What Is Stage 4 Pancreatic Cancer?

When a person has stage 4 pancreatic cancer, it means that the cells that grew into a tumor in the pancreas have spread in the bloodstream. The cells start to make tumors in other parts of the body, such as the bones or lungs. This stage is also called metastatic pancreatic cancer.

Stage 4 pancreatic cancer cannot be cured. However, there are treatments that can help a person at this stage of cancer feel better (palliative care).

This article talks about the two types of pancreatic cancer. You will learn about the stages and symptoms of each. You will also learn about how doctors find and treat stage 4 pancreatic cancer, as well as some tips for coping with the disease.

The American Cancer Society stated that about 60,430 people would be diagnosed with pancreatic cancer in 2021. About 48,220 people were expected to die from this type of cancer.

More than half of the people diagnosed with pancreatic cancer find out late. They only learn that they have cancer after the cells have started to spread. This is called late-stage diagnosis. Most people will not live longer than five years after they get diagnosed. 

What Stage 4 Pancreatic Cancer Means

Doctors use stages when they talk about how cancer has grown or spread. Stage 4 is the last stage. It means that cancer cells have spread to other parts of the body. When this happens, cancer is called metastatic.

One way to stage cancer is called the TNM system. It has 3 parts:

• T (tumor): This part is based on how big a tumor is and where it has spread to. The T rating goes from T0 to T4. In stage 4 pancreatic cancer, the (first) primary tumor can have any T rating.
• N (lymph nodes): Lymph nodes help filter substances in the body. When cancer cells get to the lymph nodes, it's easier for them to spread. Stage 4 pancreatic cancer can have an N rating of N1 (cancer is in one to three regional lymph nodes) or N2 (cancer is in four or more regional lymph nodes).
• M (metastasis): Metastasis means cancer has spread to other organs and lymph nodes. There are only two M stages: M0 or M1. Any pancreatic cancer with an M1 rating is at stage 4. 

Your Stage vs. Your Diagnosis

If you have a stage 2 pancreatic tumor that spreads somewhere else in your body, you will have a stage 4 tumor. Your doctor might not write that in your medical record, though.

On paper, the stage of your cancer will always be what it was when you were diagnosed—even if it spreads. Doctors write it down this way because it helps them understand how your cancer is progressing as time goes on.

When the cancer changes, the stage might change. This is called re-staging. When this happens, the new stage will be added to the first one. Your doctor will put an "r" next to it when they write it.

Here is an example: If you have a stage 2 pancreatic tumor your doctor might have given it a T1, N1, M0 rating. If the tumor spreads but does not change in any other ways, your doctor would rate it as T1, N1, rM1.

This rating shows a doctor that a stage 2 tumor has spread to other parts of the body. When they see the rM1 for the rating, they will know the cancer is at stage 4.

Stage 4 Pancreatic Cancer Symptoms

One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.

The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.

Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:

• Blood clots: A blood clot is also called deep vein thrombosis (DVT). This condition is sometimes the first clue that a person has pancreatic cancer. A blood clot can cause pain, swelling, and redness wherever it is (for example, in a leg). 
• Jaundice: There is a substance in your body called bilirubin. It's found in a yellowish-colored fluid called bile that is in your liver. The liquid goes out through a tube called the bile duct. If a tumor presses on the tube, the bilirubin can get backed up. When this happens, a person can get yellow-colored eyes or skin. They might also have dark urine, light or greasy stools, and skin that feels itchy.
• Gallbladder or liver getting bigger (enlargement): Bile is also in your gallbladder. If it gets backed up, the gallbladder or liver might get bigger.
• Belly or back pain: Sometimes tumors press on other organs or nerves. When this happens, it can cause pain
• Weight loss and poor appetite: People who have cancer often do not feel hungry. They might feel sick and not want to eat. If they do not eat enough, they may lose weight.
• Nausea and vomiting: When a tumor presses on the stomach, it can make a person feel sick. They might also throw up.
  
• Diabetes: The cells that make insulin are in the pancreas. Your body needs insulin to keep your blood sugar levels normal. If cancer damages the pancreas, it might not be able to handle blood sugar levels. If this happens, a person may get diabetes.

Diagnosis

About 95% of pancreatic cancers come from the cells that make digestive enzymes. These are called pancreatic adenocarcinomas (PACs).

The other 5% come from the cells that help regulate blood sugar. They are called pancreatic neuroendocrine tumors (PNETs). People with this type of pancreatic cancer usually live longer. If the cancer does not spread to other parts of the body, about 93% of people will live at least five years after they are diagnosed.

To stage pancreatic cancers, doctors need to figure out how big the first tumor is and how far it has spread. There are different tests they can use to look for each type of cancer.

Blood Tests

Your doctor might start by looking at a sample of your blood. They will look for things like:

• High levels of an enzyme called amylase, which can be a sign of PAC
• Your levels of insulin, glucagon, and different peptides that are not normal, which can be signs of PNET
• Liver function tests, which can be used to see how cancer has affected your liver

There are also signs in your blood that can help a doctor understand the tumors you have. They are called tumor markers.

