Stage 4 Pancreatic Cancer Survival Rates

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Stage 4 pancreatic cancer is the most advanced stage of the disease where the cancer has metastasized to distant sites in the body. The pancreas is an organ in the abdomen that helps the body digest and use the energy that comes from food. Pancreatic cancer occurs when cells in the pancreas grow out of control. There were an estimated 57,600 new cases of pancreatic cancer in 2020, and 52% of the cases were found in stage 4. Because the signs and symptoms of pancreatic cancer take so long to appear in those with the disease, the majority of cases are diagnosed in the later stages.

Although the five-year survival rate for stage 4 pancreatic cancer is low, data have shown that it has been increasing since 2015. It is hoped that new targeted drug therapies and immunotherapies will further raise the five-year survival rate.

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Survival Rates

The relative five-year relative survival rate for stage 4 pancreatic cancer is 2.9%. This means that those with stage 4 pancreatic cancer have a 2.9% chance of being alive five years after their diagnosis. The survival rates are typically estimated based on epidemiological data collected by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. Cancer is generally categorized into one of three stages according to the SEER program:

  • Localized: Cancer is found only in the part of the body where it started 
  • Regional: Cancer has spread to nearby lymph nodes and organs
  • Distant: Cancer has spread to distant lymph nodes and organs

Stage 4 pancreatic cancer would fall under the category of distant.

Pancreatic Cancer Stages
 Stage % of Cases by Stage Relative 5-year survival rate 
Localized  11% 39.4% 
Regional   30%   13.3%
Distant   52%  2.9% 

The Limitations of Survival Rates

Survival rates are estimates and are based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. They also don’t take into account multiple factors that could play a role in survival such as age, overall health, and how well a person's cancer responds to treatment.

Factors That Influence Survival

A prognosis is a prediction made at diagnosis of how the disease will progress. The prognosis for every case of cancer is different and is affected by many factors not reflected in the SEER statistics. Chief among them is the stage and type of cancer, but other factors can also contribute.

Cancer Staging

Cancer is most commonly staged using the TNM system. The overall stage is determined after the cancer is assigned a letter or number to describe the tumor (T), node (N), and metastasis (M) categories:

  • T: The size and extent of the main or primary tumor
  • N: The number of lymph nodes that the cancer has infiltrated
  • M: Whether or not the cancer has spread to other parts of the body

The TNM system helps doctors determine how much cancer there is and where it is to develop an appropriate course of treatment. It is used by doctors to stage different types of cancer based on a set of common standards, while the SEER system is used for survival estimates.

Most cancers have four stages. Stage 1 refers to cancers that have not spread and are small. Stages 2 or 3 are cancers that are larger and have spread to nearby lymph nodes, and stage 4 is when the cancer has spread to distant parts of the body. At stage 4, the cancer has spread to other organs within the body, most typically the lungs and the liver.

For those with stage 4 pancreatic cancer, the best course of treatment is management to help alleviate and control symptoms. Typically, doctors will recommend chemotherapy as well as palliative care. Palliative care focuses on improving the quality of life for those with a serious disease and can take place alongside curative treatment.

Tumor Type

Two types of tumors are commonly found in pancreatic cancer. The first is exocrine tumor, which accounts for roughly 93% of pancreatic cancer tumors. They start in the exocrine cells of the pancreas, which produce enzymes that help with digestion. Adenocarcinoma is an exocrine tumor and is the most common type of pancreatic cancer. About nine out of 10 people with pancreatic cancer have adenocarcinoma.

Pancreatic neuroendocrine tumors (PNETs), also called islet cell tumors, are slower-growing than exocrine tumors, and begin from abnormal growth of islet cells, which make the hormones insulin and glucagon to control blood sugar levels. People with PNETs survive longer than those with exocrine tumors.


Research has shown that adults under 60 years old who underwent resection of their tumors had a longer than those who are older. Age at diagnosis has also been found to be a significant prognostic factor in pancreatic cancer. In one study, the five-year survival of patients who were 20 to 40 years old was almost three times that of patients who were over 40. The mortality risk of pancreatic cancer patients who were 40 to 80 years old was twice that of patients aged under 40, while those who were 80 years old and over had a mortality risk three times that of patients under 40.

Performance Status

A person’s performance status is determined by their ability to carry on with their day-to-day life while living with cancer. It measures how well they perform specific daily duties. It provides a picture of what treatments may be viable and tolerable. Research has also found it to be an important prognostic indicator in pancreatic cancer.

Using the ECOG scale, a performance status can be categorized into six grades:

  • Zero: Fully active and able to carry on with life in a normal way without restriction from the disease
  • One: Somewhat restricted when participating in strenuous activities, but can continue on with light or sedentary activities
  • Two: Can take care of themselves, but cannot work. Could perform tasks 50% of the time
  • Three: Confined to a bed or chair 50% of the time and limited in self-care abilities
  • Four: Disabled and confined to a bed or chair and cannot practice any self-care activities
  • Five: Dead

One study found that severe weight loss, large tumor diameter, and especially metastatic disease were associated with significantly shorter overall survival in pancreatic cancer patients who had a poor performance status.


