Stage 4 Pancreatic Cancer

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Stage 4 pancreatic cancer, also known as metastatic pancreatic cancer, is an advanced form of cancer that starts in the pancreas. Metastatic cancer means that the cancerous cells have spread from the pancreas to other areas of the body.

What Is Stage 4 Pancreatic Cancer?

Doctors typically use the American Joint Committee on Cancer (AJCC) TNM system to determine the stage of pancreatic cancer. This system looks at three factors:

• Size of the tumor (T)
• Lymph node involvement (N)
• Metastasis, or spread (M)

Doctors determine the cancer’s stage by looking at results from the physical exam, biopsies and imaging tests, like ultrasounds or computed tomography (CT) scans.

Stage 4 pancreatic cancer is defined as cancer that has spread beyond the pancreas to distant sites, such as the liver or lungs (M1). Lymph nodes may or not be involved (any N) and the primary tumor may be any size (any T). Because cancer has spread beyond the pancreas, Stage 4 pancreatic cancer is considered unresectable, meaning it cannot be removed completely with surgery.

Where Does Stage 4 Pancreatic Cancer Metastasize?

Different types of cancers tend to follow patterns as they spread. Pancreatic cancer commonly spreads to the liver, lungs and peritoneum, which is the tissue that surrounds most organs in the abdomen.

Pancreatic cancer may also spread to the bones, brain and other organs as it advances.

Stage 4 Pancreatic Cancer Symptoms

In the early stages, pancreatic cancer does not typically show any symptoms. As it advances, symptoms might include:

• Yellow tint to skin and the whites of the eyes (jaundice)
• Unintended weight loss
• Feeling very tired
• Little or no appetite
• Dark urine
• Light stools
• Pain in the back or abdomen

The liver, lungs, bones and brain are common sites of pancreatic cancer spread. When pancreatic cancer reaches these areas, symptoms may include:

• Jaundice of the skin and eyes and/or swelling in the abdomen when cancer spreads to the liver
• Coughing, chest pain or trouble breathing when cancer spreads to the lungs
• Bone pain or fractures when cancer spreads to the bones
• Memory problems, headaches, dizziness or seizures when cancer spreads to the brain

Stage 4 Pancreatic Cancer Treatment

Because Stage 4 pancreatic cancer has spread beyond the pancreas to other organs, it is considered unresectable, meaning it is unable to be completely removed with surgery. The most common treatment for Stage 4 pancreatic cancer is chemotherapy, which is typically given with the goal of slowing the cancer’s progress or reducing the size of the tumor or tumors.

• Gemzar^® (gemcitabine) is a chemotherapy drug that is often used to treat Stage 4 pancreatic cancer. It may be given on its own, or in one of these combinations:
• Gemzar^® (gemcitabine) with Abraxane® (nanoparticle albumin-bound paclitaxel)
• Gemzar^® (gemcitabine) with Xeloda® (capecitabine)
• Gemzar^® (gemcitabine) with cisplatin
• Gemzar^® (gemcitabine) with the targeted drug Tarceva^® (erlotinib)

A combination of four chemotherapy drugs called FOLFIRINOX is another treatment option. FOLFIRINOX includes:

• 5-fluorouracil (5-FU)
• Leucovorin
• Camptosar^® (irinotecan)
• Eloxatin^® (oxaliplatin)

For pancreatic cancer that shows specific gene changes, immunotherapy or targeted therapy may be treatment options.

In Stage 4, some treatments might not treat the cancer itself, but symptoms or complications from it.

Palliative care may be used to treat symptoms of advanced pancreatic cancer, like pain. Complications from advanced cancer may be treated as well, like placing a biliary stent to relieve a blocked bile duct.

New treatment options may also be available in clinical trials testing new types and combinations of chemotherapy, immunotherapy, targeted therapy and radiation therapy.

Stage 4 Pancreatic Cancer Survival Rate

Cancer survival rates are derived from the percentage of people with the same type and stage of cancer who were alive five years or more after they were diagnosed. They are not true predictions and they do not reflect what might happen for any one person, but they do offer general estimates of life expectancy. Survival rates may change across time as new treatments are identified through clinical trials.

The five-year relative survival rate for pancreatic cancer that has spread to nearby structures or lymph nodes (regional) is 16.2%, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.

The five-year relative survival rate for pancreatic cancer that has spread to distant parts of the body, such as the liver, lungs or bones, is 3.1%.