What is the Difference Between Emphysema and Lung Cancer?

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Dear COPD Coach,
My doctor has told me I have end-stage emphysema. Is that 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), which measures the amount of air you exhale. A decrease in the FEV1 may mean there is a 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 classify 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.


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  • I have an fev1 of 22%. I read four years to live and thought, I have been at 22% for four years already and can still dress and shower and all the small things most take for granted.
    I believe the four year statement may be misleading. I have to take it slow, and at times use oxygen to exercise, but I'm not ready to drop dead just yet.
    • Hi, My fev1 was 18% three years ago. Been in the hospital twice since then with rehab afterwards. Now I can dress and do most things as long as I take it slow. I go to the gym and do a light workout and feel like I am getting stronger doing more. Just have to keep telling my self, slow, slow down,, them I'm ok. I don't believe in the charts either. Good going and keep kicking.
  • When I first saw my pulmo and he tested me, I blew a 24% FEV and I received the same dire prediction as Dave. Since then, my life expectancy has been extended from 4, then to 6, then to 10 years and at my last appointment with the pulmo, he gave up on prognosticating and said that while I would certainly die some day, there was a very good chance that it wouldn't be from COPD. That's all been in the last year and now my goal is to outlive my doctors.

    Forget all the apocalyptic terminology and live the best life you can.

    • Ben A wins "Best Attitude Award" of the day!!!
      His last line sez it all!
      Thank you, Ben!

      Mark S.
    • Aman to that last line. I have 18% FEV but go to the gym each week. Have to take it easy but i'm still kicking. Thanks
  • This discussion from the COPD coach is the best I have read. All of us must understand that we take risks every day, and some of those risks could be life ending. We are all going to pass away at some point...it is inevitable. We must learn to deal with that inevitability in a positive manner so that we can enjoy our time here. Life is what we make it!
    Having that "end stage" label just means you have completed all the stages available to classify. It would be a shame to wallow in that "end stage" category, and then all of a sudden, they develop a new stage!!So...we must make it best we can!

  • I was diagnosed with emphysema last Jan 2017, my fev1 is around 30%; I never smoked but grew up in a smokers household (my 87 year old father who STILL smokes)!

  • That was a very informative article and I am going to print it off and show it to my husband, who is convinced he is going to die soon. I was told years ago that the good news about his severe emphysema is that he will never get lung cancer, because there is hardly anything left of his lungs for cancer to grow on. :-(

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