How to Deal With Stage 4 Colon Cancer

How can you best cope when you learn you have stage 4 colon cancer? What decisions will you need to make and what do you need to know to make the best choices for yourself personally?

Let's look at what having stage 4 colon cancer means, how long people usually live with this stage of the disease, and what you need to know to make the best decisions possible.

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What Is Stage 4 Colon Cancer?

Stage 4 colon cancer is the most advanced stage of the disease and may also be referred to as metastatic colon cancer.

By definition, stage 4 colon cancers are those which have traveled beyond the colon (metastasized). There are several different regions to which this occurs. Not all stage 4 colon cancers are alike. so sometimes statistics regarding survival can be misleading.

Deciding on Treatment

For most people, stage 4 colon cancer is not considered curable. However, it can almost always be treated. People can live many months and even years with stage 4 colon cancer.

How long a person lives after the diagnosis depends on many things, including where the cancer has spread and how the individual responds to available treatments.

The most common site to which colon cancer spreads is the liver (liver metastases) but it may also spread to the lungs, the brain, and the peritoneum (the membranes which surround the abdominal cavity) as well as other areas.

While making decisions, it's important to note that there has been a new approach to treating colon cancer in recent years. In the past, stage 4 colon cancers were all treated the same, no matter where the cancer had spread. This has changed.

Now, when a person has only a few or small areas of metastases, treatment of the metastases may be considered. A single or only a few metastases are referred to as "oligometastatic" with the term "oligo" meaning few.

For those who have metastatic colon cancer with only a few metastases to the liver or lungs, removing the metastases can sometimes increase the chance of long-term survival.

For many people, however, these treatments are not possible, and the focus of treatment becomes trying to control cancer to extend life, while emphasizing the quality of life.

Learning About Your Prognosis

Among the first things you will discuss with your healthcare team is how much information you want about your prognosis. Prognosis refers to the possible course of the disease and how much time you have.

Some people want very specific information regarding how long they might live with stage 4 colon cancer. Other people prefer not to know these details. Even if you want as much information as possible, keep in mind that predicting how long someone will live with stage 4 colon cancer is not exact. Some people live much longer than expected. Others live for a shorter time.

Your healthcare provider may give you a range of time that they expect you will live. This is their best guess, which is based on your particular case.

The most important thing to know is that you can learn as much or as little as you want about your prognosis. It is up to you. Be sure to make what you want to know (or don't) clear to your healthcare team.

What Does Your Family Want to Know?

When making your decision about details, of course, it can be important to think about those who love you and may help care for you.

Many family members want complete information about how long a loved one may live after being diagnosed with stage 4 colon cancer. Other family members may find this information very upsetting. They may not want to hear it.

Make sure your healthcare provider knows who in your family wants (or needs) complete information and who does not.

Your healthcare provider can make a note in your chart describing your goals for information sharing about your cancer treatment. This way, everyone on the healthcare team will be on the same page during appointments.

Being diagnosed with stage 4 colon cancer can make you feel out of control. Knowing your options regarding information sharing about your cancer, your treatment decisions, and end of life care decisions will help you move forward at a difficult time.

Survival With Stage 4 Colon Cancer

Predictions about survival with stage 4 colon cancer are based on statistics, and people are not numbers. In addition, survival statistics are, by definition, always a few years old.

The 5-year survival rate for a disease will give you an estimate of how long someone may have lived who was diagnosed five years ago. How someone does today with colon cancer may be very different than how someone may have done even just five years ago.

With recent advances in cancer treatment, and many new cancer drugs, such as targeted therapies and immunotherapy being studied in clinical trials, these numbers are expected to change.

It's important to understand this changing course of cancer medicine when you make your decisions. If you talk to someone, perhaps a neighbor or another family member, who dealt with colon cancer in the past, the approach to treatment may be very different now.

When people comment on others who have had the disease—which will almost certainly occur—you may want to gently remind them (or at least remind yourself) that treatments are changing. Better treatments are available for colon cancer than we had even two years ago, and long-term survival rates—even with stage 4 disease are improving.

The current 5-year survival rate for stage 4 colon cancer, according to the American Cancer Society, is 14%. However, a 2017 study found survival rates for those with stage 4 colon cancer that metastasized to the liver and were candidates for removal of the liver metastases at the same time as colon surgery improved to up to 70%.

There are more people living longer, even disease-free, with stage 4 colon cancer than ever before. If you have colon cancer with liver metastases that are treatable, there are many people who are living evidence that sometimes stages 4 colon cancer is survivable.

MD Anderson Cancer Center has a colon cancer survival calculator which takes into account cancer stage, cancer grade, age, ethnicity, and sex,

Of course, even with these variables, survival can vary considerably based on other medical conditions you may have, the specific treatments you receive, and the molecular profile of your tumor.

When to Stop Treatment

While we have better treatments than in the past, and sometimes can even treat metastases, we know that many people with stage 4 colon cancer will reach a time at which the risks and side effects of treatment outweigh the benefits.

The advent of new treatments is a double-edged sword. These newer treatments can extend life and provide options not available just a few short years ago.

