Why Is Stage IV Cancer Difficult to Treat?

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.

However, 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.

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.

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.

25 thoughts on “Why Is Stage IV Cancer Difficult to Treat?”

  1. We have been on a cancer journey for 23 years now……and this poem is a fave
    Cancer is so limited…
    It cannot cripple love.
    It cannot shatter hope.
    It cannot corrode faith.
    It cannot eat away peace.
    It cannot destroy confidence.
    It cannot kill friendship.
    It cannot shut out memories.
    It cannot silence courage.
    It cannot reduce eternal life.
    It cannot quench the Spirit.

    To all walking this road…….blessings and love

    • Thank U!!That is sooo o inspirational for me with stage 4 ovarian cancer with mets.I was diagnosed 3 years ago and doing well,needed to stop Avastin .Positive attitude is the key

  2. I was diagnosed with stage 3b colon cancer in 2013 and did the customary six months of chemo and surgery. In 2015, my colon cancer spread to one ovary. I had my ovary removed and no other treatment. I have been cancer free since 2015 and am hopeful for many more healthy years. I am now 48 and super active, so my lifestyle has not been impacted due to the treatments. Emotional health was a much harder slog than physical.

  3. in 2014 I had two major Surgeries 1st Kidney and lymph node near by removed at St. peters Hosp in Albany. later a malignant Lymph node removed from my Aorta at Brigham and Women’s Hospital So I’m firmly on Stage four grounds. But get this it is now 2019 and I’m so far Cancer free! Regular CT scans are important. I read I had an 8% chance of it not coming back. (not good) but in five years it has not returned. they will watch me closely for a total of seven years. no chemo.no radiation yet. just fast and thorough surgery. Thanks Albany & Boston. I did have Spinal sepsis last year but that didn’t kill me either. Feeling lucky Blessed and Strong

  4. I am 46 .I was diagnosed with metastatic appendix cancer just about one year ago. On top of that it’s poorly differentiated signet ring cell. A very aggressive form. I had chemo then cytoreductive surgery with HIPEC now I’m back on chemo. I’m on 5FU generally used to treat colon cancer. Appendix cancer is rare and there aren’t many options. I go for a Pet Ct scan next month. If all is good my chemo will be reduced from every two weeks to three to help give me a better quality of life. If the chemo isn’t working then I have some life changing decisions to make. It’s been a tough road for a lot of us but we keep on getting on!

    • Jason,
      Good luck on your upcoming Pet scan. I know how difficult all this is. My motto is someone has to live so why not me!
      Denise

  5. I am in my 20th years of survival of ovarian cancer survivor, stage 4! And I had no symptoms, except a swollen lymph node in my neck. And a few days before my surgery, the cancerous cells perforated my colon, so when my cancerous ovaries were removed, the doctors also took out part of my colon and created a colostomy. I was incredibly fortunate to have it reversed six months later.

    To say Thank You, I give out Ovarian Cancer Cards that have Facts on one side and Symptoms on the other. Many, many women die of ovarian cancer because they ignore the symptoms, not because they are reckless, but because the symptoms are so familiar!
    I am in my 20th years of survival of ovarian cancer survivor, stage 4! And I had no symptoms, except a swollen lymph node in my neck. And a few days before my surgery, the cancerous cells perforated my colon, so when my cancerous ovaries were removed, the doctors also took out part of my colon and created a colostomy. I was incredibly fortunate to have it reversed six months later.

    To say Thank You, I give out Ovarian Cancer Cards that have Facts on one side and Symptoms on the other. Many, many women die of ovarian cancer because they ignore the symptoms, not because they are reckless, but because the symptoms are so familiar!

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