How Do People Die From Lung Cancer?

"How do people die from lung cancer?" Tumor spread and blood clots are just two possibilities. Hearing this can be tough, but the full answer to the question does offer something positive: If you've been diagnosed, it can help you determine paths that may improve your chances of living a longer, fuller life or help you prepare for end-of-life decisions and care.

Understanding factors that can lead to lung cancer-related death can also firm up your and your loved ones' understanding of end-stage disease, giving you some sense of control—and with that, even peace—at a time when uncertainty would leave you feeling lost.

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Causes of Death From Lung Cancer

Research on the specific causes of death related to lung cancer is limited. However, at least one influential study has broken down the immediate and contributing causes of death among 100 lung cancer patients.

The causes, in order from most common to least, include:

  • Tumor burden (the size and spread of tumors or cancer cells)
  • Infections
  • Metastatic complications (when problems occur in areas where tumors have spread)
  • Pulmonary hemorrhage
  • Pulmonary embolism
  • Diffuse alveolar damage
  • Other complications

Respiratory failure is the immediate cause of mortality in about 38% of lung cancer deaths. But different factors lead to a lack of oxygen including tumor burden, pneumonia, or hemorrhage. Often, more than one condition contributes to death.

Tumor Burden

In the study of causes for death, tumors were responsible for 30% of deaths in people with lung cancer, with about 4% of the overall patients dying from tumor burdens in the lungs and 26% from those in sites where lung cancer metastasized (spread). This means that tumors grew so large in the lungs or in regions the cancer reached that the organs shut down, which led to death.

Infections

Infections were responsible for death in 20% of the patients in the study. Of those people, 60% suffered from pneumonia and 40% from sepsis, an overwhelming infection that begins in the bloodstream and spreads through the entire body.

Complications of Metastatic Disease

In stage 4 lung cancer, the malignant cells have metastasized beyond the lungs to other parts of the body. Sometimes the tumors will shut down the organ. Other times, the cancer interferes with the normal functioning of those organs causing other complications.

In the study of causes of death in lung cancer, metastatic complications were responsible for 18% of deaths.

These complications cause fatalities in very different ways. For example, lung cancer metastatic to the brain can disrupt your ability to walk, talk, and swallow, or it may result in a hemorrhagic stroke. Once lung cancer is in the nervous system, it can also cause leptomeningeal metastases, when cancer cells invade the cerebrospinal fluid, which is a terminal stage of the disease.

Lung cancer metastatic to the liver can interfere with the liver's ability to do its job of removing toxins from the body, causing a buildup that can lead to death. This is usually painless, as people slowly become less alert.

Lung cancer can sometimes spread to the pericardium, which surrounds the heart. This may cause bleeding between this lining and the heart, resulting in compression of the organ and sudden, rapid—although painless—death.

Pulmonary Hemorrhage

Pulmonary hemorrhage, or bleeding into the lungs, was responsible for 12% of deaths in the study of lung cancer patients Coughing up blood is the main symptom of this disorder.

Approximately 20% of people with lung cancer cough up blood at some point in the course of their disease, but this doesn't mean you should ignore the symptom or treat it as something "expected." 

Even a small amount of bleeding in the lungs can be a medical emergency. In smaller amounts, blood in the lungs can produce a feeling of suffocation. When massive bleeding occurs, however, death is usually rapid.

Pulmonary Embolism

Blood clots in the legs, known as deep venous thrombosis, can break off and travel to the lungs, causing pulmonary emboli. This results in breathing difficulties, severe pain, low blood pressure, and possibly death.

Pulmonary emboli caused 10% of lung cancer deaths in the study of lung cancer patients. This is a significant finding because blood clots are sometimes preventable and often treatable. Understanding your risk factors can help you avoid this common problem.

Blood clots may occur any time after a diagnosis and are sometimes the first symptom of lung cancer. They are particularly common among people with lung adenocarcinoma.

Diffuse Alveolar Damage

Approximately 7% of patients from the study of lung cancer fatalities died as a result of damage to their lungs. Alveoli are the sacs in the lung where oxygen and carbon dioxide are exchanged. Infection and inflammation can damage these balloon-like structures and cause respiratory distress.

