly caused by smoking tobacco. Smoking is linked to 80% of lung cancer deaths in the U.S. Smoking cigars or menthol cigarettes and using chewing tobacco can also cause lung cancer. It is rare to be diagnosed with lung cancer if you have never smoked, but it's possible. Exposure to secondhand smoke, air pollution, and diesel exhaust can also cause lung cancer. Risk Factors There are several environmental and lifestyle risk factors for lung cancer. Depending on the environment you live or work in, you may be able to alter some of the following risk factors: Secondhand smoke: Being physically close to someone who is smoking increases your risk of lung cancer over time. Radon exposure: Radon is a radioactive gas found in soil and rocks. Consider conducting a radon test in your home to check for exposure. Asbestos exposure: People who work in mines, textile plants, and shipyards are at increased risk for asbestos exposure. Asbestos is a chemical commonly used to create commercial and industrial products. Exposure to chemicals: Inhaling chemicals such as arsenic, beryllium, or diesel exhaust in work environments increases your risk of lung cancer. Beta-carotene supplements: People with a history of heavy smoking may have an increased risk of lung cancer if they take beta-carotene (a compound that gives plants their color) supplements. Radiation therapy: If you have received radiation therapy for another type of cancer, it may raise your risk of lung cancer. Air pollution: People who live in cities with more air pollution with more exposure to things like diesel exhaust from cars are more likely to develop lung cancer. Family history: If one of your family members has been diagnosed with lung cancer, your risk is higher. With stage 4 lung cancer, you can experience the symptoms of lung cancer that people with less advanced stages might experience, as well as symptoms in other parts of your body based on where the cancer has spread. Common symptoms of lung cancer include: A bad cough Hoarse voice Chest pain The presence of blood when you cough Loss of appetite Unintended weight loss Shortness of breath Wheezing Tiredness or weakness Chronic (long-term or repeated) respiratory infections like bronchitis and pneumonia Because stage 4 lung cancer affects other parts of the body, you may also experience: Bone pain, such as in your back or hips Yellowing of the skin and eyes (jaundice), if the cancer has spread to the liver Swollen lymph nodes in the neck or above the collarbone Headache, weakness or numbness in your arm or leg, dizziness, balance issues, seizures, and other nervous system changes if the cancer has spread to the brain Lung cancer can also cause syndromes as it spreads. For instance, cancer that spreads to nerves in the face can lead to Horner syndrome, which causes eyelid drooping. Other conditions that may occur include superior vena cava syndrome (cancerous tumors that grow in the upper right lung) and paraneoplastic syndrome (a group of syndromes that can affect organs that lung cancer cells have not yet spread to). Several tests help diagnose stage 4 lung cancer. When you develop symptoms of lung cancer, your healthcare provider will likely start by performing a physical exam and asking about your medical history. They will ask questions about the symptoms you are experiencing and any risk factors, such as smoking history. Diagnostic tests for lung cancer include: Blood tests: A complete blood count (CBC) can measure blood cells and tumor markers. Sputum markers: A test of saliva and phlegm can detect tumor markers. Lung biopsy: A small sample of lung tissue is taken and sent to a lab to be tested for cancer cells. Bronchoscopy: A healthcare provider inserts a tubed camera into the lungs to look for signs of cancer. Chest X-ray: Images of the lungs and chest cavity can identify abnormalities like tumors. Magnetic resonance imaging (MRI) scan: This test uses strong magnets to take X-ray pictures of the lungs at several angles. Computed tomography (CT) scan: This radiation test can locate the lung tumor and determine its size. People with a history of heavy smoking may benefit from regular lung cancer screenings with a low-dose CT scan. Positron emission tomography (PET) scan: This nuclear scan locates cancer cells throughout your body and determines how far lung cancer has spread. Several treatment options are available, but stage 4 lung cancer can be hard to cure. Your healthcare provider will discuss the ultimate goal of treatment, which may be to help prolong your life or to let you live more comfortably in the time you have left. The treatment plan will depend on how much your cancer has spread and which areas of the body are affected. Stage 4 NSCLC: Treatment may include a combination of surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, photodynamic therapy, and laser therapy. Stage 4A: If the cancer has spread to just one other location, you might have surgery and radiation on the secondary location before treating the cancer in the lung. Stage 4B: If the cancer is more widespread, your treatment may begin with genetic testing. Tumors that test positive for certain gene mutations may have to receive targeted therapy (treatment that uses drugs to target specific molecules). Stage 4B NSCLC: If you have high levels of the PD-L1 protein, your healthcare provider may recommend immunotherapy. Immunotherapy drugs boost the immune response to cancer cells, which can attack the PD-L1 protein in cancerous tumors. Targeted therapy and immunotherapy may be given with chemotherapy (cancer cell-killing drugs are injected into your vein). Treatment for stage 4 SCLC typically does not include surgery or radiation, as they are usually ineffective. Chemotherapy and immunotherapy may improve your symptoms and prolong your life. If your symptoms are breathing-related, radiation may help improve your symptoms. Palliative Care With stage 4 lung cancer, it is not uncommon for the cancer to return even after a period of