What is the Difference Between Emphysema and Stage-4 Cancer?

September 14th, 2011 | Author: COPD Coach

Dear COPD Coach,

My doctor has told me I have end-stage emphysema. Does that mean the same as Stage-4 cancer?



Dear Concerned,

COPD, like many other medical conditions, is classified by its severity. There are four stages of COPD. Each stage is measured by what is called your Forced Expiratory Volume (FEV1), measures how much of the air you blew out was breathed out during the first second. A decrease in the FEV1 may mean there is blockage to the flow of air out of your lungs. Obstructive pulmonary diseases, such as emphysema, asthma or chronic bronchitis, can cause reduced FEV1 values. This value is often the most important value followed over time in COPD patients.

In the first stage of COPD, often referred to as either “Mild” or “At Risk”, generally indicates that you have 80 percent or more of predicted lung capacity. During this stage, most people will not even realize that they may have a problem, and often will attribute getting out of breath to “just being out of shape” or a normal process of aging. Needless to say, it is rare for a person in stage one to be diagnosed unless they happen to take a spirometry test or screening.

In Stage Two, often called the “Moderate” stage, your FEV1 falls between 50 percent and 79 percent. Your airflow limitations become more severe and you may start coughing or producing sputum.  At this stage most people seek treatment.

In Stage Three, which is often classified as “severe”, your FEV1 falls between 30 percent and 49 percent. During this stage you will notice more fatigue and a decrease in activity tolerance.

In Stage Four, often called “Very Severe” or “End Stage” your FEV1 falls below 29 percent. It is here where there is some misunderstanding. Many people, when first hearing this term, assume that death is imminent. While having very severe COPD is serious with a possible variety of complications, many people in this stage who eat right, exercise, take their medications and generally take very good care of themselves, are still enjoying an active, quality life. Having advanced emphysema should not be viewed as having Stage Four lung cancer.

With that said, there are still many people in Stage Four who are very sick. What determines which group you are in has a lot to do with such things as smoking history and your level of dyspnea (shortness of breath). It is also influenced by how well you take care of yourself.

Research shows that COPD patients who are smokers have a higher risk of getting lung cancer. However there is increasing evidence that even those non-smokers with COPD have a greater risk of developing lung cancer. The link between the two could be that smoking is an acknowledged cause of COPD, and a cause of lung cancer. But, recent evidence suggests that COPD itself is an independent risk factor for developing lung cancer, separate from any smoking history.

A final word: stages are medical terms that classifies where you are in a particular stage of your illness. A stage does not necessarily indicate your life expectancy, and the factors that actually influence just how long you may live are numerous enough to fill a book. I view having the “label” Stage Four as a call to take even better care of my health, as well as closely following the advice of my medical professional.

Best Wishes,

The COPD Coach

Ask the Expert is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice.

If you would like to submit a question to the Coaches Corner email us at coachescorner@copdfoundation.org. We would love to hear your questions and comments. You can address your emails to any of the following: COPD Coach, Caregiver Coach, COPD Doctor or COPD RT.


  1. Charlene Crosthwaite says:

    My husband has had COPD for many years. He quit smoking 12 years ago, but the coughing and hacking were bad even at that time. He is now in “late stage emphysema” with what they believe is lung cancer (further testing can’t be done because it will kill him according to his lung doctor). He is now on oxygen 24/7 after ending up in the hospital from either a viral or bacterial infection that settled in his lungs. He also has diastolic heart failure and afib. His FEV1 was below 25% last April.
    You are right when it comes to being frightened. Shock and fright was what I felt and a bit numb. Weeks later I called his lung doctor’s office and was surprised to have the doctor call me back that night. My husband has started to have episodes of turning blue. The doctor answered ALL my questions and after going into more details about end of life situations, I felt much better. We have gotten all legal issues taken care of and hope to “make the best of the time we have left” as the doctor put it.

  2. Suzannah says:

    I have about 50% ability to exhale during first second, will be tested again soon. I’ve just had a major exacerbation of emphysema and bronchitis that caused hospitalization and a rehab. What is the medication with the least side effects and the lowest dose and impact that I can first try?
    Many thanks, Suzannah

  3. Nice post. Basically my point up views :

    Emphysema is a chronic respiratory disease where there is over-inflation of the air sacs (alveoli) in the lungs, causing a decrease in lung function, and often, breathlessness.

    Cancer staging is the process of determining the extent to which a cancer has developed by spreading. Contemporary practice is to assign a number from I-IV to a cancer, with I being an isolated cancer and IV being a cancer which has spread to the limit of what the assessment measures. The stage generally takes into account the size of a tumor, how deeply it has penetrated within the wall of a hollow organ (intestine, urinary bladder), whether it has invaded adjacent organs, how many regional lymph nodes it has metastasized to (if any), and whether it has spread to distant organs.

  4. Dr, Pullen says:

    Thanks for taking such a gentle approach to your answer. The last thing advanced emphysema patients need is to be more frighened. In emphysema tha keys as you know are to quit smoking, use appropriate medications, and get early intervention for exacerbations. Thanks.

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