Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisCancer StagingTreatmentPalliative CarePrognosisFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Cancer Staging
Treatment
Palliative Care
Prognosis
Frequently Asked Questions
Stage 4 cancer is the most advanced stage, meaningcancerhas spread to other parts of the body. You may be able to live for years with stage 4 cancer, but the prognosis often isn’t good. Rather than focusing on curing the cancer, treatments work to slow or stop growth, relieve symptoms, and help you live longer and enjoy a high quality of life.
When cancer spreads to organs away from the original tumor site, it’s said tometastasize. That’s why stage 4 cancer is also calledmetastaticcancer.
This article gives an overview of stage 4 cancer. It explains what it is, how it’s diagnosed, possible treatment options, and what you should know about survival rates.
Verywell / Julie Bang
Stage 4 Cancer Symptoms
The symptoms of metastatic cancer depend on thetype of cancerand, more importantly, where the metastases have occurred.In some cases, there are no symptoms at all, so it’s possible to have stage 4 cancer and not know it.
Most of the time, a cancer that reaches stage 4 affects not only the part of the body where it originated but the areas where 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.
Hearing your healthcare provider call a liver tumor “breast cancer” may sound strange. But stage 4 cancer is diagnosed based on where the original cancer is located,notwhere it has spread. So, breast cancer that has spread to the liver will be called stage 4 breast cancer withliver metastasis—not stage 4 liver cancer.
Cancer diagnosed as stage 4 has spread to an organ or a part of the body away from the original tumor. For this to happen:
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 ways that cancer metastasizes include:
Stage 4 Cancer and the LungsBecause cancer cells that break away from the original tumor travel through the body via the bloodstream, the lungs are a common site of metastasis since blood always filters through the lungs.
Stage 4 Cancer and the Lungs
Because cancer cells that break away from the original tumor travel through the body via the bloodstream, the lungs are a common site of metastasis since blood always filters through the lungs.
Diagnosing Stage 4 Cancer
Oncologistsare 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, skin, or even bone marrow.
It is examined under a microscope for signs of abnormal cells.
What Cancer Looks Like Under a Microscope
Imaging Tests
Images make it possible to view the inside of the body to check a tumor. They help to identify where it is, how large it is, and how it’s affecting other organs and blood flow.
Tests used to diagnose cancer include:
Lab Tests
Many tests that are run to analyze blood, other body fluids, and biopsied tissues can be used to diagnose cancer.
Endoscopy
Endoscopyis a procedure in which a tube or wire with a small camera attached is used to look at and take pictures of internal organs.
This procedure can also help guide a practitioner as they perform a biopsy.
Different Types of Endoscopy
Stage 4 cancer is the most advanced stage of cancer based on what is known as the TNM system in which aspects of the cancer are graded on a numerical scale.The letters T, N, and M refer to specific features of a cancer:
Taken together, the TNM score will help you and your healthcare team to understand how the cancer has progressed and what treatment options are available.
An M score of 1 automatically classifies cancer as stage 4. Still, prognosis of an M1 case varies depending on the T and N classifications of the cancer.
Substages
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.
The goal of treatment is to prolong survival and improve your 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 (targeted therapy), immunotherapy, and chemotherapy.
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. In these instances, 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 targeted therapy drugs.
Immunotherapy
Immunotherapy 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).
How Immunotherapy Works for Cancer
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 to cope with symptoms.
Palliative care may be used in stage 4 cancer pain management. One example might be the use of radiation therapy to shrink a tumor that’s causing pain or interfering with body functions.
This type of care may also include counseling to help people manage mental and emotional issues that arise with chronic or life-threatening illnesses.
How Palliative Care Is Used in Cancer
Stage 4 Prognosis
In many cases, stage 4 cancer can’t be cured. However, this is not true of all cancers. Stage 4 testicular cancer, for example, is highly curable. Lymphomas are highly curable regardless of stage.
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 even when stage 4 cancer can’t be cured, it isn’t necessarily terminal—in other words, it doesn’t necessarily mean that the end of life is near.
People with stage 4 cancer often live many years after diagnosis, which is why it’s more accurate to describe it as “advanced” or “late-stage.”
Survival Rates
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 far beyond the original site.
