People with stage 4 pancreatic cancer have cancer that has spread to other parts of the body, including the liver and lungs. The available treatments won’t cure this stage of cancer, but they can help control symptoms and extend life.
Your doctor can tell you more about your outlook (prognosis) based on your specific situation. Treatment options include surgery, chemotherapy, and clinical trials.
Symptoms
Pancreatic cancer is rare and often doesn’t cause symptoms until it gets very large or spreads to other parts of the body. Symptoms of stage 4 cancer can vary and depend on where the cancer has spread.
The pancreas is an organ about 6 inches (15 centimeters) long that looks like a pear lying on its side. It releases hormones that help control the way your body digests food and regulates blood sugar. Cancer that starts in the pancreas can grow into or press on nearby nerves, blood vessels, and other organs. When this happens, it causes pain. It can also cause a blockage in the flow of food from the stomach to the small intestine.
Symptoms of pancreatic cancer may include belly pain that moves around the abdomen or to the sides and back. Your health care team will also look for yellowing of the skin and the whites of the eyes, called jaundice. This is because a substance in your liver, called bile, helps with digestion. The bile goes out through a tube called the common bile duct into your intestines. If a tumor presses on this tube, you may get a yellow color in your urine or stool. Other symptoms might be a stiff or sore back, loss of appetite, weight loss, or fat in your stools.
Some people with stage 4 pancreatic cancer are able to have surgery to remove the tumor, which can improve their outlook. Other treatments can manage pain and other symptoms to increase a person’s quality of life.
When a cancer spreads, it can no longer be removed surgically. Doctors can treat the area where the cancer is located with radiation therapy and medicines to kill cancer cells and stop them from growing.
The outlook for someone with pancreatic cancer depends on the type of cancer, how far it has spread, and their general health. Your health care team can give you more information about your specific outlook. This PDQ cancer information summary has current information about the treatment of pancreatic cancer in adults. It is written for patients, families, and caregivers. It does not give formal guidelines or recommendations for making health care decisions.
Diagnosis
In stage 4 pancreatic cancer, the tumor has spread from its original location to other parts of the body. Symptoms may vary depending on where the cancer has spread to, but may include abdominal pain, jaundice (yellowing of the skin and eyes), and pancreatic inflammation (pancreatitis).
When a patient experiences symptoms, the doctor will take a sample of the tumor for testing. This is called a biopsy. During a biopsy, the doctor inserts a needle into the tumor or takes a piece of tissue from the pancreas for examination under a microscope by a pathologist.
The results of the test determine whether or not the pancreatic cancer can be removed during surgery. The doctor will also determine the cancer’s stage based on the results of the diagnostic tests and exams. The cancer’s stage is usually described using the TNM staging system, which classifies the tumor by its size and whether or not it has spread. T stands for the tumor, and is categorized as T0, T1 or T2 based on its size. N stands for nodes, and is categorized as N0 or N1 based on whether or not the cancer has spread to the nearby lymph nodes. M stands for metastasis, and is categorized as M0 or M1 if the cancer has spread to other organs in the body.
Only about 15 to 20 percent of pancreatic cancers are resectable, meaning that they can be removed with surgery. However, doctors are continually improving their techniques to increase the number of patients who can benefit from surgery.
Even if the tumor is not removed, treatment can help prolong the patient’s life and suppress symptoms. Chemotherapy is a common treatment for pancreatic cancer, and can be administered orally or intravenously. Gemcitabine, a drug that helps to suppress tumor growth and spread, is often used alone or in combination with other chemotherapy drugs to treat stage 4 pancreatic cancer. Radiation therapy can be used to shrink the tumor, and can also be administered alongside chemotherapy in some cases. If the tumor has caused an obstruction in the bile duct, a stent can be inserted to keep the bile duct open.
Treatment
At this stage, cancer has spread beyond the pancreas and into nearby tissue and lymph nodes. It can also have grown into the major blood vessels that surround the pancreas. But it has not yet spread to distant sites, such as the liver or lungs (T4; N0; M1).
Doctors use tests and imaging scans to see how big a tumor is and whether it has spread. They may take a sample of cells from the tumor to look at under a microscope (biopsy). They can also use computed tomography scans and magnetic resonance imaging to find out what parts of the body are involved.
In this stage, doctors cannot cure the cancer. But they can try to manage the symptoms. They can do this by removing the part of the pancreas that has grown into a nearby organ or blood vessel. For example, surgeons can remove the head of the pancreas, the gallbladder and parts of the stomach and small intestine. Doctors can also perform a procedure called a biliary bypass, where they create a new way for the bile to flow through the body.
Medications can help control pain, nausea and other side effects. People may need to stay in the hospital for weeks or months during this time.
Some research is ongoing to develop better treatments for late-stage pancreatic cancer. For instance, researchers are trying to find drugs that can stop cancer cells from growing. Another area of research involves targeting specific genetic mutations in cancer cells. For example, some types of pancreatic cancer have a mutation in the ras gene. In this case, researchers are looking for drugs that can block the activity of a protein that allows mutated cells to grow.
Overall, people with pancreatic cancer have more treatment options today than they did a decade ago. This includes more clinical trials that test different treatments. People who are diagnosed with pancreatic cancer can get support from their medical team, friends and family. It’s important to stay active and eat well during treatment. They can also get help managing the emotional side effects of treatment, such as depression or anxiety.
Prognosis
A person with stage 4 pancreatic cancer has a very poor prognosis. This is because the disease has spread from the pancreas and into other areas of the body when this stage is diagnosed. The five-year survival rate for pancreatic cancer at this stage is around 3 percent, according to the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program.
Your prognosis depends on how large the tumor is and whether it has spread when you are diagnosed with stage 4 pancreatic cancer. The type of cancer and its grade—how abnormal the cells look under a microscope—also affects your chances of recovery. Your age, general health and the type of treatment you receive also influence your prognosis.
Doctors use the information from diagnostic tests and pathology to determine the stage of a person’s pancreatic cancer. The staging information can help your care team recommend the best kind of treatment and predict your chance of recovery. It can also help them find clinical trials that may be suitable for you.
The most common treatments for stage 4 pancreatic cancer are chemotherapy and radiation therapy. These are given in combination to kill cancer cells and reduce the size of the tumors.
These treatments can cause many side effects. It’s important to tell your doctor about any new or worsening symptoms so they can adjust your treatment plan.
You can improve your quality of life by eating a healthy diet and getting regular exercise. It can also help to seek support from friends and family, or join a support group. You can also ask your care team about financial resources, such as help paying for prescriptions or housing assistance.
People with pancreatic cancer often have a hard time swallowing and digesting food, so it can be helpful to take a digestive enzyme supplement. It’s also important to talk with your palliative care team about ways to manage pain and other symptoms. For example, you can learn breathing and relaxation techniques, or ask about medical marijuana and other alternative therapies. You can also learn how to cope with the emotional impact of a cancer diagnosis.
