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Metastatic Lung Cancer: Symptoms, Treatment, And Palliative Care - WebMD

Lung cancer becomes advanced when it spreads to the other lung or other parts of your body. Sometimes, it's called metastatic or stage IV disease.

There are two main forms: non-small-cell lung cancer and small-cell lung cancer. The names describe the type of cancer cells seen with a microscope. Non-small-cell lung cancer is the most common type, accounting for about 85% of cases.

Lung cancer is very hard for doctors to find in the early stages. Even if you have symptoms, such as a cough or feeling tired, you might not feel bad enough to see a doctor. Most people are diagnosed after their disease becomes advanced. Although there's no cure for lung cancer at this stage, some treatments can make your symptoms easier to handle.

Here are some common symptoms, and what you can do to help manage them.

Fatigue

You may feel tired or drained, even after a nap or a full night's sleep. This can happen for many reasons, from the cancer itself to trying to process all the emotions you have about it. To reclaim some energy, you can try to:

Take short (less than an hour-long) naps when you need to.

Drink plenty of water and eat healthy, nutrient-rich foods.

Figure out what needs to get done today and what can wait.

Try gentle exercise, such as walking, yoga, or tai chi.

If you still have trouble getting through your day, let your doctor know.

Headaches

You can try some simple steps, such as getting enough sleep, eating a balanced diet, and lowering your stress levels. You also might try some nonmedical treatments to relieve your headache:

Acupuncture

Massage

Visual imagery, which is a stress management technique

Relaxation

Blurred vision

This is something you should get checked out by your doctor. Ask them if they suggest the following home remedies:

Use of over-the-counter artificial tears to keep your eyes moist

Cleaning your eyelids with warm water and baby shampoo

Using special glasses to help with your sight

Placing a warm washcloth on your eyelids

Balance problems

Your care team can help you learn how to use tools, such as a wheelchair or walker, that can help with your day-to-day activities. You can also try strength training and coordination exercises to benefit your balance and help you stay safe as you move around.

Metastatic lung cancer cough

Coughing is a common symptom of lung cancer. It can also be caused by radiation therapy. 

Your coughs could be wet and bring up sputum (thick mucus) from your lungs. You could cough up blood. Or you could have a dry, hacking cough.

Your doctor will try to pinpoint the reason for your cough. For instance, a tumor may be blocking your airway. Or it might stem from a condition such as asthma or a chest infection. Treating the root cause is the best way to deal with the issue.

Experts say cough suppression exercises can help. These are ways that you try to stop yourself from coughing. They include things like pursed lip breathing, swallowing, or sipping water. Other techniques, such as breathing exercises and counseling, can also help ease a chronic cough.

Shortness of breath

This is a pretty common symptom, both from your lung cancer and its treatments. Your doctor may have you try supplemental (extra) oxygen to help you feel more comfortable. But this may not always be enough.

It might be hard to do when you're short of breath, but try to relax if you can. That may ease your stress and anxiety. Play music, meditate, or do something that calms you down.

It might also help to find a comfortable position to sit or stand. Leaning forward can make it easier to take in more air.

It's also important to focus on your breath. Don't think about filling your lungs with air. Instead, focus on moving the muscles around your diaphragm. Breathe through pursed lips and keep your breaths in line with your current activity.

Pain 

Stress and a fear of pain can actually cause you to be more sensitive to pain. This can make you more uncomfortable. Tell your doctor if your chest hurts or if you think you might have heart problems. Otherwise, relaxation techniques may offer relief. For example, you can:

Breathe deeply at a slow and relaxed pace.

Tense or squeeze your muscles for a few seconds at a time to relax your body.

Close your eyes and use imagery (for instance, think of a favorite place) to calm your mind.

You can also try other nonmedical treatments to ease your pain. These might include:

Acupuncture

Hypnosis

Massage

Yoga

Meditation

Seizures

If you have seizures from your cancer or its treatment, you'll need to rely on your caregiver to help keep you safe. This is especially important if your seizures are intense. Among other things, your caregiver should:

Help prevent a fall, especially if a seizure starts while you're on a bed or chair

Use side rails and bumper pads on your bed

Not open or touch your mouth during a seizure, even if you begin to bite your tongue (which can happen because you lose control of your movements)

Stay with you and keep you safe during a seizure

Not move you unless you're in a dangerous location

Keep track of what movements you make and how long your seizure lasts

Loosen clothing or accessories around your neck

Put padding or rolled-up clothing under your head and roll you on your side if you do fall onto the ground

Turn your head carefully to the side if they can't move your body

Cover you up and allow you to rest after the seizure

Avoid giving you any medications, drinks, or food until you call your doctor

Weight loss

Another thing to watch for is unexplained weight loss. Weigh yourself once a week, and keep track of how tight or loose your clothes are.

