What Is Stage 4 Cancer?

Stage 4 cancer is the most advanced stage of cancer. It is diagnosed when cancer cells spread, or metastasize, to other parts of the body away from the original tumor site. As such, stage 4 cancer is also called metastatic cancer.

Although some people with stage 4 cancer can live for years, the prognosis often isn't good. Therefore, the goal of treatment is not to cure the cancer but to slow or stop its growth, relieve symptoms, and extend survival time.

This overview of stage 4 cancer explains what it is and how it is diagnosed. It will help you to learn more about treatment and possible stage 4 cancer outcomes. 

Stage 4 Cancer Symptoms

The symptoms of metastatic cancer depend on the type of cancer. In some cases, there are no symptoms at all.

Most of the time, a cancer that reaches stage 4 will affect not only the part of the body where it originated, but the areas it has spread to as well.

Stage 4 cancer also can cause more general symptoms, such as extreme fatigue and lack of energy. Some people become so tired and weak they have trouble doing everyday things. They may even need help with getting dressed or other routine tasks.

Cause

Cancer diagnosed as stage 4 will have spread to an organ or a part of the body away from the original tumor. For this to happen:

• Cancer cells break away from the tumor. They find their way into the bloodstream or, less often, the lymphatic system—a network that helps transport white blood cells and clear harmful substances from your system.
• Cells are carried in the blood or lymph fluid to another part of the body. They attach to the tissue there.
• Once they're attached, the cells grow while simultaneously fighting off the immune system.

The cancer's spread will often begin in the same region where the original cells were found. For example, breast cancer may spread to lymph nodes under the arm.

Common sites of cancer metastasis include:

• Lung cancer: Adrenal glands, bones, brain, liver, and the other lung
• Breast cancer: Bones, brain, liver, and lungs
• Prostate cancer: Adrenal glands, bone, liver, and lungs
• Colorectal cancer: Liver, lungs, and peritoneum (lining of the abdomen)
• Melanoma: Bones, brain, liver, lung, skin, and muscle

Diagnosis

Oncologists are doctors who specialize in diagnosing and treating cancer. Many of the same tests and procedures used to diagnose earlier stage cancers can be used to diagnose stage 4 cancer.

Biopsy

A small amount of tissue from the suspected area of spread is removed. This could be something like breast tissue or skin, or even bone marrow.

It is examined under a microscope for signs of abnormal cells.

Imaging Tests

Images make it possible to look inside the body in order to see a tumor. They help identify where and how large it is, and how it affects other organs and blood flow.

Tests used to diagnose cancer include:

• X-rays
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Ultrasound
• Positron emission tomography (PET) scan

Lab Tests

Many tests used to analyze blood, other body fluids, and biopsied tissues can be done to diagnose cancer.

Endoscopy

Endoscopy is a procedure in which a tube or wire with a small camera attached is used to look at and take pictures of internal organs.

Endoscopy might be used to diagnose some cancers, but not others. For example, it may be useful for colorectal cancer, but not lymphoma.

This procedure can also help guide a practitioner as they perform a biopsy.

Staging

Stage 4 cancer is the most advanced stage of cancer based on what is known as the TNM system. Each letter refers to specific features of a cancer:

• T refers to the size of the tumor and whether it has spread to nearby tissue or organs. The T rating ranges from 0 to 4.
• N refers to whether the cancer has spread to lymph nodes, the extent of which is scored from 0 to 3.
• M stands for metastasis. There are two M stages: M0 means there's no spread, while M1 means cancer cells have metastasized.

Some stage 4 cancers have sub-stages. For example, stage 4 prostate cancer may be labeled as stage 4A. This means it has spread to lymph nodes near the site.

Stage 4B means the spread is farther away, and the cancer may have reached bones or distant lymph nodes.

Treatment

Stage 4 cancer usually can't be cured. In addition, because it will have spread throughout the body, it is unlikely it can be completely removed.

The goal of treatment is to prolong survival and improve quality of life.

