What Is Stage 4 Cancer?
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Medically reviewed by Marla Anderson, MD
Stage 4 cancer is the final stage of cancer. Cancer staging is a tool to determine how advanced a case of cancer is and how far it has spread. The stages range from 0 to 4. Stage 4 cancer is also referred to as metastatic cancer because it has spread (metastasized) to distant areas of the body from where it started.
Stage 4 cancer is the most advanced stage of cancer, and a cure is usually not possible. The goal of stage 4 cancer treatment is often to focus on quality of life and relieving symptoms and pain. There are cancer treatments available to stop or slow the growth of stage 4 cancer.
It is possible to live for years with stage 4 cancer. The symptoms vary depending on the type of cancer. An oncologist (a medical doctor who specializes in the diagnosis and treatment of cancer) may treat stage 4 cancer with chemotherapy, radiation therapy, targeted therapy, and immunotherapy, as well as palliative care.
The Cancer Stages
Cancer staging is an important tool that oncologists and their teams use to determine how advanced a case of cancer is. The stage is determined by several tests, including a physical exam, medical history, imaging studies, blood tests, and other tests.
The American Joint Committee on Cancer (AJCC) developed the TNM staging system to determine how advanced cancer is by evaluating the following factors:
T for tumor: Measures the size and location of the tumor
N for nodes: Determines if cancer cells have spread to the lymph nodes (parts of your immune system that carry white blood cells around your body to help fight infection)
M for metastasis: Assesses if cancer cells have spread to other areas of the body
Cancer spreads by first growing into nearby tissue. It then moves through the walls of lymph nodes or blood vessels. From there, it can travel through the lymphatic system or bloodstream to distant areas of the body. This is what leads to metastasis and stage 4 cancer.
Once your healthcare team assesses your cancerous tumor and determines how far it has spread, they will assign a stage from 0 to 4. This number helps the team determine a treatment plan and prognosis for you. The cancer stages include:
Stage 0: Also called carcinoma in situ, abnormal cells are present but have not spread.
Stage 1: Cancer is present but has not grown into nearby tissues.
Stage 2: Cancer is present and has grown into nearby tissues. It may have spread to the lymph nodes as well.
Stage 3: Cancer is present and has grown into nearby tissues. It may have spread to the lymph nodes as well.
Stage 4: Cancer has spread to distant areas of the body.
Common Types of Stage 4 Cancer
Any type of cancer can advance to stage 4 but certain types are more aggressive and more likely to spread. In addition, cancer can spread to any area of the body, but more common areas include the bones, liver, and lungs.
Some common types of stage 4 cancer (and where they typically spread) include:
Lung cancer: May spread to the adrenal glands, bones, brain, and liver
Colon cancer: May spread to the liver, lungs, and peritoneum (the membrane that lines the abdominal cavity)
Pancreatic cancer: May spread to the liver, lungs, and peritoneum
Breast cancer: May spread to the bones, brain, liver, and lungs
Prostate cancer: May spread to the adrenal glands, bones, liver, and lungs
Uterine cancer: May spread to the bones, liver, lungs, peritoneum, and vagina
Melanoma: May spread to the bones, brain, liver, lungs, skin, and muscle
Symptoms
The symptoms of stage 4 cancer vary depending on where the cancer started and where it has spread. General symptoms of stage 4 cancer include:
Fatigue
Weakness
Pain
Unintentional weight loss
Other symptoms of stage 4 cancer depend on which areas of the body are affected. Symptoms by area of metastasis include:
Bones: Bone pain, fractures
Brain: Headaches, dizziness, nausea, trouble walking, confusion, seizures
Lungs: Shortness of breath, cough, chest pain, coughing up blood
Liver: Jaundice, swelling in the abdomen, pain, weight loss
How Is Stage 4 Cancer Diagnosed?
Your oncology team will use several different medical tests to diagnose stage 4 cancer. Diagnostic tests for stage 4 cancer include:
Blood tests: A complete blood count (CBC) can be used to measure the number of blood cells and tumor markers to detect cancer cells, as well as others
Biopsy: A tissue sample is taken and sent to the lab to look for cancer cells.
Endoscopy: A thin tube is inserted into the body to look at an internal organ.
X-ray: This is an imaging test that is used to view the bones or internal organs.
Magnetic resonance imaging (MRI): A test that uses strong magnets to take X-ray pictures at several angles.
