“I have been diagnosed with stage 4 lung cancer: what does this mean?”
Stage four lung cancer is divided into two substages: 4A and 4B.
If substage 4A is diagnosed, this means that one of the following conditions is met:
- Foci of tumor tissue are present in both lungs.
- Cancer cells have spread to the serous lining of the lung ( pleura ) or heart ( pericardium ).
- Fluid containing tumor cells accumulates around the heart or lungs.
- There is distant metastasis - a secondary focus in organs or lymph nodes that are located outside the chest.
Substage 4B is diagnosed if multiple distant metastases are found in one or more organs.
Diagnostic stages
- Consultation with a specialist - a gastroenterologist, and, if necessary, other specialists, since vomiting can be a symptom of various diseases.
- Laboratory examination, including tests of blood, stomach contents, gall bladder and stool. Biochemical studies, bacterial cultures and immunological tests, for example, to detect hepatitis, may be required.
- Study of the form, structure and function of the gastrointestinal tract. At the Yauza Clinical Hospital, endoscopic, ultrasound, X-ray diagnostic methods, CT and MRI, as well as their combinations, are used for this purpose. Research is carried out using modern expert-level equipment, the results are assessed by experienced specialists.
- In the diagnosis of diseases that are accompanied by vomiting of bile, the exclusion of oncological processes and formations is of great importance. For this purpose, at the Yauza Clinical Hospital, it is possible to conduct a specialized oncological search, MRI (MR - whole body diffusion), genetic studies that reveal the patient’s predisposition to tumors of various parts of the gastrointestinal tract, and blood tests for tumor markers.
Treatment methods for stage 4 lung cancer with metastases
The doctor focuses on the substage, number, size and location of metastases, age and health status of the patient.
Depending on the microscopic structure of the tumor tissue, there are two types of lung cancer:
- Non-small cell is the most common. It accounts for 80–85% of cases.
- Small cell occurs in 10–15% of cases.
These types respond differently to certain types of treatment.
Tumor cells may have different molecular genetic characteristics: they use different substances that help them multiply uncontrollably, survive, and protect themselves from the aggression of the immune system. Knowing the molecular genetic characteristics of a tumor in a particular patient, the doctor can select the optimal, personalized treatment. Currently, such tests are available to patients in Russia.
How to cope with nausea and vomiting caused by chemotherapy
To take medicine
Your healthcare provider may give you medicine to prevent or relieve nausea and vomiting. In this case, you will be told when to take it. This may be before, during or after chemotherapy.
Medicines affect everyone differently. If the medicine you are taking does not relieve your nausea or vomiting, tell your healthcare professional. You may need to try a different medicine or take another type of medicine in addition. Together with your healthcare professional, you will choose the most appropriate medicine for you.
Directions for taking the medication
If your healthcare provider gives you a prescription for a medicine that you must take at home, it is important to follow their directions for taking the medicine. You may be prescribed to take it regularly, even when you don't feel nauseous. Or you may need to take the medicine the moment you start to feel nauseous. In any case, take the medicine on time and without delay.
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Follow food and drink guidelines
Beverage recommendations
- Drink at least 8 to 10 8-ounce (240 ml) glasses of fluid per day.
- Drink slowly and little by little.
- Do not drink anything for at least 1 hour before and 1 hour after meals.
- Try to drink cool, clear, unsweetened fruit juices or light-colored sodas that have released the gas.
- Choose caffeine-free drinks. Caffeine leads to dehydration.
Recommendations for food consumption
- Eat food often, in small portions. Eat slowly.
- Chew your food thoroughly and sit upright for two hours after eating. It may improve digestion.
- Avoid foods with strong odors. If strong odors bother you, try to eat food that is chilled or at room temperature.
Be sure to brush your teeth and keep your mouth clean. Rinse your mouth after vomiting.
If you have questions about eating and drinking, ask your healthcare provider to make an appointment with a dietitian. A dietitian will help you eat healthy during treatment to ensure you get all the nutrients your body needs.
Use relaxation techniques to control stress levels
Examples of relaxation techniques include:
- listening to music;
- deep breathing exercises;
- yoga;
- meditation;
- applying a wet terry cloth to the forehead or back of the head.
Use acupressure and other complementary therapies
Acupressure is a healing practice in which finger pressure is applied to specific points on the body. Acupressure can help relieve muscle tension and increase blood circulation. In addition, it may help relieve nausea and vomiting. To learn how to give yourself acupressure, check out our material Acupressure for Nausea and Vomiting or watch the video at the link below.
Complementary therapies (such as massage, acupressure, and music therapy) may be used along with traditional medical care to help you relax and control nausea and vomiting. For more information or to schedule an appointment, contact Memorial Sloan Kettering's (MSK) Integrative Medicine Service at 646-888-0800.
to come back to the beginning
Treatment of stage 4 non-small cell lung cancer
A very rare situation occurs when a patient has single metastases that can be removed surgically or using stereotactic radiosurgery (“gamma knife”). In such cases, sometimes it is even possible to achieve remission.
For example, if one small metastasis is detected in the brain, a gamma knife is used. A special device generates about 200 beams of gamma radiation, which converge at one point - where the tumor is located. Individually, each beam is very weak and cannot damage tissue, but in the place where they are focused, a large dose is created that destroys cancer cells. After the tumor is removed, a course of radiation therapy to the head is performed. Depending on the size and location, the primary tumor in the lungs is treated with surgery, radiation therapy, and chemotherapy.
If there are many metastases and they cannot be removed, chemotherapy will be the main treatment method. Usually 2 chemotherapy drugs are prescribed, but this depends on the patient’s condition. Some patients feel so bad that they have to be given only one chemotherapy drug because of the risk of side effects.
