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Cancer-Stages

Cancer stages

Stage 4 cancer

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on August 25, 2021.

Stage 4 cancer, also known as stage 4 cancer, is a serious disease that requires immediate expert care. Patients who have been diagnosed with stage 4 cancer may consider getting a second opinion to confirm the diagnosis and explore treatment options. At Cancer Treatment Centers of America® (CTCA), we use a variety of tools, tests and procedures to confirm your stage 4 diagnosis, determine where your cancer may have spread and develop a comprehensive treatment plan designed specifically for you. Stage 4 cancer patients also may be eligible to participate in available clinical trials. Chat with us to set up an appointment with one of our cancer experts.

What is stage 4 cancer?

Stage 4 cancer is sometimes referred to as metastatic cancer, because it often means the cancer has spread from its origin to distant parts of the body. This stage may be diagnosed years after the initial cancer diagnosis and/or after the primary cancer has been treated or removed.

When a cancer metastasizes to a different part of the body, it is still defined by its original location. For instance, if breast cancer metastasizes to the brain, it is still considered breast cancer, not brain cancer. Many stage 4 cancers have subcategories, such as stage 4A or stage 4B, which are often determined by the degree to which the cancer has spread throughout the body.

Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:

  • The ratio of healthy blood cells to cancerous cells 
  • The degree to which lymph nodes, the liver or spleen may be swollen
  • Whether the cancer has resulted in blood disorders such as anemia

Stage 4 cancer is determined in the five most common cancers this way:

Stage 4 breast cancer

The cancer has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. Metastatic breast cancer most often spreads to the bones, brain, lungs and/or liver.

Learn more about breast cancer stages

Stage 4 lung cancer

The cancer has spread beyond the lungs or from one lung to the other. Metastatic lung cancer most often spreads to the adrenal glands, bones, brain and/or liver.

Learn more about lung cancer stages

Stage 4 prostate cancer

The cancer is found in other parts of the body, even after the prostate has been removed. Metastatic prostate cancer usually travels to the adrenal glands, liver, bones and/or lungs.

Learn more about prostate cancer stages

Stage 4 colorectal cancer

The cancer has spread to one or more organs that are not near the colon. Metastasized colorectal cancer most commonly spreads to the liver, lungs and/or bones.

Learn more about colorectal cancer stages

Stage 4 melanoma

The cancer cells have spread beyond the skin and local lymph nodes to distant lymph nodes, organs and/or other areas of skin. Metastasized melanoma may be found in the bones, brain, liver or lungs.

Learn more about melanoma stages

Staging and grading for stage 4 cancer

Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:

  • T (tumor), or the size of the original tumor
  • N (node), or whether the cancer is present in the lymph nodes
  • M (metastasis), or whether the cancer has spread to other parts of the body

Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Female reproductive system cancers, such as cervical cancer, are staged with a separate staging system created by the International Federation of Gynecology and Obstetrics (FIGO).

As your care team gathers information about your cancer for the purposes of staging, they may need to order several tests, including:

Your care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell your care team where your cancer is, but looking at the cancer cells specifically tell them how fast they are likely to grow—or what grade they are.

Grading is different from staging and is done for most, but not all, cancers.

Generally, tumors are low, intermediate or high grade. Low-grade tumors that look similar to normal cells tend to grow slowly. High-grade tumor cells look very different from normal tissue cells and tend to grow more rapidly.

Tumor grades tend to go from G1 (low) to G4 (high), but specific grading systems may be used depending on the cancer, so be sure to ask your care team if you have any questions along the way.

The grade of your cancer is part of how your cancer care team stages your cancer and determines your prognosis, or outlook.

Cancers of the central nervous system (CNS) are graded rather than staged. Grade 4 brain and spinal cancers are considered aggressive and fast-growing. Tumors that have spread to the CNS from another location in the body are much more common than primary brain or spinal column tumors.

Treatment options for stage 4 cancer

Stage 4 cancer is challenging to treat, but treatment options may help control the cancer and improve pain, other symptoms and quality of life. Systemic drug treatments, such as targeted therapy or chemotherapy, are common for stage 4 cancers.

Often, a clinical trial may be an option, offering new treatments to help you fight stage 4 cancer.

Below are the prevailing treatment options for the five most common cancers.

Treatment of stage 4 breast cancer: For cancer that has spread beyond the breast and nearby lymph nodes, systemic drug treatments are typically used. These include:

  • Hormone therapy
  • Targeted drugs
  • Chemotherapy
  • Immunotherapy

They may be used alone or in combination, and they may also be determined by the hormone receptor and the HER2 status of the cancer.

Surgery and radiation may be treatment options in specific cases to help improve symptoms caused by a growing tumor, not to get rid of the cancer. The tumor may be removed with surgery or shrunk by radiation therapy if, for example, it’s:

  • Blocking a blood vessel
  • Causing a wound
  • Affecting the spinal cord

Treatment of stage 4 lung cancer: In general, stage 4 lung cancer is also treated with systemic drug therapies.