Computed tomography (CT) scan: This is a radiation test used to locate the tumor and determine its size.
Positron emission tomography (PET) scan: This is a nuclear scan that locates cancer cells throughout the body and determines the spread
Treatments for Stage 4 Cancer
There are several treatment options available for stage 4 cancer. Your individual treatment plan will depend on your type of cancer, where it has spread, how advanced it is, your symptoms, and your overall health.
The goal of stage 4 cancer treatment is usually to stop or slow the growth of cancer. Treatment options may include:
Chemotherapy: Chemotherapy is a common treatment for stage 4 cancer. It refers to drugs that kill fast-growing cells, including cancer cells.
Radiation therapy: Your healthcare team may recommend radiation therapy to shrink tumors that are causing pain or troublesome symptoms.
Targeted therapy: Targeted therapy includes medications that target specific proteins or genetic mutations. This can slow the growth of cancer.
Immunotherapy: Immunotherapy works by boosting the immune system’s response to cancer cells.
Surgery: Surgery is not usually an option for stage 4 cancer. However, if it is possible to remove cancerous tumors that are causing uncomfortable symptoms, your healthcare team may recommend surgery. For example, a surgeon may remove lung tumors to make breathing easier.
Palliative Care
Palliative care is a type of treatment that focuses on improving your quality of life. The goal of palliative care is to extend and improve your life; it is not intended to cure cancer.
It is important to note that palliative care is not hospice or end-of-life care. It is possible to receive palliative care while undergoing other treatments meant to cure cancer.
Palliative care can be beneficial for people with stage 4 cancer. Treatment options depend on the type of cancer, how far it has spread, and which treatments have already been tried. One of the main goals of palliative care is to lessen or relieve pain.
Prognosis
In most cases, the prognosis for stage 4 cancer depends on the type of primary cancer. Primary cancer refers to where the cancer originated. For example, if cancer starts in the breast and then spreads to the bones and lungs, it is still considered breast cancer.
In addition to the stage of cancer, other factors that affect prognosis include:
Primary cancer
Cancer cell traits
Age
Overall health
Which cancer treatments have already been tried
One way to measure cancer prognosis is to determine the 5-year survival rate. This rate estimates the number of people who will survive five years past their diagnosis date. The 5-year survival rates for the following types of stage 4 cancer are:
Lung cancer: 9% for non-small cell lung cancer and 3% for small cell lung cancer
Colorectal cancer: 22%
Pancreatic cancer: 3%
Breast cancer: 31%
Prostate cancer: 34%
Uterine (endometrial) cancer: 18%
Melanoma: 35%
Coping
A stage 4 cancer diagnosis changes every area of your life. It is impossible to describe all of the emotions you are likely feeling right now. It is common to feel overwhelmed, angry, sad, and frightened. It is also possible to feel hopeful. No matter how you feel right now, know that it is normal.
Stage 4 cancer causes several major life changes and challenges. It is critical to have a strong support group around you. Your support team may include your family, friends, healthcare providers, and other community members.
Consider asking for support in the following areas:
Treatment decisions: It can be difficult to decide which treatment options to pursue. Talk with your healthcare team and loved ones about your treatment plan frequently.
Daily life: It is common to feel very tired and weak when you have stage 4 cancer. You may need help with activities of daily living such as dressing, bathing, and moving around.
Nutritional needs: You may feel too weak or nauseous to eat. Seek support from a dietitian to develop an eating plan. Ask friends or family members for help with preparing meals.
Family responsibilities: If you are caring for children or other family members, you will likely need help with caretaking, driving, and scheduling.
You may find yourself feeling very down and even hopeless at some point during your cancer journey. Seek out emotional and mental health support with:
Friends and family: If you feel comfortable, talk with your loved ones about how you’re feeling.
Mental health professional: Consider meeting with a therapist or counselor to work through your emotions and learn new coping skills.
Peer support group: You may find it helpful to talk with other people who have been diagnosed with stage 4 cancer.
Online support: There are several online options for reaching support groups and sharing your journey. The American Cancer Society is a good place to start.
A Quick Review
Stage 4 is the most advanced stage of cancer. It occurs when cancer cells spread to distant areas of the body from where they started. Stage 4 cancer is also referred to as metastatic cancer because it has spread (metastasized) to distant areas of the body.
In most cases, stage 4 cancer is not curable. The goal of treatment is usually to relieve pain and improve quality of life. Treatment options for stage 4 cancer may include chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
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