remission (symptoms of your cancer go away). Palliative care is a type of treatment that focuses on extending and improving your quality of life. The goal of palliative care is not to cure cancer but to ease the burden of symptoms from treatment. Palliative care is different from hospice or end-of-life care. This is supportive care that aims to improve symptoms and reduce pain or discomfort. Palliative care varies from person to person, depending on the toll the cancer takes on your body. Your healthcare provider may prescribe pain medications and anti-nausea medications to reduce symptoms related to the cancer and cancer treatments. If one of your symptoms is difficulty breathing, you may be given airway support and oxygen to open your airways and improve breathing. Experiencing cancer often affects your mental health. A solid support system is important throughout the treatment process. For this reason, your healthcare team may add emotional support and counseling to your palliative care. Most cases of stage 4 lung cancer are not curable. Your prognosis (how the cancer will behave in your body over time) depends on several factors: The type of lung cancer you are living with How the cancer is spreading Your age Your overall health before being diagnosed How your body responds to treatment When predicting outcomes, your healthcare team will consider the five-year survival rate. This estimates the percentage of people who will survive five years after diagnosis. The five-year survival rate is 9% for NSCLC and 3% for SCLC. Preventing all lung cancer cases may not be possible, but you can take steps to lower your risk. Although it can be challenging, quitting smoking can reduce your chances of developing lung cancer later in life. The risk of lung cancer can decrease 30-60% after 10 years of quitting smoking. For long-term smokers, it is also important to not take beta-carotene supplements. Check with your healthcare provider right away if you are experiencing common symptoms of lung cancer. Being diagnosed with stage 4 lung cancer can be a scary experience. A big part of living with stage 4 lung cancer is the palliative care you receive as you go through the treatment process. This can vary depending on multiple factors, including the type of lung cancer you are living with, your age, and how your cancer is progressing. Treatment for stage 4 lung cancer can be mentally taxing. Reach out to your healthcare provider or a loved one for emotional and mental health support if it is not already a part of your treatment plan. Although not many people with stage 4 lung cancer live for long, there are treatments available to extend your life.Thanks for your feedback!
A Path After Cancer Doesn't Have To Be Linear
I used to think that having lung cancer canceled all of my life's plans, but I realized I shouldn't give it that much power.
When Knox thought about her goals and dreams, she realized the end result was what mattered most.
When I got my stage 4 lung cancer diagnosis at age 32, it was two weeks after my wedding; just seven days after my husband was deployed to South Korea. At the time, I had so many goals and dreams, and all I could think about was how I would never get to do any of them. A diagnosis tends to strip away any feelings of hope and a future. It's so easy to let go of dreams and desires out of sheer doubt and fear.
After three lung drains and with a PleurX catheter in my left lung, I slowly returned to kickboxing and felt fine! Well, fine enough. But it was then that I realized I could still do the things I wanted to do. I just need to do them differently and they may not look like what I originally expected.
I always dreamed of being a mother and with my new husband, we were excited to start discussing future plans. I felt like cancer took that from me almost immediately. It was the first goal I mourned. But possibilities outside of natural birth were presented to me, and I realized that I could still be a mother in some capacity. But was that good enough?
I began to consider what was most important to me about my goals and dreams: the process or the end result. I came to terms with the fact that it doesn't matter what the path looks like, as long as I get to where I'm trying to go. My whole world opened back up and a whole shelf of dreams, I thought I had to put away forever, became possible for me. These included motherhood, fitness, travel, weddings and careers. If I focused on that end result, how I got there didn't matter. And I have slowly been checking those bucket list boxes off my list!
Before my diagnosis, I used to think of things very linearly. Having cancer has taught me to be creative, open-minded and to always stay positive. Life doesn't have to end with cancer unless you let it. And if you truly want to do something, find a way to make it happen and it will be that much sweeter when it does. The feeling of relief I had when I finished that first kickboxing class post-diagnosis was such a rush. I felt like I was reclaiming my power and my life from this disease.
On the other side, I understand that I am incredibly blessed in my journey. A lot of things are working in my favor. And I realize that no two cancer journeys are the same. But I think if we all think of our goals from this lens, we can all achieve much more than we thought. I am a firm believer that whatever part of your life you can take back from cancer, you should. Cancer takes away so much from us and we all deserve those little victories.
My motto is, "I may have cancer, but cancer does NOT have me."
This post was written and submitted by Jaymie Knox. The article reflects the views of Knox and not of CURE®. This is also not supposed to be intended as medical advice.
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Now Doctors Face New Cancer Crisis - Mystery Rise Of Lung Tumors In Young People Who've NEVER Smoked
As scientists work to unravel the mysterious rise in early-onset colon cancers, a new worrying trend has emerged.
