Stage 4 lung cancer includes cancers that have spread beyond the chest and those with related malignant pleural effusion. This cancer cannot be cured, but there are stage 4 lung cancer treatments available. Treatment is focused on easing the patient’s breathing, reducing pain, and extending and improving quality of life.
While this cancer cannot be cured, chemotherapy is still the most commonly recommended treatment. It can help to stop or slow tumor growth, which in turn, can help to prevent or slow further spreading of the cancer. How often a patient will take the chemotherapy will depend on the patient. Most patients will be given two different chemotherapy drugs and they will be administered intravenously. In most cases, the patient will receive four to six cycles of chemotherapy. Chemotherapy is not without side effects. It may cause a temporary blood count drop, a fever or chills, numbness in the toes or fingers, skin rash, temporary hair loss or nausea and vomiting.
Targeted therapies interfere with how cancers spread and grow. They work differently than chemotherapy and there are several different types that can be used as stage 4 lung cancer treatments. Erlotinib and gefitinib block the molecule known as epidermal growth factor receptor. These work best when a tumor contains a genetic mutation. The most common side effects include diarrhea and skin rash.
Cetuximab targets epidermal growth factor receptor as well. However, it is usually used along with chemotherapy instead of alone. The most common side effects include skin rash, low blood counts and diarrhea.
Bevacizumab interferes with tumor growth and blocks vascular endothelial growth factor. This targeted therapy is usually given once every three weeks intravenously, in combination with chemotherapy. A small percentage of patients have experienced serious or fatal episodes of heavy bleeding. Those taking warfarin or those who cough up blood are at the highest risk for this.
Managing Pleural Effusion
When fluid collects in the pleural space this is known as pleural effusion. If a patient develops this and experience shortness of breath, treatment may be necessary to help them breathe easier. The easiest way to treat this is by draining the fluid. This involves using a small catheter and inserting it into the pleural space through thoracentesis. If a patient quickly re-accumulates fluid, other procedures, such as tunneled catheter or pleurodesis may need to be done.
This involves improving the patient’s quality of life through assessing the patient’s psychological and physical needs and goals for care. When it is determined the patient has less than six months to live, hospice care is generally recommended. This will provide all of the patient’s and the patient’s loved ones needs. During this time the patient will be made comfortable, will be given adequate nutrition and will be helped with end-of-life decisions.
National Cancer Institute. (2011). Stages on Non-Small Cell Lung Cancer. Retrieved on March 22, 2011 from National Cancer Institute: https://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/Patient/page2
UpToDate. (2010). Patient Information: Non-Small Cell Lung Cancer Treatment; Stage IV Cancer. Retrieved on March 22, 2011 from UpToDate: https://www.uptodate.com/contents/patient-information-non-small-cell-lung-cancer-treatment-stage-iv-cancer