If the tumor has certain molecular genetic characteristics, modern targeted drugs and immunotherapy drugs can be prescribed:
- For changes in the ALK gene, targeted drugs are prescribed: alectinib (Alecensa), ceritinib (Zikadia), crizotinib (Xalkori). If these drugs are not well tolerated, your doctor may prescribe another ALK blocker, brigatinib (Alunbrig).
- For changes in the EGFR gene, targeted drugs are prescribed: erlotinib (Tarceva), afatinib (Gilotrif), gefitinib (Iressa).
- For changes in the ROS1 gene, the ALK inhibitor crizotinib is used.
- For changes in the BRAF gene, targeted drugs are used: dabrafenib (Tafinlar) and trametinib (Mekinist).
- Some cancer cells use the PD-L1 protein to block immune system activity. In such cases, the immunodrug pembrolizumab (Keytruda) is used.
Radiation therapy is also used.
Nausea as a sign of cancer
The cause of nausea in oncology is toxins that enter the circulatory system. Their poisonous effect causes an unpleasant symptom. The first to react to this is the central nervous system, which sends an alarm signal to the appropriate organs. It causes nausea due to irritation of receptors in the gastrointestinal tract, the vomiting center in the brain or the vestibular apparatus of the ear.
If nausea occurs in isolated cases, this may indicate digestive disorders. With oncology, nausea is constantly observed, and over time the patient only feels worse. This applies to cancer of the esophagus, stomach, liver, brain and other organs. The patient may complain of the following symptoms:
- temperature 37-37.2°C;
- constant feeling of fatigue;
- loss of appetite and sudden weight loss for no apparent reason;
- headache;
- frequent infections;
- chronic pain in bones or other parts of the body.
In some cases, nausea may result in vomiting. With colon cancer, traces of feces appear in the vomit.
Treatment of stage 4 small cell lung cancer
For stage 4 small cell lung cancer, treatment usually begins with chemotherapy. Typically, a combination of the chemotherapy drug etoposide with carboplatin or cisplatin is used. Sometimes, after a course of treatment, tumors are no longer found in the lungs. Unfortunately, as a rule, this does not mean that cancer has been defeated. Usually, microscopic lesions remain in the lungs, which lead to relapse in the future.
After a course of chemotherapy, chest radiation therapy is prescribed. This may be followed by a course of preventative chemotherapy for the head. Small cell lung cancer often metastasizes to the brain.
Causes of nausea in oncology
The fight against nausea in cancer is based on the cause that caused it. This is explained by the fact that there is no drug that would relieve the symptom regardless of the mechanism of development. In this regard, the main causes of nausea in oncology must be taken into account:
- effect of chemotherapy. Nausea appears during the session or after some time;
- intestinal obstruction. May occur during treatment for colon cancer. Causes obstruction and dysmotility of the organ;
- waiting for chemotherapy or other therapeutic measures. This is the cause of nausea in 20% of cases. Here it is associated with the psychological state of the patient, which is why medications do not bring the desired result;
- radiation therapy. The reaction to it is individual for each patient. The patient’s condition, dose and location of irradiation matter.
For stomach cancer
Stomach cancer, like other gastrointestinal diseases, is complicated by nausea and vomiting. Nausea may occur after resection (removal) of the stomach or against the background of an inoperable tumor. Resection leads to the development of dumping syndrome. It causes insufficiently processed food to enter the jejunum too quickly. In addition to nausea in oncology, this can cause severe weakness, increased heart rate and loss of consciousness.
In other cases, against the background of nausea, the following are noted:
- sensation of a foreign body in the stomach;
- bloating and vomiting almost immediately after eating;
- constant pain and discomfort in the stomach, heartburn;
- diarrhea or constipation.
For liver cancer
Nausea in liver cancer occurs when the organ itself is damaged or metastases spread from the primary site. The liver loses its ability to perform its functions normally, and blood contaminated with toxins continues to circulate throughout the body. The brain receives a signal about the presence of abnormal cells and reacts to them by irritating the corresponding receptors.
Treatment of complications
pleural effusion often forms : fluid accumulates inside the chest. Because of this, breathing is impaired, the patient’s condition worsens, and the effectiveness of treatment decreases. Pleural effusion is dealt with in the following ways:
- Thoracentesis is a procedure during which a puncture is made in the chest using a special instrument and excess fluid is removed.
- For constant outflow of fluid, a pleural catheter is installed, one end of which is located in the chest, and the other is connected to a special container.
- Pleurodesis is a procedure during which a drug (for example, doxycycline or bleomycin) is injected into the pleural cavity, causing the layers of the pleura to stick together, and as a result, fluid stops accumulating.
If fluid accumulates around the heart, a pericardial puncture or surgery to create a “ pericardial window ” is performed. Part of the pericardial sac is removed, this facilitates the outflow of fluid.
Sometimes the tumor blocks the airway. a stent is placed in the respiratory tract - a special tube made of silicone or metal.
Gastrointestinal diseases manifested by vomiting bile
- Acute poisoning, infectious diseases (for example, hepatitis, salmonellosis, etc.), acute gastritis.
- Diseases of the gallbladder - cholecystitis, including calculous (with the formation of stones), helminthic lesions of the gallbladder (opisthorchiasis).
- Liver diseases.
- Diseases of the pancreas - pancreatitis.
- Diseases and situations when the normal patency of the gastrointestinal tract is disrupted: narrowing of the stomach, most often its outlet (pylorus), which is possible with a stomach ulcer, tumors, after surgical interventions,
- blockage of the bile ducts (cholestasis) by stones, tumors, adhesions,
- intestinal obstruction, and vomiting of bile can occur when passage in both the small and large intestines is disrupted.