Talk to your doctor if you want to gain weight. They may suggest that you:

Add certain drinks or foods that are high in calories. You can add more calories to your diet with full-fat milk, butter, milky coffees, buttermilk, sugar, dried fruits, and cheese as a topping to foods. You can also snack more throughout the day.

Eat two to three servings of protein a day, such as red meat (like pork or beef), white meat (like chicken or turkey), vegetable proteins (like tofu), fish, eggs, dairy, or beans.

Most of the time, surgery won't work for advanced lung cancer because it has spread.

It's more common to have treatment with a mix of radiation, chemotherapy, and targeted therapies — drugs that attack specific parts of the cancer cells. Your doctor will suggest the therapies they think are most likely to help you.

Often, the goal of treatment isn't to get rid of the cancer but to help you live longer and feel better, even with cancer still in your body. Your doctor may call this approach palliative care. It will make you more comfortable by improving your symptoms, such as pain, nausea, and coughing. You can also get palliative care along with other treatments such as chemotherapy.

"Although metastatic lung cancer is incurable, it is not uncommon for patients to live many years with very good quality of life," says David Jonghan Park, MD, Medical Director of Providence St. Jude Crosson Cancer Institute in Fullerton, CA.

Factors that may affect your outlook include:

The type of lung cancer you have 

Which biomarkers (including genetic traits) the cancer cells have

How well you respond to treatment

Your overall health

The more this type of cancer spreads, the harder it becomes to treat. 

The five-year relative survival rate shows how people with your same type and stage of lung cancer fare at least five years after being diagnosed.

Stage IV metastatic non-small-cell lung cancer has an 8% survival rate.

People with stage IV metastatic small-cell lung cancer have a 3% survival rate.

Keep in mind that these numbers don't reflect the latest advances in treatment. And they don't take into account your personal situation.

A strong health care team can help improve your outcome, Park says. "The availability and opportunity to participate in potentially innovative clinical trials may also contribute. Lastly, stopping cigarette smoking, alcohol intake, and maintaining a more active lifestyle as tolerated can also be beneficial."

Metastatic lung cancer life expectancy without treatment

Without treatment, the cancer cells in your body will keep spreading quickly. The average life expectancy in this case is two months. But remember, everyone is different. The best person to talk to about your outcome is your doctor.

After your diagnosis, it can help to:

Talk to others. It's normal to feel a mix of emotions, such as fear, anger, and sadness, when you learn you have cancer. You don't have to deal with them alone. Talk to friends, family, or a professional counselor to sort through what you're feeling. Other people with lung cancer might also be able to offer understanding and advice.

Prioritize your to-do list. Metastatic lung cancer might make you feel tired much of the time. Think about which activities or tasks are important to you, and focus your energy on them.

Get support. This can come in different forms. For instance, some people hire professional caregivers to take care of the basics. You might have friends and family members who can help. Others opt for hospice care, which helps you and your family prepare for the end of life.

Avoid "powering through" your pain. People with advanced cancer often have pain, though not everyone does. Tell your doctor about it and talk about different ways to control it, such as medications.

Pace yourself. Shortness of breath is common with metastatic lung cancer. It can help to pace your activities and take rests, even if you're just going to the bathroom. Some people can breathe easier with medications or oxygen therapy.

Get your legal papers in order. You might get peace of mind if you have your finances and legal documents in order. An advance directive tells people what kind of care you do and don't want if you can't make your own decisions in the moment. A durable power of attorney for health care (or health care power of attorney) will give someone the ability to make those decisions if you no longer can.

Advance directives vary from state to state. You can find out more at CaringInfo.Com, a program of the National Alliance for Care at Home.

The Conversation Project can help you learn more about a health care power of attorney.

Try to take things day by day. There's no "right" way to deal with this diagnosis. But if you take care of yourself and let others help you, you'll be better able to enjoy each moment as it comes.

If you have metastatic lung cancer, cancer cells that first grew in your lungs have spread to distant areas of your body. Treatment for this type of cancer can be a challenge. Your doctor will try to manage your symptoms and stop the cancer from spreading further. There are things you can do to feel more comfortable and improve your quality of life. Let your doctor know when you need more physical or emotional support.

What is the survival rate for metastatic lung cancer?

