What is the Difference Between Emphysema and Lung Cancer?

This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on February 5, 2020.

Dear COPD Coach,
My doctor has told me I have end-stage emphysema. Is that the same as Stage-4 cancer?


Dear Concerned,

Lung cancer and emphysema are not the same things. While both lung cancer and emphysema can be caused by smoking or exposure to dangerous substances, they cause different problems in the lungs and require different treatments.

Lung cancer occurs when there is an uncontrolled growth of abnormal cells in the lungs. These cells do not contribute to the normal action of the lungs, and these abnormal cells actually get in the way of healthy lung function and prevent a person from breathing well – worsening over time.

Emphysema is an illness that falls under the umbrella of COPD and occurs when the tiny alveoli in the lungs are damaged. This damage makes it increasingly difficult for the alveoli to perform their main task of exchanging oxygen and carbon dioxide as a person breathes in and out.

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.

Your doctor used the term “end-stage” to describe your emphysema. That is a phrase that the medical community is trying to stop using because it isn’t really an accurate way to explain your condition and can cause confusion. 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 what your doctor called "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.

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.

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

Coaches Corner 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 The COPD Coach.


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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. :-(
    • I hate to hear that your husband has severe emphysema,,I have it too I've had it since 2016 ,it messes with other parts of your body the right side of your heart I get out of breath when I bend over. I liked the article I think emphysema is worse than lung cancer that's my opinion emphysema destroys the top part of your lung,s

  • I found out last month {October] that I have blood clots in my lungs and Mild emphysema, along side of a nodule on side of thyroid and degenerative spine disease mid to low .
    All found in a CT scan to try and work out why the pain in my chest weeks earlier.
    I have investigated since getting this information to understand how and why these things are there, to hear from my Dr that the blood clots are in my DNA and have had this all my life :( and have been put on blood thinners to try and stop my blood from clotting, but my focus is on my lungs and from what I have seen and learned....wow, even the sprays one uses in the toilet, hair spray cans etc are ALL BAD for our lungs and no one tells us this.. :(
  • COPD vs. Lung Cancer
    We all know that both COPD and Lung cancer can be caused by smoking, but the development of cancer is a totally different process than developing COPD. In cancer there is commonly a tumor that starts in one area and has the potential to grow and spread (slowly or very rapidly).
    COPD is caused by lung tissue becoming damaged or destroyed. It can be found throughout the lungs or more localized. It is usually slow in its progression.
    A lung biopsy, blood test and/or sputum test can check for cancer cells.

  • Thanks for the advice. I have a Question for everyone, I, will be 58 years old September 22,I have smoked for 42 years, I have had severe emphysema for 3 years I've been hospitalized 5,times with lung infections and I was hospitalized for 6 days in June 2019 with pneumonia. I stay wore out all the time knowmatter how much rest I get I stay in bed most of the time and only exercise I get is when me and my girlfriend go to the store I just feel so tired I can be sitting on the bed and I get dizzy plus I've been walking from the bedroom to the kitchen and just about fall over I dropped a cup I had in my hand. Also my feet are numb from the ball of my foot to my toes and my right knee hurts and leg my calf muscle hurts and swells sometimes. DO AND OF YOU GUYS AND LADIES DO THAT. SHOULD I GET EXERCISE EVEN IF I'M SO WORE OUT I GET OUT OF BREATH EASY.
    • Whether or not you should be exercising is a discussion you should have with your pulmonologist.
      When I was first diagnosed with COPD, I was exhausted all of the time. I was given supplemental oxygen to use 24/7 and that helped some, but not a lot. I started Pulmonary Rehab about 2 months after the diagnosis and it turned everything around for me. I gained back my strength and stamina, and was able to work full time until my planned retirement in January 2019.
      I started very slowly at P-Rehab. The first day I only did 3 minutes on the treadmill. 14 sessions later I was able to do 30 minutes and still have energy left to do more.
      I strongly encourage you to discuss this with your pulmonologist!
    • I agree with Jean that exercise is something you have to discuss with your doctors. You need to be approved for exercise. Many of us start with pulmonary rehab where we are closely monitored. It is a safe way to learn how to safely exercise and to start building yourself up. You will learn how to monitor your O2 saturation while exercising, how to breathe properly while exercising.