For example, people with pancreatic cancer who have lower levels of a tumor marker called CA 19-9 may live longer than people who have higher levels.

Imaging Tests

There are also tests that use machines to see inside your body. One is called computed tomography (CT) and another is magnetic resonance imaging (MRI). These tests can help your doctor look for a tumor. It can also show them if a tumor is pressing on your organs.

If you have pancreatic cancer your doctor might have you do these tests:

• A multiphase CT scan or a pancreatic protocol CT scan can help your doctor see the tumor.
• Ultrasound waves can help your doctor see more detail of the tumor. One kind of ultrasound can give them a very close look, but you need to have a tube put down your throat for it. It's called an endoscopic ultrasound.
• Angiography looks at the blood vessels around the pancreas and other organs in your abdomen. It can be done with X-rays or an MRI.
• Magnetic resonance cholangiopancreatography uses an MRI machine to look closely at the tubes in your liver (bile ducts) and pancreas (pancreatic ducts).
  

Procedures

Endoscopic retrograde cholangiopancreatography (ERCP) lets your doctor take pictures of the inside of your body. You will be asleep (under anesthesia) and they will put a special tube with a camera on it down your throat and into your stomach.

The tube can also help your doctor take out small pieces of tissue to look at with a microscope. This is called a biopsy which can help doctors diagnose cancer.

There are also other helpful things your doctor can do for you during this procedure. For example, if you have a blocked bile duct, your doctor can put a tube called a stent in your body to let the fluid drain out.

Treatment

Stage 4 pancreatic cancer cannot be cured. There are different choices a person can make about treatment at this point, but they are all focused on helping them feel better.

Some people will have surgery. Other people might have cancer treatment like chemotherapy and radiation. There are also new types of treatment that some people may try.

Surgery

People with cancer may have surgery to take the tumors out. With stage 4 cancer, the cells have spread too much and it would not be possible to take them all out. However, a person with stage 4 pancreatic cancer may still have surgery to improve their symptoms.

There are a few types of surgery for pancreatic cancer, including:

• Whipple surgery: The surgeon takes off the head of the pancreas, the gallbladder, and parts of the stomach and small intestine.
• Total pancreatectomy: The surgeon takes out the whole pancreas, the gallbladder, the bile duct, the spleen, parts of the stomach, and the small intestine. They will also take out any lymph nodes that are near these organs.
• Distal pancreatectomy: The surgeon takes out the body and tail of the pancreas. If the tumor is pressing on the spleen, they might take the spleen out too.
• Biliary or gastric bypass: The surgeon changes the path of the digestive tract to go around a part the tumor is blocking. Doing this can help make a person feel better because food can move through their body more easily.
• Stent placement: The surgeon puts a special tube (stent) in the body to drain fluids that have gotten backed up. It often happens in the bile ducts or a part of the small intestine called the duodenum.

Chemotherapy

Chemotherapy or "chemo" is a treatment that kills cancer cells with toxic chemicals. It also kills other types of cells that are not cancer, like your skin and hair cells. That's why some people lose their hair when they are having chemo.

There are different types of chemotherapy drugs that are used to treat pancreatic cancer, including:

• Gemzar (gemcitabine)
• Abraxane (albumin-bound paclitaxel)
• 5-Fluorouracil
• Oxaliplatin
• Irinotecan

Radiation 

Radiation therapy kills cancer cells with beams of energy. The beams can be directed to a certain place from inside the body using an implant. Radiation can also be done from the outside of the body.

Doctors may use chemotherapy and radiation at the same time to make a tumor smaller. Just like with chemo, radiation can have side effects, like hair loss and skin changes.

Immunotherapies 

Immunotherapies help the immune system fight cancer. The different types of immunotherapy treatments help in their own way.

For example, some cancer cells have a protein that allows them to trick the immune system into leaving them alone. If the immune system is ignoring them, they can keep growing. A treatment called Keytruda (pembrolizumab) is a monoclonal antibody. It "exposes" the cancer cells and helps the immune system attack them. Once that happens, the cells will stop growing.

Immunotherapy can work well for some people with cancer, but it does not work for others. It is not used for very many people with pancreatic cancer. Only about 1% of them have the genetic changes that these treatments target. The treatment would not help the people who do not have those changes.

Doctors do not always look at the genes of people with pancreatic cancer. However, if someone has many people in their family who have had pancreatic cancer, they might get their genes tested to see if they have familial pancreatic cancer (FPC).

Targeted Therapies 

Targeted therapies only aim at cancer cells. Some only target pancreatic adenocarcinomas. These treatments stop an enzyme called tyrosine kinase from working. This can slow cancer's growth.

Examples of these therapies include:

• Lynparza (olaparib)
• Rozlytrek (entrectinib)
• Tarceva (erlotinib)
• VitrakviI (larotrectinib)

Clinical Trials

Researchers test new drugs and treatments through clinical trials. The tests add to what is already known about treating the disease. The scientists take what they learn and try to find new ways to help people live longer or better in the future.