According to the Surveillance, Epidemiology, and End Results (SEER) database, which is run by the National Cancer Institute:

Five-year survival rate for non-small-cell lung cancer: 9%

Five-year survival rate for small-cell lung cancer: 3%

Keep in mind that these numbers are based on people who were diagnosed and treated more than five years ago. There's a lot that they don't take into account, from newer, better treatments to your own personal health.

Seeing numbers like these may bring up a lot of different questions and feelings. Talk to your doctor so they can help you understand your outlook.

Can lung metastases be cured?

So far, there's no cure for cancers that metastasize to the lungs. But scientists have made a lot of progress in treatments in the past few years. These include medications that:

Help your immune system more easily find and fight cancer cells

Can target the genes inside certain tumors

How fast does metastatic lung cancer spread?

There's no simple answer. Many different things are involved.

But generally speaking, small-cell lung cancer tends to spread faster than many types of non-small-cell lung cancer. About 70% of the time, small-cell lung cancer has spread to other parts of the body by the time it's diagnosed.

AI Helped Diagnose My Lung Cancer And Saved My Life (Exclusive) - People.com

After 30 years, Susan Riffle finally kicked her smoking habit. Three years later, her doctor suggested the now 63-year-old have a preventative CT scan. The test showed a grape-sized lesion on the left lung of the Augusta, Ga. Florist. But it wasn't necessarily cancer; the lesion could have been histoplasmosis, an infection caused by bird droppings in the soil found near where she used to live .

Her doctor entered Riffle's age, how many years she had smoked and her CT scan imaging into artificial intelligence software, which gives a predictive score between 1 and 10 as to the likelihood of cancer. The number 1 means the risk is 2%, while a 10 means the risk is 93%.

Riffle's result was an 8, meaning there was a 64% chance the lesion was cancer. "It really surprised me," says Dr. Daniel Miller, 66, Director of the Lung Cancer Screening Program at the Georgia Cancer Center.

Because of the AI software, he ordered a PET scan. That's when Dr. Miller told Riffle it was probably lung cancer. On January 11, 2024, Riffle had surgery. A biopsy was done, and a pathologist confirmed the AI's diagnosis: She had stage 1B lung cancer. Miller performed a lobectomy, removing the lower lobe of her lung and all the lymph nodes.

"Lung cancer is still the No. 1 cause of cancer deaths in the United States since 1986 for both men and women," Miller says. "In Georgia, every two hours, someone dies of lung cancer."

Without the AI software, Miller says he would have suggested a repeat scan in three to six months, but the software helped "expedite diagnosis and treatment." Riffle was diagnosed at stage 1, whereas 75% of lung cancers are diagnosed at stage 3 or 4, according to Miller.

Riffle shares her story with PEOPLE's Wendy Grossman Kantor.

Susan Riffle developed lung cancer after smoking for 30 years.

Susan Riffle

I was a smoker off and on almost 30 years. I started as a teenager. I stopped when I was pregnant with my children and then I would start again.

I hid it from my children always. I never smoked a cigarette in front of my children. I always stepped outside. I'm sure they knew I smoked. You can smell it. If I'm standing out in the garage and quickly put out a cigarette or hide it behind my back, they're not stupid.

A few years ago, I decided I was ready to quit. I was tired of breathing heavily and I wasn't as active as I wanted to be, running on the beach or hiking in the woods.

I would take trips with my girlfriends who were nonsmokers, and I'd be the one outside while everyone else was inside playing games and having fun. I wasn't a pack-a-day smoker, but after we'd go out to dinner, I'd be the one to step outside to have a cigarette before we headed back for the evening.

I also felt like I had to plan the trip around cigarettes, make sure I have enough to go for a four-day trip, which is terrible. I was realizing these things and how smoking was occupying my time and my health. I was done. I just needed to stop and take better care of myself.

Breathing was also an issue. I wasn't able to breathe well. I could never take a deep breath. I was using an inhaler daily, and that's not good. I knew I could breathe well on my own by quitting smoking. I had become very aware of my lack of breathing capacity.

I quit smoking in October 2020.

After I quit, one of my girlfriends said, "Susan, you don't wheeze anymore. You sound great." And I was finally able to keep up with her quick pace when we went walking.

I had been smoke-free for three years when my family physician suggested that it was time to do a CT scan for proactive health care. And of course I agreed.

Susan Riffle with her daughter Samantha.

Susan Riffle

I had a CT scan December 11, 2023. My lung doctor, Dr. MIller, ran my test through the AI software.

I took notes every meeting that Dr. Miller and I had together. He said the nodule was the size of a green grape. I felt very well-informed. He said: These are your options. This is what it is. Let's make a decision together.

