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?

Sincerely,
Concerned

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.