In the past, we often simply ran out of treatments to offer, but today we have reached a point in which the choice to discontinue treatments often needs to be an active decision. If you are at this point in your journey, make sure to ask a lot of questions, and carefully contemplate the answers.

In addition to having to make decisions about when to stop treatment, people have to learn about and consider taking part in clinical trials—some of which have been changing the outlook for stage 4 colon cancer considerably. It's important to learn all you can about your cancer.

Palliative Care

If you've decided to stop active treatment for your cancer, what is the next step? Just because active treatment of your colon cancer ends, it does not mean that you will not have any treatments.

Palliative care for colon cancer addresses comfort rather than cure, but may, at times, include radiation therapy, chemotherapy, or even surgery.

Pain management is very important, as well as treatments aimed at reducing abdominal symptoms (such as constipation or bowel obstructions), lack of appetite, anemia, and the anxiety and depression, all of which can accompany an advanced cancer diagnosis.

Hospice Care

It can be difficult to bring up a discussion about hospice care. Cancer patients and their families may hope to protect each other by ignoring this discussion. Even healthcare providers are reluctant to bring up the issue.

What is important to know, however, is that choosing hospice care does not mean that you are giving up. With hospice care, people are still treated.

Instead of focusing on treatments to attack cancer, hospice care focuses on treatments to control the symptoms of cancer, and hopefully improve your quality of life.

Many people admit that after choosing hospice care, they wish they had done so earlier. In order to receive hospice care, you will need a note from your healthcare provider estimating that you have six months or less to live.

If you live beyond the six months period, that's wonderful! You are never "penalized" for choosing hospice care too soon, and at that time you could choose to renew your hospice care for another six months, if you need it.

Hospice care does not mean you are giving up hope. It means that you are choosing to hope for the best quality of life possible in the days you have left.

Finding Support

Take some time to learn about how to research your cancer online. Becoming involved in a colon cancer support community—ideally, one in which you can communicate with other people coping with stage 4 cancer—offers a source of support and can be invaluable in learning about the latest research on the disease.

Your healthcare team may include a surgeon and a radiation oncologist, along with your medical oncologist.

Palliative care specialists are often called upon to help people cope with symptoms of the disease.

Of course, the most important member of your cancer care team is you.

If you have chosen to stop treatment, expect people to respect your decision. This has to be your decision alone, and unfortunately, many people are begged by loved ones to continue treatment even when the side effects far outweigh any benefits.

That said, reach out to your friends and family for support. Not everyone is comfortable being around a person with advanced cancer, and your relationships may change; some close friends moving farther away, and new friends becoming closer.

A Word From Verywell

Stage 4 colon cancer is frightening, and until very recently had a very poor prognosis. We have many more treatments available at this time, with even more available in clinical trials. This is wonderful in many ways, and you need to be a very active part of your own cancer care team as you make the most of the treatments that are available for you.

Most importantly, learn how to be your own advocate in your cancer care. This will reduce your anxiety and help you to feel empowered in making your decisions, and it sometimes can make a difference in outcomes.

Frequently Asked Questions

  • What are the symptoms of stage 4 colon cancer?

    Colon cancer can have symptoms such as fatigue, weight loss, blood in the stool, constipation, or thin, pencil-shaped stools. This is more likely with later-stage cancers, such as stage 4.

    Stage 4 can have additional symptoms, depending on where the cancer has spread, such as the liver, lung, brain, or bones. For example, if the disease has spread to the liver, potential symptoms can include jaundice and swelling of the belly. If colon cancer has spread to the lung, it can cause shortness of breath.

  • Can you survive colon cancer?

    Yes, and the odds are best the earlier the cancer is found. Colon cancer often doesn't have noticeable symptoms until it's advanced. That's why getting regular recommended screenings—usually a colonoscopy—is so important.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016;6:29765. doi:10.1038/srep29765

  3. Massaut E, Bohlok A, Lucidi V, Hendlisz A, Klastersky JA, Donckier V. The concept of oligometastases in colorectal cancer: from the clinical evidences to new therapeutic strategies. Curr Opin Oncol. 2018;30(4):262-268. doi:10.1097/CCO.0000000000000453

  4. American Cancer Society. Survival rates for colorectal cancer.

  5. Inoue Y, Imai Y, Osumi W, et al. What is the optimal timing for liver surgery of resectable synchronous liver metastases from colorectal cancer?. Annals of Surgery. 2017. 83(1):45-53.

  6. Nosher, J., Ahmed, I., Patel, A. et al. Non-operative therapies for colorectal liver metastasesJournal of Gastrointestinal Oncology. 2015;6(2):224-40. doi:10.3978/j.issn.2078-6891.2014.065

  7. National Cancer Institute. Metastatic cancer: When cancer spreads.

  8. Cleveland Clinic. Colorectal (colon) cancer.

Additional Reading

By Suzanne Dixon, MPH, RD
Suzanne Dixon, MPH, MS, RDN, is an award-winning registered dietitian and epidemiologist, as well as an expert in cancer prevention and management.