You have to meet certain criteria to join a clinical trial. If you are approved, you may have a chance to try a new treatment that you would not normally be able to get. Since they are still being tested, it's possible that they will not work. But it's also possible that they will.

You can ask your doctor if there are any clinical trials that you might be able to be part of. You can also look at the National Cancer Institute’s clinical trial database and other national databases together.

Palliative Care

People living with stage 4 pancreatic will also work with a palliative care team. Doctors, nurses, social workers, and other healthcare providers work together to help people who are very sick with cancer feel better.

These treatments can help a person with cancer feel less stressed. They can also help a person manage pain and other symptoms. This might include having a treatment like radiation to make a tumor smaller. Sometimes, surgery can be done to cut the nerves to the pancreas to help a person not feel pain.

Palliative care is about helping a person living with cancer feel better. It's not the same as hospice or end-of-life care. Those treatments only happen in the last six months of a person's life. A person can have palliative care at any time during their illness.

Prognosis

Survival rates help healthcare providers estimate how long a person with a diagnosis will live. They make these guesses based on how well other people with the same diagnosis have done.

The cancer-specific survival rate is the percentage of people with a type of cancer who survived until a set time. The NCI’s Surveillance, Epidemiology, and End Results (SEER) Program database include cancer survival statistics from 19 states.

The SEER database does not use the TNM staging system. It uses a 3-stage approach. Stage 4 cancer is classified as cancer that has spread to other parts of the body far from where the first tumor was. It can also be called "distant" cancer.

How Long Will I Live With Stage 4 Pancreatic Cancer?

Stage 4 pancreatic cancer does not have many treatment options. Even with treatment, most people do not live for more than a year or two.

Based on SEER’s data, the five-year survival rate for people diagnosed with distant pancreatic cancer is 3%. That means 3% of people with metastatic pancreatic cancer are alive five years after they are diagnosed.

The number changes based on age. People who are diagnosed when they are younger are more likely to live longer. For example, someone who is 50 years old when they are diagnosed with distant pancreatic adenocarcinoma has a 10.5% chance of surviving at least five more years.

Here's a table that shows the survival rates for PACs.

PNET has an overall five-year survival rate of 51.3%.

• The five-year survival rate for people with PNET that has not spread to other parts of the body is 93%.
• If the tumor has spread to nearby tissue or the regional lymph nodes, the five-year survival rate is 77%.
• If the tumor has spread to distant areas of the body, the survival rate is 25%.

Survival rates depend on different factors. For example, if the tumor can be taken out with surgery, a person might be more likely to live longer.

The numbers are not a sure thing. Some people live much longer than the estimates say. The rates are also figured out using numbers from several years ago—even a decade ago. In the meantime, there might have been discoveries or inventions that can help people with cancer live longer.

Coping

If you are diagnosed with stage 4 pancreatic cancer, hearing that it has a 3% survival rate can be devastating. Living with cancer day-to-day is often hard and can be scary. You will need to find ways to take care of yourself and cope with the challenges.

What each person with cancer wants and needs will be different. If you are not sure where to start, here are a few things that you can think about:

• Ask your palliative care team about how you can manage pain.
• Talk to a mental health professional about how you are feeling.
• Find foods that you enjoy and that nourish your body. Some people with pancreatic cancer have a hard time digesting food. It might help to take a digestive enzyme supplement. Staying as active as you can, even with gentle exercise, can also be helpful.
• Keep track of how easy or hard it is for you to do daily tasks. This is called your performance status. Your doctor will use the rating to get a sense of how you are feeling and how long you will live.
• Make sure that your doctors and loved ones know about your wishes for end-of-life care. Talk with your loved ones about what life will be like after you die. This can include writing a will if you don't already have one.
• Spend time with your family and friends. Do things that you love and that make you happy.

You and your loved ones are not alone. You can also reach out to your community and beyond for support.

• Join support groups to share experiences and information about pancreatic cancer.
• Look for financial resources, such as insurance assistance, co-pay waivers, or help with housing.
• Ask pharmaceutical companies if they have programs to help people pay for medication (for example, AstraZeneca’s Access 360 program for Lynparza).

Summary

Stage 4 pancreatic cancer is a very serious illness. It means that cancer has spread to other organs and cannot be cured.

People with stage 4 cancer might choose treatments that can help make the pain or other symptoms better. This is called palliative care. It can include surgery, medication, and treatments like chemo or radiation.

Most people do not live longer than five years after they are diagnosed. However, depending on their age and the type of cancer they have, they might live longer.

A Word From Verywell

If you are told that you have stage 4 cancer, having to make choices about your care might be overwhelming. Know that you are not alone. Your doctor will talk with you about your options and help you understand what they will be like.

Talking to your loved ones about your wishes and plans for life after you die is part of coping with cancer. It's also a time for just being with your friends and family, focusing on things that make you happy.

You can also get support from your local community or even online. The Internet can let you connect with other people who are living with cancer. They may think or worry about a lot of the same things that you do. A mental health professional can also listen and help you cope with your feelings.