Five-Year Survival Rates for Distant (Stage 4) CancerCancer TypeRelative 5-Year Survival RateLeukemia65.7%Non-Hodgkin lymphoma63.9%Thyroid53.3%Prostate32.3%Melanoma (skin)31.9%Breast (female)30.0%Uterine (endometrial)18.4%Kidney, renal pelvic15.3%Colon and rectal15.1%Bladder7.7%Lung and bronchus7.0%Pancreatic3.1%* Lymphoma and leukemia are staged differently from other cancers. The non-Hodgkin lymphoma number is the stage 4 survival while the leukemia number refers to the five-year survival rate at any stage.Other factors that affect the prognosis for stage 4 cancer include age, overall health, smoking history, andperformance 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.RemissionIt 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 has been 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 termedno evidence of disease (NED).SummaryStage 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.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.Frequently Asked QuestionsStage 4 cancer is usually considered incurable.However, there are treatment options that can help to prolong survival and improve your quality of life.Learn MoreHow Can You Prevent Cancer?Stage 4liver canceris also known as distant liver cancer, which means it’s spread to other organs and lymph nodes. The five-year survival rate is 2.7% for men and 4.2% for women.Learn MoreWhat You Should Know About Stage 4 Liver CancerLung and bronchus cancer cause the most deaths each year.This is partially due to the fact that people often are not diagnosed with the disease until it is already at an advanced stage.Learn MoreThe 5 Most Deadly Cancers
Other factors that affect the prognosis for stage 4 cancer include age, overall health, smoking history, andperformance 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 has been 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 termedno 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.
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.
Frequently Asked QuestionsStage 4 cancer is usually considered incurable.However, there are treatment options that can help to prolong survival and improve your quality of life.Learn MoreHow Can You Prevent Cancer?Stage 4liver canceris also known as distant liver cancer, which means it’s spread to other organs and lymph nodes. The five-year survival rate is 2.7% for men and 4.2% for women.Learn MoreWhat You Should Know About Stage 4 Liver CancerLung and bronchus cancer cause the most deaths each year.This is partially due to the fact that people often are not diagnosed with the disease until it is already at an advanced stage.Learn MoreThe 5 Most Deadly Cancers
Stage 4 cancer is usually considered incurable.However, there are treatment options that can help to prolong survival and improve your quality of life.Learn MoreHow Can You Prevent Cancer?
Stage 4 cancer is usually considered incurable.However, there are treatment options that can help to prolong survival and improve your quality of life.
Learn MoreHow Can You Prevent Cancer?
Stage 4liver canceris also known as distant liver cancer, which means it’s spread to other organs and lymph nodes. The five-year survival rate is 2.7% for men and 4.2% for women.Learn MoreWhat You Should Know About Stage 4 Liver Cancer
Stage 4liver canceris also known as distant liver cancer, which means it’s spread to other organs and lymph nodes. The five-year survival rate is 2.7% for men and 4.2% for women.
Learn MoreWhat You Should Know About Stage 4 Liver Cancer
Lung and bronchus cancer cause the most deaths each year.This is partially due to the fact that people often are not diagnosed with the disease until it is already at an advanced stage.Learn MoreThe 5 Most Deadly Cancers
Lung and bronchus cancer cause the most deaths each year.This is partially due to the fact that people often are not diagnosed with the disease until it is already at an advanced stage.
Learn MoreThe 5 Most Deadly Cancers
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Cancer Institute.Metastatic cancer: When cancer spreads.
American Cancer Society.Cancer-related fatigue.
American Cancer Society.Cancer staging.
National Cancer Institute.Stage IV prostate cancer.
Cancer Treatment Centers of America.Cancer stages.
Bishop AJ, Ensor J, Moulder SL, et al.Prognosis for patients with metastatic breast cancer who achieve a no-evidence-of-disease status after systemic or local therapy.Cancer. 2015;121(24):4324-4332. doi:10.1002/cncr.29681
National Cancer Institute.Palliative care in cancer.
National Cancer Institute.Surveillance, Epidemiology, and End Results Program.
National Cancer Institute.Understanding cancer prognosis.
Eastern Cooperative Oncology Group.ECOG performance status.
National Cancer Institute.Remission.
Caswell-Jin JL, Plevritis SK, Tian L, et al.Change in survival in metastatic breast cancer with treatment advances: Meta-analysis and systematic review.JNCI Cancer Spectr. 2018;2(4):pky062. doi:10.1093/jncics/pky062
American Cancer Society.Understanding advanced and metastatic cancer.
National Cancer Institute.Cancer stat facts: Common cancer sites.
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