Whether you are newly diagnosed with stage 4 metastatic non-small cell lung cancer (NSCLC) or have been living with it for years, it’s normal to have questions about symptoms and treatment options. Symptoms of metastatic NSCLC vary widely depending on what parts of the body the cancer spreads to. Treatment options can also vary from person to person and change over time.

Learning more about your condition will help you have more productive conversations with your oncology (cancer care) team. Read on for an overview of possible symptoms and treatments for metastatic NSCLC.

What Is Metastatic NSCLC?

People diagnosed with stage 4 NSCLC are considered to have metastatic disease. Unlike earlier stages of NSCLC, the cancer has metastasized. This means that the cancer has spread outside the lungs to other organs.

Cancer may initially spread locally to the tissues around the lungs, including the windpipe, the esophagus (the tube that carries food to the stomach), or tissues in and around the heart. This early stage of metastasis may be caught at stage 3A or later.

As the cancer progresses in stage 4, it may spread to parts of the body that are far from the lungs. The cancer spreads through the bloodstream or lymph nodes to reach distant organs. Lung cancer commonly spreads to sites such as distant lymph nodes, the brain, liver, and bones, and the adrenal glands.

No matter where they form, the tumors are made up of lung cancer cells. Even though the cancer is present in other organs, it’s considered lung cancer.

Symptoms of Metastatic NSCLC

Stage 4 metastatic NSCLC may come with a variety of symptoms. General symptoms of metastatic lung cancer include:

• Cough or shortness of breath
• Coughing up blood
• Chest pain that’s worse when coughing or laughing
• Unintentional weight loss
• Poor appetite
• Wheezing
• Weakness or fatigue (tiredness that doesn’t improve with sleep)

These symptoms can occur at any stage of NSCLC but are more common in stage 4.

If lung cancer spreads to other parts of the body, it can cause different symptoms depending on where it goes. In the next section, we’ll cover common symptoms based on where the cancer has spread. Talk to your doctor right away if you have lung cancer and experience any of these symptoms.

Depending on where it spreads, metastatic NSCLC might cause symptoms including severe headaches, bone pain, fractures, and abdominal discomfort.

Lymph Nodes

The main symptom of lung cancer spreading to the lymph nodes is swelling, especially in the neck and armpits. However, an unrelated infection can also cause these symptoms. Your healthcare team will run tests to determine the cause and whether you need treatment.

Brain

If the cancer has spread to the brain, symptoms may include:

• Severe headaches, especially in the morning
• Weakness in the limbs
• Confusion and memory problems
• Vision changes
• Seizures

Your doctor may perform MRI or CT scans to check for metastasis. If any is found, they’ll discuss your treatment options.

Liver

Symptoms of metastasis in the liver include:

• Abdominal discomfort
• Poor appetite and weight loss
• Nausea
• Itchy skin
• Jaundice (yellowing of the skin and whites of the eyes)

If your healthcare team suspects cancer in your liver, they may order a CT scan to check for changes in the organ.

Adrenal Glands

Cancer in the adrenal glands usually doesn’t cause noticeable symptoms. However, if the cancer spreads significantly, it can cause issues similar to those seen with liver metastases, including:

• Abdominal discomfort
• Poor appetite and weight loss
• Nausea
• Weakness

Your healthcare team may use a CT scan to check for cancer in the adrenal glands. They may also do blood tests to see if there are any changes in your hormone or chemical levels that could indicate a problem.

Bones

Symptoms of lung cancer that has spread to the bones are typically noticeable and unique, including:

• Bone pain, often felt in the hips or back
• Bone weakness, making fractures more likely
• Elevated calcium levels in the blood, which may cause confusion, dehydration, or fatigue

If the cancer affects bones near the spinal cord, it can cause additional symptoms such as leg weakness, numbness, or loss of bladder control. These symptoms call for immediate medical attention.

If you experience any of these symptoms, your doctor may recommend a bone scan to check for cancer.

Treatment Options for Metastatic NSCLC

There’s no cure for metastatic NSCLC, so treatment focuses on reducing symptoms and increasing quality of life. Since metastatic NSCLC can cause a range of symptoms, there are multiple treatment options. Each person’s lung cancer treatment plan is unique, based on factors like the cancer’s type, location, and level of spread. Treatment also depends on the person’s overall health and personal preferences. Below, we’ll explore the different treatment options available.

Treatment for metastatic NSCLC focuses on reducing pain and increasing your quality of life.

Targeted Therapy

Targeted therapy works by focusing on specific gene mutations (changes) or proteins in your cancer cells. Your doctor will use biopsy and blood test results to check if your cancer cells have any targets that these therapies can address.

Since there are different types of targeted therapies, the potential side effects can vary.

Therapies for EGFR Mutations

Mutations in the epidermal growth factor receptor (EGFR) protein can encourage cancer to spread. If your cancer cells have this mutation, your doctor may prescribe a drug called a tyrosine kinase inhibitor (TKI). Common examples include:

• Amivantamab-vmjw (Rybrevant)
• Dacomitinib (Vizimpro)
• Osimertinib (Tagrisso)

Therapies for ALK Mutations

A fusion of the anaplastic lymphoma kinase (ALK) gene with another gene can accelerate cancer growth. Medications used for this gene include these TKIs:

• Alectinib (Alecensa)
• Brigatinib (Alunbrig)
• Crizotinib (Xalkori)

Therapies for ROS1 Mutations

Many people with NSCLC have a mutation in the ROS1 gene. Crizotinib is effective for this mutation. Another option is the TKI entrectinib (Rozlytrek).

Additional Targeted Therapies

There are also mutations linked to NSCLC in other genes, including RET, BRAF, MET, and KRAS. Targeted treatments have been developed for these and other mutations. Ask your doctor if your lung cancer cells have been tested for genetic mutations and whether targeted therapy might be an option for you.

Immunotherapy

When targeted therapy isn’t an option, immunotherapy might be considered. This treatment helps the immune system recognize and attack cancer cells. Your doctor will test for a protein called programmed cell death ligand-1 (PD-L1) to see if immunotherapy is a good fit for you. If your PD-L1 levels are high, you might be able to take immunotherapy alone. If they’re low, immunotherapy might be combined with chemotherapy (discussed below) for better results.

There are many treatment options for immunotherapy in NSCLC. One common approach involves checkpoint inhibitors. These drugs help your immune system identify and go after cancer cells by blocking signals that prevent it from targeting them. This makes it easier for your body to fight the cancer. Some checkpoint inhibitors used to treat NSCLC include:

• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Side effects of immunotherapy include thyroid problems, inflammation of the intestines or lungs, and skin issues.

Chemotherapy

Your healthcare team may use chemotherapy alone or combined with targeted therapy or immunotherapy. Chemotherapy slows or stops cancer spread. These medications are usually given in cycles of about three weeks to allow the body to recover from the side effects. Most people receive four to six cycles before doctors assess how well it’s working.

The side effects of chemotherapy can be intense. Your blood cell count may drop, raising your risk of infection. You may also experience hair loss, nausea, and vomiting, as well as numbness or tingling in your hands and feet.

Supportive and Palliative Care

As you explore your options, it’s important to work with your oncology team to weigh the benefits and side effects of each and find a balance that’s right for you. Supportive and palliative care can help manage cancer symptoms and treatment side effects. It’s important to address not just your physical health but also your psychological, emotional, and spiritual well-being. Talk to your healthcare team about any concerns so they can help you find the support you need.

Work with your oncology team to weigh the potential benefits and side effects of each treatment option and find a balance that’s right for you.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 14,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you living with metastatic lung cancer? What treatments have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.