Learning the AI said "cancer" was scary. But I'm a proactive person. I'm the type of person who says, "Well, let's just get in there, get it out, and be done with it. Let's treat it so we can move forward." I do not dwell and cry, "Oh, poor me." Tell me what we need to do, and I will do it. And that's what we did. Dr. Miller explained the surgery. We would do a biopsy once we got in there, which would determine how much would be removed. And that was all explained to me ahead of time. It was worrisome and concerning, but we had a plan. That, to me, is the most important thing.

My surgery was January 11, 2024.

The decision to do one surgery and biopsy at that time — as opposed to doing a biopsy, closing me up, analyzing that, and then going back for more surgery if necessary — it just made sense to me. Let's just try to do surgery once, as opposed to prolonging the procedure.

When I came out of anesthesia, I had a wonderful nurse who was there to take care of me, and I remember her to this day. I was in a little pain, of course, but Dr. Miller and the many others on his team came to visit me and there was constant communication.

The day after surgery, I was in my hospital bed and the sun was coming in and I just snapped a selfie and sent it to my family, and they were like, "Oh, you had surgery? Where are your wrinkles? How do you look so good?" Now, maybe they were all being nice, but it was uplifting and supportive. I'm fortunate. I just had a great network of friends and family around.

Susan Riffle sent a post-surgery selfie to her family.

Susan Riffle

I only spent two days in the hospital.

The biggest thing my husband Randy, 64, and two daughters Kelsey Earnest, 31, and Samantha Riffle, 28, did, was just be there for me. Kelsey, a traveling radiation therapist, was out of state but came home and spent a full week helping me recover. Both daughters did the cooking, cleaning and bandage changes. Samantha, a beverage manager at a restaurant and pet portrait artist, lives just across the river in North Augusta, so she continued to come every day after Kelsey left for another two weeks. Randy took over in the evenings and after that. (He was actually the best at changing bandages.)

Right away I made sure I was moving. Every day I changed my clothes and dressed and came downstairs and walked around the house.

I don't like to be sedentary. I have trouble sitting through a manicure and pedicure. I like to get up and move — I just know that's better for you. If you just sit and watch TV, or read a book for six or eight weeks, you're not going to feel well for a really long time.

I have very minimal scars. As a matter of fact, when I went for a mammogram a few months after the surgery, the technician said, "Well, where are your scars? I expected a huge scar, you had lung surgery." And I have a few three-inch scars.

I was fortunate enough to be back up and out at seven or eight weeks post-op, and I was back to work, being a productive person and walking and exercising and breathing air without any other treatments.

The fact that I haven't had to have any radiation or chemotherapy is fantastic. It is amazing that we caught it and were able to remove enough to determine that I didn't have to have those treatments.

 Today I feel very well. I have no complaints and I have no limitations.

Randy and I joined Kelsey and her husband on a trip to the Grand Canyon last summer. That was a real test because of the higher elevations and the thin air. I did have to take a few breaks. But you just stop and take few deep breaths and then keep going. It was wonderful.

The fact that I am able to do that, that I'm still here, is because of Dr. Miller and the team and the hospital and AI. I have a normal life again after a relatively short time.

Susan Riffle with her daughter Kelsey Earnest in the Grand Canyon.

Susan Riffle

Randy is still a smoker.

We have all been pressuring him, but you can't make anybody stop smoking. They have to be in the headspace to stop. You can read every book, you can read the literature, you can try cold turkey. You can do all kinds of things, but until you yourself are ready to commit and come up with a plan — or two or three — because it usually doesn't work the first time or first three times, you won't quit.

He's not ready to quit. He's not there.

He did get a prescription for Chantix recently. And he's in the yearly screening program at the Georgia Cancer Center, and his doctor monitors him. I think he's close to retirement. I ask him, "So what are you going to do? Sit around and smoke cigarettes all day?" Hopefully, quitting will be one of his goals. I hope.

My cancer was caught early. It was stage 1B. If we waited another six months, who knows what could have happened?

I feel very fortunate to have had the advantage of the AI to look at my scans. It saved my life. It certainly saved me from what potentially could have been a horrible diagnosis down the road.

I think a lot of people don't get scanned because they're afraid. What if? What if? But like I said, if you find something early and you make a plan, you can take care of it. I think education and trying to tell people it doesn't all have to be so fearful is important. Yes, it is a frightening diagnosis, but caught early, many cancers can be taken care of completely

Get those screenings. If a medical professional suggests a screening, just do it. That would be my advice. Don't be afraid. Just do it and deal with whatever is found out.

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