Symptoms of Stage 4 Lung Cancer

Although everyone's experience is different, there are some typical stage 4 lung cancer symptoms that may indicate a person is near to dying, including:

• Pain
• Shortness of breath due to fluid build-up
• Persistent cough
• Fatigue
• Muscle loss and weight loss
• Headaches, seizures, or other neurological problems if the cancer has spread to the brain

People's needs may also vary. Some need oxygen, for instance, while others don't. It can be hard to think about what to expect at the end of life with lung cancer. But knowing the signs can help you prepare yourself or a loved one for the final stages of this challenging disease.

Symptoms of Stage 4 Lung Cancer

The signs and symptoms that develop during the final stages of lung cancer are a result of the lung tumor, the cancer's spread to other parts of the body, or the end stages of cancer in general.

Some common signs and symptoms of stage 4 lung cancer include:

• Fluid build-up around the lungs: Fluid with cancer cells may build up in the spaces around the lungs. This malignant pleural effusion causes shortness of breath, and doctors often drain the fluid to improve breathing and comfort levels. If fluid build-up continues, they may recommend pleurodesis, a procedure to prevent fluid from accumulating again. They may also place a shunt to drain the fluid at home.
• Obstruction or bleeding from the large airways: Lung cancers that grow near the airways may block them as the tumors spread. These tumors may also cause bleeding, which can be treated with radiation or another procedure meant to shrink the tumor.
• Symptoms due to brain metastases: When lung cancer spreads to the brain, people may have headaches, seizures, and related symptoms like weakness or speech problems. Radiation therapy may slow tumor growth and ease symptoms. New drugs also may be needed to limit the number of seizures.
• A cough that won't let up: Sometimes, the coughing is because of tumor growth in the airways or fluids that just won't come up. A healthcare provider can show you ways to control coughing and make you or your loved one more comfortable.
• Shortness of breath: Some people are understandably afraid and feel like they are suffocating because of shortness of breath. Thankfully, this rarely ever happens. Oxygen may be helpful, but other drugs are crucial to controlling it. Morphine can "turn off" the signal to the brain so that even if oxygen levels fall, you won't experience shortness of breath.
• Fatigue and weight loss: Profound fatigue is expected in the late stages of lung cancer. Weight loss is nearly universal, too, even when people eat enough. Cancer cachexia, a syndrome of unexplained weight loss and muscle wasting, is very common in the late stages of cancer. 
• Pain: When lung cancer spreads to other parts of the body, it may result in pain. However, there are options for pain control, including radiation and pain medications. Using drugs to treat today's pain won't mean that nothing is available if the pain gets worse tomorrow. There are different methods for pain control, and you or your loved one won't run out of options.

In late-stage lung cancer, it's not unusual for people to seem lost in thought, begin to sleep a lot, or “have one foot in the next world.” They also may be frustrated and irritable over fatigue and other limitations that mean they need more help.

Additional End-of-Life Changes

There's no single roadmap, but many families can tell when things "start to change." Some of these changes are nearly universal, no matter what condition a person dies from.

In addition to physical changes, here's a look at some other things you may see:

• Emotional changes: Some people want to fight their cancer to the end, but others seem ready to accept death. Your loved one may start to withdraw in those last few months. They may seem less open to visiting with family and friends. Activities that once excited them now no longer capture much interest.
• Spiritual changes: One thing that happens often, and that may seem troubling, is for people to talk about seeing heaven or loved ones who have died before. That's common whether the dying person was religious in life or not. Sometimes, a family may think these visions are delirium or terminal restlessness, an end-of-life agitation that can be frustrating to experience. They may occur when a dying person seems to have an awareness that death is near.
  

Final Days With Stage 4 Lung Cancer

Many researchers now believe that dying is an active process the body is designed to go through. During the final days, your loved one may begin a phase known as "active dying."

Signs and symptoms of this phase may include:

• Skin and temperature changes: Your loved one's skin may become cool as body temperature lowers, and you may notice mottling (bluish, blotchy patches) on the skin. The dying person often sweats, and even though the skin is cool, it may feel wet and clammy.
• Decreased appetite: It's normal for your loved one to stop eating and drinking during the final days. They will not feel thirsty or hungry.
• Changes in breathing: As death approaches, the person's breathing may change. Rapid, deep breaths may alternate with periods of very shallow breathing (Cheyne-Stokes respirations). Fluids building up in the back of the throat may cause a gurgling sound (the death rattle). This may distress family members but apparently is not upsetting to the dying person.
• Confusion: Confusion may also be a sign death is near; your loved one may be restless, picking at the sheets or clothing.
• A sudden burst of energy or mental clarity: There may be a surge of energy or even the appetite for a full meal after eating little for days. This can be heart-wrenching if family members misinterpret this as a sign that their loved one is getting better. Most likely, it is the body's way of giving them a last chance to say goodbye. They will stop communicating and enter a deep sleep as the dying progresses.
  

Final Moments

As dying continues, all breathing stops, and the heart stops beating. Some say they know the exact moment or "feel" when a loved one has left them. Others find comfort in staying near their loved one's body as it becomes cooler and find it easier to let go after that.

Tips for Caregivers

Caring for a dying loved one can, at the same time, be the most challenging and even most rewarding thing you have ever done. That said, there are some things you can do to help with this process, including:

• Caring for yourself: Be sure to take care of yourself during this time, even if it feels selfish. Keep in mind that grieving often begins before a loved one dies—called anticipatory grief. It can be lonely as others around you may not recognize it. Develop a support system that helps you maintain your well-being so you can better support your loved one with cancer.
• Knowing what to expect: As your loved one with cancer gets close to death, know what to expect and what you can do to best support them during this transition.
• Planning ahead: When your loved one passes, you may find yourself in a state of shock. What comes next? If you are connected with hospice, check with your hospice nurse or healthcare provider in advance to know what next steps to take when the time comes.

Summary

With stage 4 lung cancer, there are signs and symptoms along the road that point to its end. Some of these include pleural effusions, pain, severe fatigue, and more. Dying is a natural process, but it's also a profound mystery in the human experience, and no two deaths are ever truly the same. Nonetheless, there are some common steps as you navigate the physical, emotional, and spiritual changes that come when lung cancer patients die. It helps to know that a range of support is available if you need it.