Lung cancer rates, which have been dropping for decades as the world weans off tobacco, are now rising in young, otherwise healthy people who've never smoked.
One in 10 lung cancer diagnoses in the US are patients under 55, but the rate of early cases has been increasing for the past two decades. And the share of these young patients who have never smoked cigarettes is also growing.
Researchers believe that the way new homes are built may be exposing residents to a poisonous gas. They also say vaping and cannabis could be factors.
Matt Hiznay, who shared his story at ASCO, was diagnosed with stage-four lung cancer in 2011. He was just 24 years old
Researchers presenting at ASCO in Chicago said that lung cancer is rising in young Americans due to chemical exposure, vaping, and genetic mutations rather than solely from smoking
Lung cancer is the deadliest form of the disease, making up one in five US cancer deaths. Along with over 230,000 diagnoses, 125,000 Americans are expected to die of it this year.
Though most patients are over 70, Dr Laura Mezquita, a medical oncologist in Spain, said during a panel at the world's largest cancer research conference this weekend that there is 'increased incidence' in Americans under 50.
Beyond smoking, 'we must consider other aspects,' she said.
Science has long established that smoking definitively causes lung cancer and is the primary risk factor for the disease.
However, while smokers make up as many as 90 percent of older lung cancer patients, this number drops to 71 percent for younger patients.
Young patients also have significantly shorter exposures, with an average of 11.5 years compared to 49 years in older patients.
'The shift away from the perception of smoking as trendy is further diminishing the proportion of smoking in the young population,' the researchers wrote in a report published ahead of ASCO.
According to recent data from Pew Research, just 10 percent of young adults said they smoked from 2019 to 2023 compared to 35 percent in 2001 to 2003. This, the team suggested, indicates nearly an all-time low.
'Therefore, new evidence is emerging involving exposure to group 1 carcinogens beyond tobacco, where potency... Degree of exposure... May play a more significant role in younger patients.'
The above shows lung cancer cases among men and women split by age groups. It reveals the disease is now more common in younger women, compared with other groups
Tiffany Job, 40, was diagnosed with stage four lung cancer after mistaking her symptoms for a pulled muscle. She had never smoked
Group 1 carcinogens are substances that are proven to cause cancer. Beyond smoking, others include air pollution and ultraviolet radiation.
'Radon gas is a primary cause of lung cancer among nonsmokers and the second leading cause among smokers,' the researchers wrote.
Radon is an invisible, odorless gas produced from the decay or uranium in rocks, soil, and water. The World Health Organization estimates that radon is responsible for three to 14 percent of lung cancers.
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Advertisement'Radon is the main cause of cancer in non-smokers,' Dr Mezquita said. 'Radon is a risk factor also in young populations.'
She said this could be due to radon exposure in homes from birth, which could enter the home through contaminated soil.
Additionally, a 2019 report in Nature found that radon exposure in homes is increasing due to modern construction being more airtight.
Dr Mezquita also pointed toward vaping, which she noted 'is very prevalent in younger populations.'
Much of the science is unclear, but some recent reports have suggested that vaping can increase the risk of lung cancer - especially in those who have previously smoked.
A first-of-its-kind study from Seoul, South Korea, analyzed health data from 4.3million ex-smokers and found those who switched to vapes were twice as likely to die from lung cancer, compared to those who went cold turkey.
Additionally, the ASCO researchers noted that in young people who do smoke, marijuana could exacerbate the risks.
'Cannabis consumption often occurs in conjunction with tobacco, posing challenges for separate evaluation. Emerging evidence has linked it to more aggressive forms of lung cancer among young patients,' the team wrote.
Dr Mezquita said that while there is evidence pointing toward all of these factors, there is not just one to blame. 'This is not just radon, this is not just air pollution, this is not just smoking. It's an interaction between all of these risk factors.'
During ASCO, lung cancer survivor and scientist Dr Matt Hiznay, 37, of Ohio, took the stage to detail how being diagnosed with lung cancer as a young adult affected him.
In 2011, Dr Hiznay was diagnosed with stage four adenocarcinoma after several months of persistent cough and pain in his back and chest. He was only 24, and he had never smoked.
'There were really no warning signs whatsoever,' he said. 'Cancer was nowhere on the radar.'
'You're at the start of your life. When you're young and you get diagnosed, it's very hard to see the future. Thoughts of the future are gone.'
Though he never smoked and had no family history of lung cancer, Dr Hiznay did test positive for a mutation of his EML4-ALK gene.
Previous reports have shown that EML4-ALK patients are 'significantly' younger than patients with other mutations like the more common EGFR. The median age of these patients was 52 compared to 66 in the control group.
Dr Hiznay relapsed twice but has been cancer-free since 2015. 'As a 12-year survivor, I've made many friends in the lung cancer survivor, and I've outlived all of them, and that's something I carry with me,' he said.
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