Stage 4 Cancer: What It Is and What to Know

The more widely cancer has spread from the site where it is first diagnosed, the more difficult it becomes to treat. Cancer is labeled stage IV when it is found not only in its original location, but also in distant tissues and organs.

There are several staging systems used by pathologists and cancer specialists to describe the characteristics of a particular tumor. In the most general system, stage 0 means abnormal cells are present, but have not spread to nearby tissue; stage I, II, and III reflect that cancer is present—the higher the number, the larger the tumor and the more it has spread into nearby tissues. Stage IV means the cancer has spread, or metastasized, to distant parts of the body.

There are more detailed staging systems that consider the characteristics of the tumor, such as the size and extent of the main tumor, the number of nearby lymph nodes that contain cancer cells, and whether it has metastasized. Stage IV cancer is also defined somewhat differently for each type of cancer.

When cancer is localized, it’s often possible to remove it surgically or eradicate it with radiation treatment. This is sometimes followed by chemotherapy to eliminate cancer cells that have escaped into the bloodstream or the lymph system.

Is stage IV cancer curable?

When cancer has metastasized, treatments are rarely curative, although there are exceptions. For example, about 80 percent of men who are treated for metastatic testicular cancer will survive five or more years after diagnosis. A small percentage of patients with stage IV thyroid cancer live beyond 10 years.

Certain types of cancer (such as lung and pancreatic cancer) often do not cause symptoms in their early stages and therefore tend to be diagnosed when they are already advanced and have metastasized to other organs, making them difficult to treat.

Pancreatic cancer cells.
Pancreatic cancer cells.

How is stage IV cancer treated?

In most cases, treatment of stage IV cancer is aimed at prolonging survival and improving quality of life. These treatments may involve chemotherapy, radiation therapy, biological and hormone therapy, or surgery, or a combination of these modalities. In cases where there are only a few small areas of cancer that has spread, surgeons can remove them in an effort to prolong survival. Radiation therapy is sometimes used to help relieve pain or other symptoms caused by advanced cancer.

New treatments that harness the body’s immune system, such as checkpoint blockers and CAR T-cell therapy, are being tested in late-stage cancers including melanoma and lung cancer. They are not yet labeled as cures, but in some patients they have achieved impressive and long-lasting slowing of advanced cancers, and even eradication of tumors in some patients.

Why is stage IV cancer hard to treat?

Metastatic cancer causes most cancer deaths, but exactly why it is so difficult to treat is not precisely understood. Metastatic tumors often acquire additional genetic changes from those in the primary tumors that spawned them, and these genetic characteristics may cause them to resist standard treatments. Moreover, metastases that have spread to diverse organs may be growing in different microenvironments, causing them to respond differently to treatment. While chemotherapy can often kill small numbers of cancer cells, it is usually less effective in eradicating the larger number of tumor cells present in widespread metastases.

25 thoughts on “Stage 4 Cancer: What It Is and What to Know”

  1. I am a cancer survivor of metastatic oesophageal cancer.Thank you for your articles it is very informative.I want to know of latest treatments for this disease.Thank you

    • i am also a stage 4 esophageal cancer patient. I have had 6 different types of treatments including immunotherapy trials. I have been stage 4 for 3 plus years. I am now on FolFox and irinatecan. I am sure I did not spell them correctly. I belong to an esophageal group out of milford DF and it is very helpful.

  2. My husband diagnosed with SCLC inoperable. Also on tail of pancreas and abdominal area and 3 small lesions on brain. What treatments are available?

  3. The drug and medical industries need to do a better job of communicating the limitations of the new generation of biologicals. They don’t work for most people yet the ads make them seem like life savers, rather than short-term life extenders, if that. In addition, Stage V patients largely feel abandoned by the system once it’s clear treatments have failed. There should be FAR more focus on improving end-of-life care and preparing patients and families for what is going to happen. Perhaps if cancer doctors had to treat patients until the very end, rather than pass them off to hospice, the quality of end-stage care would improve.

  4. I am a stage IV survivor, 3 years … no sign at all of returning cancer. Melanoma , treated with two immunotherapy medications. Was gone in 6 to 8 weeks! Keep fighting! In time there will be immunotherapy for nearly all types of cancer. Much less side effects. But attention must be paid to symptoms.

    • Thank you Kevin for you post.
      I am so happy for your excellent response to immunotherapy. My husband was just diagnosed with stage 3c melanoma. Started Opdivo therapy last month. I hope he responds as well as you did. Your post is inspiring.

  5. Thank you for the info. I have Stage IV lung cancer with the EGFR mutation. The original tumor is not visible on scans I was originally on a trial with Afatinib and Cetuximab but three years later it spread to the right axcilla and trachea. I’m now being treated with radiation for 10 days then infusion with carboplatin and pemetrexed while still taking Afatinib. Is there anything else I can talk to Dr about regarding changing new infusions. I think I’m more worried about side effects with this new treatment that will never had with my first trial. Thank you

  6. I have Stage 4 Ovarian Cancer and have done well on chemotherapy and now Avastin for over 6 years. So any Immunotherapy Trail that maybe be available for me..Here I am! I respond very well to treatments!

  7. I am bursting with enthusiasm not only for the gentleman that has been NED for a long time but for the woman whose husband is in the throes of this disease. Get to Dana Farber!!! If you can’t, do the second opinion!! Just do it. I wish you good health. They are amazing. AnneMarie

  8. I was diagnosed with stage 4b cervical cancer in March of 2015. After surgery and chemo therapy, I have remained with NED status ever since. Is there a way to verify if my original pathology report was correct?

    • Hi Lisa,

      Thank you for reading. You can address any specific questions about with either your clinical care team or the Department of Pathology at Dana-Farber, if you are a patient here. To reach the Department of Pathology, please call this number: 617-732-7510.

      Wishing you the best,

  9. I am a 10 year survivor of Stage 4 Soft tissue sarcoma. I had many, many mets in my lungs. To everyone on this journey, keep putting one foot in front of the other. Hopefully, this gives encouragement and hope to others.

  10. Thanks for this informative article. I was successfully treated through DFCI for Stage 1a Hodgkin Lymphoma in 1986. In 2004, I was diagnosed with Non-Hodgkin Lymphoma (B cell, but I don’t recall the other details of the Dx). I was treated with CHOP+R and have been NED for nearly 15 years. During the NHL diagnosis and treatment, nobody ever mentioned staging, and I guess it never occurred to me to ask. My question is: is NHL simply not staged? If that’s the case, are there other cancers that are not staged? Why not?

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