Lung Cancer Progression: Timeline of Decline (2023)

After being diagnosed with lung cancer, you may wonder how the cancer will progress. The progression in part depends on the type of lung cancer, which is grouped into small cell lung cancer and non-small cell lung cancer (which also has many subtypes). Some types are more aggressive and progress faster, while others progress more slowly.

Lung Cancer Progression: Timeline of Decline (1)

The early stages of lung cancer often have no obvious symptoms. By the time symptoms are noticeable, cancer may have already progressed and spread beyond the lungs, and the symptoms may reflect the effects it is having elsewhere in the body. The symptoms of lung cancer can include:

  • Persistent cough
  • Coughing up blood
  • Chest pain
  • Shortness of breath
  • Wheezing (whistling sound while breathing)
  • Unintentional weight loss
  • Feeling tired

People are living longer with lung cancer as new screening tools, such as lung computed tomography (CT) scans, are able to diagnose cancer at an earlier stage, and newer cancer treatments have been effective. Unfortunately, it continues to be a very serious illness, especially when diagnosed at a later stage.

This article will review lung cancer, the staging of the disease, and how it can progress.

Stages of Lung Cancer

After lung cancer has been diagnosed through a biopsy (removal of tissue of the suspected tumor to analyze in the lab), staging of the cancer needs to be completed. Staging refers to determining how far cancer has spread in the body.

Stages are numbered from stage 0 to stage 4. This number will be included in the diagnosis. There can be slight differences in the staging between small cell lung cancer and non-small cell lung cancer, but generally, it follows the same pattern. The stage of cancer is made at the initial diagnosis, even if it progresses beyond that in the future.

Stages of Lung Cancer

The stages of lung cancer include:

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  • Stage 0: A tumor is very small and has been caught very early.
  • Stage 1 to 3: As the number of the stage increases, the tumor is larger in size or has begun to spread into lymph nodes or other tissues nearby.
  • Stage 4: Cancer has spread outside of the lung and into other organs or areas of the body (metastasized).

Unfortunately, most cases of lung cancer are not diagnosed until they are at stage 3 or stage 4, so they have already progressed.

The exact treatment of lung cancer depends on what stage the cancer is, among other factors. Typically, stage 4 lung cancer is not considered to be curable, though there are treatments available.

The treatment options for each stage may vary. If you're unsure of the stage of your cancer or what treatment options exist for you, ask your healthcare provider for an explanation.

Where Does Lung Cancer Spread?

Timeline of Decline

As cancer cells multiply, there is a greater risk of spreading (metastasizing). During this process, cancer cells escape from the original tumor and travel through the lymphatic system or blood vessels into other areas of the body. The most common sites for lung cancer to spread are the brain, bones, liver, and adrenal glands.

The exact timeline of when cancer cells begin to metastasize is unknown. Some lung cancers grow slowly, while others are aggressive and grow quickly.

How quickly cancer grows is referred to as doubling time, meaning how long it takes the cancer to double in size. The doubling time may not be known for each person with lung cancer, but can be used as a guide to predict survival time.

Studies have shown that lung cancer doubling time can vary, from 229 days to 647 days in one study, depending upon the type. It's possible that some types of lung cancer progress within weeks to months, while others may take years to grow.

Every person living with lung cancer will experience a different progression of their cancer. There is often a period in which the symptoms of the cancer are minimal. Eventually, as the cancer progresses the symptoms become more severe, which leads to a quicker decline. That decline can be quite quick in some people with lung cancer.

Performance status is the measurement used by healthcare professionals to gauge how well a patient living with cancer is functioning. There are multiple scales that can be used, such as the ECOG (Eastern Cooperative Oncology Group) scale or the Karnofsky Performance Status Scale.

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These scales rate a person's ability to maintain their normal activities and take care of themselves. A decline in performance status occurs as cancer progresses.

The survival rate decreases for cancers of higher stages. Survival rates are often reported as five-year survival, meaning the percentage of people diagnosed with that stage of cancer that are alive in five years. When lung cancer is diagnosed at stage 4, the five-year survival is 3%–7%, depending upon the type of lung cancer.

End Stage Lung Cancer

The exact amount of time someone with end stage lung cancer will live is not the same for everyone. Treatments may extend a person’s life for a period of months to even years.

Where lung cancer spreads has a lot to do with how long someone will live. One study showed that for those who develop brain metastases, average survival is seven to 12 months.

When lung cancer progresses to the point at which further treatments won't help or if a person living with end stage lung cancer wishes to stop therapy, there may be questions about what happens as they decline.

Although the cancer growth rate may be unpredictable, the end-of-life process follows a somewhat expected patten.This process can happen over days to a few weeks.

As someone declines, they often experience the following symptoms:

  • Extreme weakness
  • Inability to get up on their own
  • Difficulty swallowing
  • Decreased appetite
  • Increased time sleeping
  • Decreased fluid intake
  • Confusion
  • Loss of focus

Other symptoms that may be related to cancer may be:

  • Pain
  • Shortness of breath
  • Cough
  • Restlessness

What Can You Expect During End Stage Lung Cancer


Lung cancer often has no symptoms in its early stages and is diagnosed after it has progressed. It is staged from stage 0 to stage 4, reflecting growth and spread. Life expectancy decreases as the stage increases.

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Currently available treatments have been improving lung cancer survival over the years, but it can still be a terminal illness for many. As someone nears death from lung cancer, they may experience symptoms such as increased sleepiness, weakness, and confusion.

A Word From Verywell

Lung cancer is one of the most common types of cancer in the United States and a leading cause of cancer deaths. Having a diagnosis of lung cancer or being a caregiver for someone who has lung cancer can be a scary and stressful time.

Having realistic expectations about what can happen can help you feel prepared for the future. Talk to your cancer care team if you have questions about your situation.

Frequently Asked Questions

  • What are the signs of end stage lung cancer?

    Signs of end stage lung cancer can include:

    • Shortness of breath
    • Cough
    • Pain
    • Increased sleeping
    • Restlessness
    • Decreased food/fluid intake
    • Confusion
  • Where does lung cancer spread first?

    (Video) Stage IV lung cancer from symptoms to diagnosis | Jaymie shares the beginning of her cancer story.

    Lung cancer most often spreads to the bone, the other lung, brain, adrenal glands, and the liver.

  • How quickly does lung cancer progress from one stage to the next?

    It can be difficult to determine how quickly lung cancer will spread from one stage to the next. It often depends upon the type of lung cancer, as small cell lung cancers tend to be more aggressive and grow more quickly, while some types of non-small cell lung cancer can take years to become metastatic.

    (Video) Last Signs of Lung Cancer Before Death


1. A Lesson in Dying: A Nurse With Cancer Offers Herself as Instruction in Caring | The New York Times
(The New York Times)
2. Updates in the Management of Lung Cancer
3. Lung Cancer Facts : Last Signs of Lung Cancer Before Death
4. What Dying Looks Like During Final Days of Life
(Heart House Hospice)
5. New study shows decline in lung cancer deaths
(FOX 2 St. Louis)
6. 5 Things You Should Know When Someone is Actively Dying
(Hospice of the Chesapeake)


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