An oncologist will treat the cancer depending on its type, where it has spread, and other factors. Some of the options include surgery, medication, and

Surgery

Surgery typically is not used to treat stage 4 cancer. However, if the sites of spread are small and there aren't very many of them, they can be removed along with the primary tumor.

Surgery may relieve symptoms and help prevent the cancer from spreading even more.

Targeted Therapy

Some cancer cells can be treated with medications that target specific proteins or genetic mutations.

These drugs work in different ways. For example, some help starve a tumor of its blood supply, while others block signals that prompt cancer cells to divide.

Testing can determine whether your tumor could respond to any of the available drugs.

Immunotherapy

This treatment relies on drugs that use your immune system, including blood proteins called antibodies, to attack tumor cells.

Immunotherapy drugs exist for many types of cancer, including bladder, breast, colon and rectum, kidney, liver, lung, and blood (leukemia, lymphoma, and multiple myeloma).

HIPEC

Hyperthermic intraperitoneal chemotherapy, or HIPEC for short, is a procedure sometimes used after surgery for stage 4 cancer that has spread to the lining of the abdomen. A heated chemotherapy solution is used to bathe the tissue.

HIPEC has been shown to improve survival and extend life by as much as 60%.

Palliative Care

The goal of palliative care for stage 4 cancer is to improve quality of life. It is provided by a team of healthcare providers and social workers who work with seriously ill patients.

It is not hospice or end-of-life care. Rather, palliative care is designed to relieve pain, ease stress, and help a person with advanced cancer feel as comfortable as possible.

Radiation therapy used to shrink a tumor that is causing pain or interfering with how well the body functions is an example of a palliative therapy.

Care may also include counseling to help people manage mental and emotional issues that arise with chronic or life-threatening illness.

Prognosis

Once you're diagnosed with stage 4 cancer, you will always have stage 4 cancer. That may not mean that you'll always be sick or that the cancer will kill you.

In most cases, how stage 4 cancer is likely to progress (its prognosis) depends on the type of cancer.

Some advanced cancers are very aggressive and fast-growing. Some may have fewer treatment options than others. The outlook for these cases is not likely to be positive.

However, remember that although stage 4 cancer can't be cured, it isn't necessarily terminal—which suggests the end of life is near.

Survival Rates

One aspect of the prognosis for advanced cancer is called relative survival rate. This refers to the percentage of people with a certain diagnosis who are likely to live a specific amount of time.

The rates for advanced cancers are based on statistics published in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database.

SEER does not use TNM to classify cancers. Instead, it uses three stages—localized, regional, and distant—with "distant" generally meaning the same thing as stage 4.

It refers to cancer that has spread beyond the original site, or nearby tissue or lymph nodes.

For most types of cancer, SEER uses five-year survival rates.

Other factors that affect the prognosis for stage 4 cancer include age, overall health, smoking history, and performance status (PS).

PS is how well a person is able to perform everyday tasks. It's based on a classification system that uses a scale of 0 to 5.

Remission

It doesn't happen often, but some cancers can go into remission even if they are stage 4. Breast cancer is one such example.

Remission is when the signs and symptoms of cancer have gone away to the point where doctors declare the patient successfully treated.

Remission rates for stage 4 cancer vary. Even if a stage 4 cancer patient goes into remission, the cancer will probably come back. In cases like these, the stage 4 remission may instead be termed no evidence of disease (NED).

Summary

Stage 4 cancer, sometimes called advanced cancer or late-stage cancer, is cancer that has metastasized (spread) to other parts of the body from the original site. This happens when cancer cells break away from the primary tumor and enter the bloodstream or lymphatic system.

Symptoms of stage 4 cancer mainly depend on which organs are affected, though there may be no symptoms at all.

The prognosis for stage 4 cancer, often described in terms of survival rate, typically is not good. However, it does vary among different types of cancer. The treatment goal is not to cure stage 4 cancer, but to ease symptoms, improve quality of life, and try to keep it from progressing.

A Word From Verywell

Survival rates for some cancers are low, but they are improving. For instance, compared to breast cancer average life expectancy statistics of the 1980s, those after 2010 nearly doubled.

With next-generation targeted therapies and immunotherapies, those gains are likely to continue.