Stage 4 lung cancer that has spread to one distant area (stage 4A) tends to be treated differently than lung cancer that has spread more widely. For stage 4A cancers, treatment tends to focus on the one site where the cancer has spread.

Surgery and/or radiation may be used to try to fully remove cancer from the distant site. From there, treatment may focus on the primary cancer site in the lung and possibly include chemotherapy, surgery or radiation, or some blend of these treatments.

More commonly, stage 4 lung cancer has spread widely, also called stage 4B. Since there are several gene mutations associated with lung cancer, your first step may be genetic testing.

If you have a genetic mutation that accounts for your lung cancer, your treatment may include a targeted drug that focuses on that specific mutation. Immunotherapy may also be given, as well as chemotherapy. Palliative care may be included in your treatment, too, if tumors are causing any symptoms.

Treatment of stage 4 prostate cancer: This cancer is typically treated with systemic drug therapy and/or radiation therapy. Treatments may include:

  • Hormone therapy
  • Hormone therapy combined with chemotherapy
  • Radiation therapy, possibly followed by hormone therapy

Surgery and/or radiation may also be used to treat specific symptoms, such as if the tumor is affecting how you urinate or causing bleeding. Prostate cancer that has spread to the bones may need specific treatment such as drugs to strengthen the bones or radiation that targets cancer in the bones.

Even at stage 4, the most appropriate treatment for some men who are older or have serious health problems may be observation or watchful waiting. Your care team would keep an eye on the cancer and how fast it’s growing and intervene with treatment if it reaches a certain size or begins to cause symptoms.

Treatment of stage 4 colorectal cancer: Surgery followed by chemotherapy may be a treatment option if the cancer has only spread to a few small areas in the lungs and/or liver.

For cancer that has spread to more places or that surgery cannot remove, chemotherapy may be used first in an attempt to shrink the tumors. If they’ve shrunk enough, your care team may be able to remove them with surgery, and then you may have more chemotherapy after surgery.

For stage 4 colon cancer that is widespread, chemotherapy and/or targeted therapies are the main treatments. If the cancer is causing specific symptoms or pressing on other organs, your care team may suggest surgery to treat that specific area and reduce symptoms.

Rectal cancer treatment for stage 4 cancer follows a similar pattern. For cancer that has only spread to a few, distinct areas in the liver or lungs, different combinations of chemotherapy, radiation and surgery may be used to try to shrink and remove the cancer. After surgery, it’s likely that you’ll have chemotherapy and/or radiation as adjuvant treatment.

Treatment of stage 4 melanoma: Options for a stage 4 melanoma that has spread to distant lymph nodes, other organs and/or other areas of the skin are the same as those for recurrent melanomas and for stage 3 melanoma that cannot be removed with surgery.

In general, targeted therapy and immunotherapy tend to be used before chemotherapy. Options for stage 4 melanoma may include:

  • Targeted therapy with oncolytic virus therapy, which includes injecting a virus to specifically break down cancer cells while leaving normal cells alone
  • Targeted therapy with one or several signal-transduction inhibitors, which are drugs that block communication between cancer cells, preventing cell division and causing cell death
  • Immunotherapy with one or several drugs that help strengthen your immune system to fight cancer cells
  • Chemotherapy to slow the growth of cancer cells or kill cancer cells Palliative therapy to decrease symptoms rather than remove cancer for curative purposes.
  • Palliative care may include surgery or radiation therapy for affected lymph nodes or tumors affecting the digestive system or brain

There may also be clinical trials assessing new treatments for stage 4 melanoma.

How to find support

With a stage 4 cancer diagnosis, getting the right support around you is key. Below are some ideas for where to begin in building your support system.

  • Your cancer care team: They are the hub of your cancer care and can serve as great resources. They know that your stress levels, nutrition and other medical issues all affect your cancer treatment. Ask open questions and let them know what you need, even if it’s services beyond what they provide. They can help make a referral for you or get you connected.
  • Counseling: Having time and space to process your feelings and emotions with a mental health professional may be a helpful way to manage the stress that comes with a stage 4 cancer diagnosis and treatment. Consider speaking with a counselor on your own, or with family or a partner, to explore how to manage this stressful time together.
  • Pain clinics and palliative care: Palliative care focuses on treating your symptoms rather than treating the disease. Symptoms of stage 4 cancer often include pain. Your treatment plan should include ways to help you be most comfortable, so speak with your care team about your pain and comfort levels. They may be able to provide additional services or refer you to specialized palliative care.
  • Look for support groups: If you have stage 4 cancer, you’re joining a host of others who are walking a similar path. You’re not alone, and participating in a support group may help you feel more connected and understood. The American Cancer Society has a tool to find local resources for cancer support in your area.

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