Stage 4 cancer is a serious disease that requires immediate expert care.
Patients may live for years following treatment for stage 4 cancer. Specific treatment options depend on the type and location of cancer, as well as the patient’s overall health, but the goal is to try to slow or stop the growth of cancer cells, reduce symptoms and side effects, and improve quality of life.
What is stage 4 cancer?
Stage 4 cancer has spread from its original location to distant parts of the body. It’s sometimes referred to as metastatic cancer. This stage may be diagnosed years after the initial cancer diagnosis and/or after the primary cancer has been treated or removed.
When a cancer metastasizes to a different part of the body, it is still defined by its original location. For instance, if breast cancer metastasizes to the brain, it is still considered breast cancer, not brain cancer. Many stage 4 cancers have subcategories, such as stage 4A or stage 4B, which are often determined by the degree to which the cancer has spread throughout the body. Similarly, stage 4 cancers that are adenocarcinomas are often referred to as metastatic adenocarcinomas.
Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:
- The ratio of healthy blood cells to cancerous cells
- The degree to which lymph nodes, the liver or spleen may be swollen
- Whether the cancer has resulted in blood disorders such as anemia
Stage 4 cancer in the five most common areas of occurrence
Stage 4 breast cancer
In stage 4 breast cancer, the cancer has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. Metastatic breast cancer most often spreads to the bones, brain, lungs and/or liver.
Learn more about stage 4 breast cancer
Stage 4 lung cancer
In stage 4 lung cancer, the cancer has spread beyond the lungs or from one lung to the other. Metastatic lung cancer most often spreads to the adrenal glands, bones, brain and/or liver.
Learn more about stage 4 lung cancer
Stage 4 prostate cancer
The cancer is found in other parts of the body, even after the prostate has been removed. Metastatic prostate cancer usually travels to the adrenal glands, liver, bones and/or lungs.
Learn more about stage 4 prostate cancer
Stage 4 colorectal cancer
The cancer has spread to one or more organs that are not near the colon. Metastasized colorectal cancer most commonly spreads to the liver, lungs and/or bones.
Learn more about stage 4 colorectal cancer
Stage 4 melanoma
The cancer cells have spread beyond the skin and local lymph nodes to distant lymph nodes, organs and/or other areas of skin. Metastasized melanoma may be found in the bones, brain, liver or lungs.
Learn more about metastatic melanoma
Staging and grading for stage 4 cancer
Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:
- T (tumor), or the size of the original tumor
- N (node), or whether the cancer is present in the lymph nodes
- M (metastasis), or whether the cancer has spread to other parts of the body
Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. The care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell the care team where the cancer is, but looking at the cancer cells specifically tells them how fast they are likely to grow—or what grade they are.
Grading is different from staging and is done for most, but not all, cancers.
Generally, tumors are low, intermediate or high grade. Low-grade tumors that look similar to normal cells tend to grow slowly. High-grade tumor cells look very different from normal tissue cells and tend to grow more rapidly.
Tumor grades tend to go from G1 (low) to G4 (high), but specific grading systems may be used depending on the cancer, so be sure to ask the care team about any questions along the way.
The grade of the patient’s cancer is part of how the cancer care team stages the cancer and determines the patient’s prognosis, or outlook.
Cancers of the central nervous system (CNS) are graded rather than staged. Grade 4 brain and spinal cancers are considered aggressive and fast-growing. Tumors that have spread to the CNS from another location in the body are much more common than primary brain or spinal column tumors.
Stage 4 cancer treatment
Stage 4 cancer is challenging to treat, but treatment options may help control the cancer and improve pain, other symptoms and quality of life. Systemic drug treatments, such as targeted therapy or chemotherapy, are common for stage 4 cancers.
Often, a clinical trial may be an option, offering new treatments to help the patient fight stage 4 cancer.
Below are the prevailing treatment options for the five most common cancers.
Treatment of stage 4 breast cancer
For cancer that has spread beyond the breast and nearby lymph nodes, systemic drug treatments are typically used. These include:
- Hormone therapy
- Targeted drugs
- Chemotherapy
- Immunotherapy
They may be used alone or in combination, and they may also be determined by the hormone receptor and the HER2 status of the cancer.
Surgery and radiation may be treatment options in specific cases to help improve symptoms caused by a growing tumor, not to get rid of the cancer. The tumor may be removed with surgery or shrunk by radiation therapy if, for example, it’s:
- Blocking a blood vessel
- Causing a wound
- Affecting the spinal cord
Learn more about breast cancer treatment
Treatment of stage 4 lung cancer
In general, stage 4 lung cancer is also treated with systemic drug therapies.
Stage 4 lung cancer that has spread to one distant area (stage 4A) tends to be treated differently than lung cancer that has spread more widely. For stage 4A cancers, treatment tends to focus on the one site where the cancer has spread.
Surgery and/or radiation may be used to try to fully remove cancer from the distant site. From there, treatment may focus on the primary cancer site in the lung and possibly include chemotherapy, surgery or radiation, or some blend of these treatments.
More commonly, stage 4 lung cancer has spread widely, also called stage 4B. Since there are several gene mutations associated with lung cancer, the patient’s first step may be genetic testing.
If the patient has a genetic mutation that accounts for his or her lung cancer, the patient’s treatment may include a targeted drug that focuses on that specific mutation. Immunotherapy may also be given, as well as chemotherapy. Palliative care may be included in the patient’s treatment, too, if tumors are causing any symptoms.
