End of Life Symptoms From Colon Cancer

With end-stage colon cancer, once treatments are no longer working, the cancer is considered terminal. At this point, it is essential to know what to expect. Though the condition will continue to progress, the timing of death is very unpredictable.

Usually, with cancer, people do not experience a "sudden death." Instead, death comes over days to weeks. However, some symptoms are synonymous with the end of life. Knowing what these are can help you prepare.

This article explains what you can expect during the final stages of colon cancer.

Holding hands
Kiyoshi Hijiki / Moment / Getty Images

What Are Stage 4 Colon Cancer Final Symptoms?

At stage 4, colon cancer has spread to other parts of the body, usually the liver, lungs, or lining of the abdomen.

Stage 4 colon cancer final symptoms may include:

  • Pain
  • Withdrawal
  • Fatigue
  • Breathing changes
  • Confusion and agitation
  • A rally, or moments of clarity during the dying process
  • Weight loss
  • Bloody stool
  • Constipation
  • Pencil-like stool
  • Jaundice, if the liver is impacted


One of the most feared symptoms of death is pain. If your loved one is dying from colon cancer, they most likely have diffuse ​metastases. That means their cancer has spread from the colon to other organs and lymph nodes. Metastatic cancer often causes pain in the location where cancer has spread.

When someone with cancer experiences pain, their doctor will prescribe opioid narcotics or powerful pain medicines. If your loved one cannot swallow the medicine, you can give some preparations sublingually (under the tongue) or rectally as a suppository.​

Since you sleep a lot towards the end of life, people often wonder how to tell if their loved one is in pain. However, even in rest, there are signs of discomfort that you can watch for:

  • Grimacing and frowning
  • Breathing quickly
  • Fidgety arms, legs, and feet

Before assuming your loved one is in pain, be sure to check their environment. For instance, there may be simple reasons for these signs of discomfort, such as wet sheets or a fever.


Coming in and out of consciousness is typical during the weeks before the end of life. But in the days and hours preceding death, most people enter a sleeping or almost comatose-like state.

Withdrawing is not a voluntary choice—your loved one is not ignoring you. Similarly, this withdrawal is not an effect of the medications they are taking for comfort, as many family members fear.

It is not entirely understood why people withdraw, but it may be a combination of physical and mental exhaustion from fighting illness.

Changes in Breathing

Changes in the way your loved one breathes might be a signal that the end of life is approaching. For example, if you start to see pauses between breaths or hear an audible gurgling noise, also known as the death rattle, your loved one is most likely within hours of passing on.

To make them more comfortable, try elevating the head of the bed and do not offer any more fluids at this point. That's because fluids can accumulate in the throat and make gurgling worse.

Gurgling is not thought to cause people discomfort, though it may be distressing to those around them.

Agitation and Confusion

Symptoms at the end of life can include periods of confusion, agitation, and even hallucinations. Your loved one may see insects in the room, angels, or even people that you cannot see. They may not recognize you or may seem upset and out of sorts for no apparent reason.

Medications may help calm them and decrease these symptoms. Try not to escalate the situation. It's best not to argue with your loved one. Instead, give them calm, gentle reassurance.

The Rally

A rally is when someone who is dying develops moments of complete clarity or alertness. They might even request food after abstaining for days. Not everyone will experience a rally at the end of life, but it can confuse ​the family if they do.

Some family members might see this as a hopeful sign that their loved one is improving. No one knows why some people experience this and other people do not. A rally may last up to a few days or occur just for a moment or two before death.


When colon cancer is terminal, some things typically happen. Knowing about them can help you emotionally prepare for this stage.

Rest assured that your doctor will offer effective medications to manage any pain. In the final days and weeks, sleeping a lot, confusion, and changes in breathing patterns are common. Some people, but not all, develop moments of clarity and alertness soon before they pass.

5 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.
  1. National Cancer Institute. Metastatic cancer: When cancer spreads.

  2. National Cancer Institute. The last days of life.

  3. McGuire DB, Kaiser KS, Haisfield-Wolfe ME, Iyamu F. Pain assessment in noncommunicative adult palliative care patients. Nurs Clin North Am. 2016;51(3):397–431. doi:10.1016/j.cnur.2016.05.009

  4. American Cancer Society. When death is near.

  5. AgingCare. When loved ones rally before death.

By Julie Wilkinson, BSN, RN
Julie Wilkinson is a registered nurse and book author who has worked in both palliative care and critical care.