      Talk to your pulmonologist about getting you into a pulmonary rehab program. Or perhaps you need to start with physical therapy, the numbness and swelling needs to be sorted out.

  • I applied for disability in June of 2018 because of my severe emphysema and chronic bronchitis and copd I had a breathing test in February of 2017 I don't know what the results are I have copies of my medical records and will have to look at the time I had the test I was in the hospital for a lung infection social security disability sent me to their doctor last month and was supposed to do a physical and breathing test they only did the physical I got a letter this past Saturday and I have to go to the social security disability doctor and have a breathing test October 16th. Did anyone have that happen to them,?
    • Hello Emphysema mike,

      I totally agree with Jean and Debbie that you should talk about pulmonary rehab with your doctor. In addition to physical conditioning, you can learn a lot at pulmonary rehab. A few of these things are how to: avoid lung infections, maintain a healthy weight, and understand how to have an adequate oxygen level (to make sure your heart, brain, and other body systems have enough oxygen).
      Regarding your application for disability, the staff at pulmonary rehab should be able to point you to a social worker or discharge planner who can answer your questions about that process.

  • Hey, Thanks for sharing this informative article. Emphysema is a form of COPD, there is no cure for any form of COPD but treatment can help to slow the progression of the disease and manage symptoms. It is very important to recognize the signs and symptoms as early diagnosis can increase the chances to cure the disease.

    • I blew in the 30% range. When my pulmonologist told me I was stage 3, five years ago, I was heartbroken, as most everybody felt. But I am doing well as long as I take my medications. I am a semi-active retiree, and can still travel.
      I understand the fear well.
  • This was very informative. I’m still processing and somewhat denying my battle with COPD/emphysema. The last hospitalization seemed to take so much out of me. Had rebounded after the previous two and following several exacerbations but have not been able to this time around (it’s been over a year). Several physicians including my pulmonologist have said I’ve entered stage four and it certainly feels that way. An added difficulty is I contracted pseudomonas which is what shut my lungs down last time and it is proving to be an ongoing nightmare as it’s difficult to know when it has reached a critical point and you have a limited window of opportunity to begin the Levofloxacin which is about the only antibiotic that will knock the bacterial infection back. COPD is the ‘gift that just keeps giving’.

    I’m 56 and, honestly, unsure if there’s much of a future left but trying to climb upon a plateau psychologically that would enable me to enjoy some semblance of a happy, productive ‘life’. There’s not a lot of resources or specialists in my immediate area so signed up for hospice care in order to access additional benefits. I miss being active. Can still, on occasion, go for a decent walk yet activities like yoga, tennis, biking and hiking are in the rear view mirror. I hope there will be a breakthrough resulting in a cure some day for COPD so that no one has to endure the suffering that accompanies this disease as it seems an especially cruel way to end one’s life but I suppose that is with a lot of diseases. Anyways, sorry if that’s too much information and thanks again for the article.

    • Hi, Dren. I'm sorry to hear that you're working through all of that. It's definitely a tough road that you have to follow.

      One thing I would say is that the whole idea of "stages" is getting a little outmoded. That used to be how we measured how severe someone's case was, because we assumed that the worse one's airflow was, the worse off they were. More recently, we've found that airflow problems don't always match up well with symptom levels or activity tolerance, and there are many, MANY people with stage 4 obstruction that are still quite active in their lifestyles. So, while it's easy for me to say, I would encourage you to not let those words get you down too much.

      It's really important to stay as active as possible to start building things back up. Some days, that's your decent walk, some days, it could be sitting on the couch with some hand weights or resistance bands. Every little step (literally or not) makes a difference!

      Hopefully, you can access some online resources, whether it's through us or through a hospital organization or other support group. There are a lot of people on the journey with you, and we can all try and give you the support you need and deserve, as well as point you in the direction of whatever resources might be available for you. We're here for you!
    • To Add on to Mike's comments- you would be a great candidate for a pulmonary rehabilitation program. If a physical one is not available- perhaps you can find a virtual one.