Learn more about lung cancer treatment
Treatment of stage 4 prostate cancer
This cancer is typically treated with systemic drug therapy and/or radiation therapy. Treatments may include:
- Hormone therapy
- Hormone therapy combined with chemotherapy
- Radiation therapy, possibly followed by hormone therapy
Surgery and/or radiation may also be used to treat specific symptoms, such as if the tumor is affecting how the patient urinates or causes bleeding. Prostate cancer that has spread to the bones may need specific treatment such as drugs to strengthen the bones or radiation that targets cancer in the bones.
Even at stage 4, the most appropriate treatment for some men who are older or have serious health problems may be observation or watchful waiting. The patient’s care team would keep an eye on the cancer and how fast it’s growing and intervene with treatment if it reaches a certain size or begins to cause symptoms.
Learn more about prostate cancer treatment
Treatment of stage 4 colorectal cancer
Surgery followed by chemotherapy may be a treatment option if the cancer has only spread to a few small areas in the lungs and/or liver.
For cancer that has spread to more places or that surgery cannot remove, chemotherapy may be used first in an attempt to shrink the tumors. If they’ve shrunk enough, the care team may be able to remove them with surgery, and then the patient may have more chemotherapy after surgery.
For stage 4 colon cancer that is widespread, chemotherapy and/or targeted therapies are the main treatments. If the cancer is causing specific symptoms or pressing on other organs, the care team may suggest surgery to treat that specific area and reduce symptoms.
Rectal cancer treatment for stage 4 cancer follows a similar pattern. For cancer that has only spread to a few, distinct areas in the liver or lungs, different combinations of chemotherapy, radiation and surgery may be used to try to shrink and remove the cancer. After surgery, it’s likely that the patient will have chemotherapy and/or radiation as adjuvant treatment.
Learn more about colorectal cancer treatment
Treatment of stage 4 melanoma
Options for a stage 4 melanoma that has spread to distant lymph nodes, other organs and/or other areas of the skin are the same as those for recurrent melanomas and for stage 3 melanoma that cannot be removed with surgery.
In general, targeted therapy and immunotherapy tend to be used before chemotherapy. Options for stage 4 melanoma may include:
- Targeted therapy with oncolytic virus therapy, which includes injecting a virus to specifically break down cancer cells while leaving normal cells alone
- Targeted therapy with one or several signal-transduction inhibitors, which are drugs that block communication between cancer cells, preventing cell division and causing cell death
- Immunotherapy with one or several drugs that help strengthen the immune system to fight cancer cells
- Chemotherapy to slow the growth of cancer cells or kill cancer cells Palliative therapy to decrease symptoms rather than remove cancer for curative purposes.
- Palliative care may include surgery or radiation therapy for affected lymph nodes or tumors affecting the digestive system or brain
There may also be clinical trials assessing new treatments for stage 4 melanoma.
Learn more about melanoma treatment
Stage 4 cancer survival rate
After a stage 4 cancer diagnosis, it’s normal to want to learn more about survival rates. Survival rate estimates for patients with cancer vary based on several factors, including:
- Type of cancer
- Age
- Overall health before beginning cancer treatment
- Grade of the cancer
Although the overall prognosis may be poor based on cases with previous patients and older treatments, many patients with stage 4 cancer can live for years.
A few factors to keep in mind:
- Many treatments are available to help fight cancer.
- The body’s response to treatment may differ from that of others.
- The patient will be able to share decision-making with his or her care team at each stage of treatment.
Advanced cancer treatments may be used to help treat symptoms, slow the cancer’s growth and improve quality of life. Additionally, having the appropriate support for the patient and his or her family can make a big difference.
How to find support
With a stage 4 cancer diagnosis, getting the right support is key. Below are some ideas for where to begin in building a support system.
- The cancer care team: They are the hub of the patient’s cancer care and can serve as great resources. They know that the patient’s stress levels, nutrition and other medical issues all affect his or her cancer treatment. Ask open questions and let them know what the patient needs, even if it’s services beyond what they provide. They can help make a referral or get the patient connected.
- Counseling: Having time and space to process any feelings and emotions with a mental health professional may be a helpful way to manage the stress that comes with a stage 4 cancer diagnosis and treatment. Consider speaking with a counselor independently, or with family or a partner, to explore how to manage this stressful time together.
- Pain clinics and palliative care: Palliative care focuses on treating symptoms rather than treating the disease. Symptoms of stage 4 cancer often include pain. The patient’s treatment plan should include ways to help him or her be most comfortable, so speak with the care team about any pain and comfort levels. They may be able to provide additional services or refer the patient to specialized palliative care.
- Look for support groups: Patients diagnosed with stage 4 cancer are joining a host of others who are walking a similar path. The patient is not alone, and participating in a support group may help him or her feel more connected and understood. The American Cancer Society has a tool to find local resources for cancer support in the patient’s area.
How to support someone with stage 4 cancer
It’s important to be supportive when a loved one has stage 4 cancer. Support means different things for different people, but knowing a few tips can help as a starting point.
- Keep the focus on the patient: It’s important to focus on the cancer patient’s interests and needs rather than talking about personal experiences or complaints.
- Stay in touch: Avoiding or ignoring someone with stage 4 cancer is likely to make them feel worse. Let them know they can reach out any time, and check in with them often.
- Be a good listener: Sometimes, cancer patients just want someone to listen without interruptions or interjections. Be a sympathetic ear for cancer patients and give them undivided attention.
- Don’t compare them to other cancer patients: It can be tempting to talk about other people and their cancer experiences, but it’s better to let the cancer patient be their own person and share their thoughts and feelings without comparison.
- Avoid personal questions: Don’t ask a stage 4 cancer patient what their lab results are or how long their doctor says they have. They’ll share that information if they want to.