Other Possible Causes of Death From Lung Cancer

Additional research has looked at other specific causes of death from all types of cancer. These factors can also impact lung cancer patients.

  • Chemotherapy: These medications cause a low white blood cell count, which predisposes you to infections that can be fatal.
  • Radiation therapy: In some instances, you can develop radiation pneumonitis (RP), an inflammation of the lungs due to radiation therapy. In fewer than 2% of cases, this can be fatal.
  • Complications of surgery: Reactions to anesthesia, bleeding, and other complications can lead to unexpected fatalities.
  • Medical errors: It's estimated that medical errors are the third leading cause of death in the United States. Unfortunately, anyone under a doctor's care could be at risk for errors. Staying informed and involved in your treatment, though, can help you avoid some common problems.

In addition to lung cancer complications, you may be at risk for other diseases and disorders. Heart disease, including heart attack and blockage, is one of the most common (though unrelated) problems cancer patients face.

Why Knowing Can Be Helpful

Learning what is known about the possible future of your disease course can help you identify steps you can take now to prevent or manage such risks and, hopefully, avoid premature death.

For example, knowing the potential for and risk associated with blood clots, you can be on the lookout for symptoms and signs that should prompt you to seek medical care.

Knowing all the mortality risks of advanced stages of lung cancer can also improve your overall quality of life. Even if the causes can't be directly treated, the symptoms that result may be able to be eased by appropriate therapies.

Furthermore, a full understanding of how people can die from lung cancer allows you and your loved ones to make a plan if you choose to stop cancer treatment or move to palliative care. Having some idea of what to expect can help those close to you be ready to help in any way possible.

Knowledge is power. Being clear about what may be in store can at least help reduce the element of stress that stems from something being unknown.

Emotional Readiness

That said, while information about end-of-life care and risks can help some people feel a sense of control and peace, not everyone is ready or able to confront these issues.

Before delving far into how all of the above may factor into your case with your doctor, be sure you are emotionally prepared. If you think you are but discover that what they say is more than you handle, seek the help of a counselor who can help walk you through what you are feeling and how to deal with your emotions.

Likewise, before you share information with others—either family members who will be caregivers, people you know who are fighting the disease, or others—be certain that they really want all the facts upfront. Respect what each individual can handle and when they can do so.

Will Death Be Painful?

One of the biggest fears of those living with cancer and those who care for them is that pain will be severe at the end of life. In fact, in asking "How will I die?," many people are really asking, "Will dying be painful?"

Some people do have severe discomfort at the end of life. Lung cancer treatment options such as chemotherapy and radiation can be used to relieve some types of pain. In addition, your doctor may recommend seeing a pain management specialist who can help.

The important point is that nobody needs to die in pain. Talk with your doctor or get a second opinion if you have gotten little to no relief.

Preparing for End of Life

Because of the poor survival rate of many types of lung cancer, you may eventually need to confront the question of what the end stages of lung cancer will be like.

This can be a terrifying time, but you have the ability to make it less frightening and more physically, emotionally, and spiritually peaceful.

The timeline for the decline in end-stage lung cancer varies greatly depending on the type of cancer and other health complications. There are, however, ways to prepare for some aspects of final care.

One of the decisions you should be prepared to make is setting a point when it may be time to move from palliative care to hospice care. While the two terms are sometimes misunderstood to mean the same thing, there are differences in where and how you are taken care.

For Loved Ones

When talking about death, many people experience grief that’s not unlike the grief that occurs after an actual loss. This is called anticipatory grief.

Grieving before death is not only normal but may allow families to come together to heal from past hurts and form memories that will live on. You may be coping with feelings of grief even though your loved one is still alive.

Consider seeking help from a counselor or support group to navigate this. Remember to take time to care for and nurture yourself physically and emotionally, especially if you are a caretaker.

It's also important to understand that people often know they will die soon. Your loved one may speak of talking to other loved ones who have died before. While this can be unsettling and you may want to avoid talking, it's important to engage in conversation with your friend or family member.

Research shows that communication at the end-of-life is as important for both friends and relatives and those who are dying. 

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