Surgery is, in general, not pursued in stage 4 pancreatic cancer because cancer has spread to other parts of the body. Although perioperative survival tends to be low, surgery can sometimes improve survival times for these people. This is most especially true with left-side pancreas cancer.

Adjuvant therapy with chemotherapy alongside surgery has also been shown to be effective in increasing chances of survival for people with pancreatic cancer. In one study, metastatic-stage patients with stable or partial response to chemotherapy had an increased overall survival, as did surgical patients with localized disease who received adjuvant treatment.

Biliary Drainage

People with pancreatic cancer may experience certain complications. One is the obstruction of the biliary system. The biliary system is a collection of ducts and organs that produces, stores, secretes, and transports bile, which helps with food digestion. When an obstruction occurs because of a tumor, a person will need biliary drainage to remove the blockage.

Biliary drainage can be helpful in improving survival rate in those with metastatic pancreatic cancer because it can alleviate jaundice. If jaundice is not treated, it can lead to inability to absorb nutrients and cholestasis. Biliary drainage decreases the risk of developing these conditions.

Advances in Treatment

There have been some advances in treatment options in recent years that may help those with stage 4 pancreatic cancer live longer and experience fewer symptoms of their disease. New chemotherapy drugs Abraxane (nab-paclitaxel) and Gemzar (gemcitabine) have been shown to improve survival rates in those with pancreatic cancer that has become metastatic.

FOLFIRINOX, a combination drug made up of four different medications, has also been shown to be more effective against stage 4 pancreatic cancer than conventional therapies.

Lynparza (olaparib) is a PARP inhibitor, a type of medication designed to block certain enzymes in cells that repair damaged DNA. This is used in the treatment of pancreatic cancer because when the medication blocks these enzymes, it can hinder the cancer cells' ability to repair themselves. It is especially useful for those with BRCA1 and BRCA2 mutations. These two genes make proteins that repair damaged DNA, and when someone inherits a mutated version of these genes, it can increase their risk for developing certain cancers such as pancreatic cancer.

Another type of medication known as a TRK inhibitor has been shown to be useful in those with tumors affected by gene fusions involving neurotrophic tyrosine receptor kinases, or NTRK. These specific gene fusions are rare, but the use of TRK inhibitors such as Larotrectinib and Entrectinib has sparked interest because of their possible treatment applications.

Other types of medications like those that inhibit the RAS gene are undergoing rigorous investigation to help those with stage 4 pancreatic cancer. When any members of the RAS gene family become mutated, they can cause cells to grow uncontrollably in the body, including cancer cells. The hope is that medications that inhibit this gene can significantly slow the growth of pancreatic tumors.


The physical and emotional toll that stage 4 pancreatic cancer can take can be hard to bear. There will be side effects to contend with for each treatment option. Make note of any changes in your symptoms, whether they are improving or worsening, while undergoing treatment, and speak with your healthcare professional about them. They may be able to tweak your treatment plan to minimize these effects and provide options for symptom relief.

Pancreatic cancer often causes weight loss and weakness from poor nutrition. These symptoms may be caused by treatment or by the cancer itself. A team of doctors and nutritionists can work with you to provide nutritional supplements and information about your individual nutritional needs. This can help you keep up your weight and nutritional intake. 

The emotional aspect of a cancer diagnosis is often overlooked, but studies have shown that it can play a role in the overall outcome. By being chronically stressed, certain signaling pathways in cancer cells become activated and can increase tumor growth. This small but important effect can be mitigated by managing stress levels through activities such as yoga or meditation or making time for yourself to participate in something you enjoy doing.

Another way to cope with stress is by talking to someone. The Pancreatic Cancer Action Network offers a database of support groups that are available. You can connect with others who have gone through similar experiences and share your own.

Lifestyle Recommendations

The pancreas is an important organ for digestion and blood sugar regulation, and because of this, it's important for people with pancreatic cancer to eat a health diet. This means eating a diet rich in whole foods, fruits, and vegetables. By eating foods that are rich in nutrients and easy for the body to digest, you can improve your quality of life while minimizing the side effects that come with treatment.

Specific foods that should be avoided include:

  • High-fat meats, cheeses, and milk products
  • Fried foods
  • Spicy foods
  • Simple carbohydrates
  • High-fiber foods
  • Caffeinated beverages

Eating smaller meals more frequently throughout the day may help improve your body’s ability to digest. Drinking plenty of fluids can improve your appetite, and letting your food cool to room temperature can aid in digestion.

A Word From Verywell

Stage 4 pancreatic cancer is a serious diagnosis, but thanks to science and medicine, there are now many treatment options that can help you manage your condition and help you live longer and better. There are many other things you can do to improve your quality of life, such as seeking support from a support group and eating a healthy diet to manage your symptoms. People such as Alex Trebek and Patrick Swayze, who both survived for well over a year after their diagnosis. You can seek out clinical trials since they may be able to offer a new treatment option that is not yet available and may work well for you.

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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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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.