Pancreatic Carcinoma Stage IV
Stage IV pancreatic cancer occurs when the disease has spread beyond the pancreas to other parts of the body. While this is a serious diagnosis, understanding treatment options and supportive care can help patients and families navigate this challenging time.
Table of contents
- What Is Stage IV Pancreatic Cancer?
- Where the Cancer Spreads
- How Patients Are Diagnosed
- Treatment Options
- Supportive and Palliative Care
- Why This Stage Is Difficult to Treat
- Treatment Rates and Survival
What Is Stage IV Pancreatic Cancer?
Stage IV pancreatic cancer means the cancer has metastasized, or spread, to another part of the body beyond the pancreas. The tumors may be any size at this stage.[1] Your doctor might also call this advanced cancer or metastatic cancer.[2]
Doctors use staging to describe the cancer’s size and location. The cancer’s stage helps your doctors figure out your treatment choices.[1] Even though the cancer has spread to other areas of the body, it is still called pancreatic cancer because that is where it started.[1]
Most pancreatic cancer patients are diagnosed at stage IV. Patients diagnosed at an earlier stage can also develop stage IV cancer if it spreads.[1]
Where the Cancer Spreads
Pancreatic cancer at stage IV often spreads to several specific areas of the body. The most common places include the liver, abdominal wall (the layers of tissue that form the wall of the belly), lungs, bones, and faraway lymph nodes (small bean-shaped organs that are part of the body’s defense system).[1]
Research has found that when compared to all stages of pancreatic cancer, stage IV has a lower proportion of cancer starting from the head of the pancreas. This happens because tumors starting in the head of the pancreas are more likely to cause early symptoms related to bile flow, so they get caught at an earlier stage.[5]
How Patients Are Diagnosed
Unfortunately, pancreatic cancer is difficult to diagnose early. Early on, pancreatic cancer may not cause any signs or symptoms, making it hard to detect.[3] As the cancer grows, symptoms may include jaundice (yellowing of the skin and whites of the eyes), light-colored stools, dark urine, pain in the upper or middle abdomen and back, and weight loss.[3]
Tests that examine the pancreas are used to diagnose and stage pancreatic cancer.[3] The stage of a cancer tells the doctor about its size and whether it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage.[2]
Treatment Options
The stage of your cancer helps your doctor decide which treatment you need. Treatment also depends on your type of cancer, where the cancer is, and other health conditions that you have.[2]
For stage IV pancreatic cancer, the aim of treatment is to help control or prevent symptoms. Unfortunately, treatment won’t cure this stage of cancer, but it might help you live longer and relieve symptoms.[2]
Stage IV patients usually get a treatment that travels through the bloodstream to reach cancer cells that are in many places throughout the body. Stage IV treatment is usually chemotherapy (medicines that kill cancer cells or stop them from growing).[1] Generally, the main treatment is chemotherapy or radiotherapy (treatment using high-energy rays to destroy cancer cells). The treatment you have depends on how well you are.[2]
A small number of people may have a targeted cancer drug (a medicine that targets specific features of cancer cells) or immunotherapy drug (treatment that helps your immune system fight cancer).[2]
The cancer cannot be removed by surgery at this stage because it is unresectable (unable to be removed surgically).[1] However, other treatments may include surgery or a procedure to prevent or relieve symptoms. For example, you may have a small tube called a stent put into the bile duct to help clear a blockage and prevent symptoms such as jaundice.[2]
The Pancreatic Cancer Action Network strongly recommends discussing your treatment goals with your healthcare team and knowing all of your options. They also recommend considering clinical trials (research studies testing new treatments) at diagnosis and during every treatment decision, and biomarker testing of your tumor to help determine the best treatment options.[1]
Supportive and Palliative Care
Patients may also get treatment to control side effects, called supportive or palliative care (treatment focused on comfort and quality of life). This treatment focuses on comfort, quality of life, and the patient’s total well-being. Supportive care can go with cancer-fighting treatments or be the focus of care.[1]
The Pancreatic Cancer Action Network strongly recommends symptom management and supportive care early in your diagnosis as well as during and after treatment.[1]
Other supportive treatments may include medicines to help with pain control or other symptoms such as sickness, enzyme replacement therapy (treatment with digestive enzymes) to help digest fats and protein if the pancreas is not working properly, and blood sugar control since you may develop diabetes if your pancreas isn’t working properly.[2]
Proper nutrition and choosing the right foods can also help a patient better tolerate treatment, control side effects, and improve quality of life. The Pancreatic Cancer Action Network strongly recommends that patients have access to pancreatic enzymes and see a registered dietitian (a professional trained in nutrition and diet).[1]
Why This Stage Is Difficult to Treat
Pancreatic cancer is hard to treat at any stage. The more the cancer spreads, the more challenging treatment becomes.[1] Surgery is the best option for long-term survival of pancreatic cancer, but at stage IV the cancer cannot be removed by surgery.[1]
Treatment Rates and Survival
Stage IV pancreatic cancer, also called metastatic pancreatic cancer, constitutes more than half of all pancreatic cancer diagnosed.[5] Research studying treatment patterns found that the overall treatment rate with first-line chemotherapy was about 38 percent.[5]
The rate of treatment has increased over the years. One study showed treatment rates increased from 33 percent in 2000 to 42 percent in 2014. This improvement corresponded with an increase in survival rates, with one-to-five-year survival rising from about 9 percent in 2000 to 23 percent in 2014.[5]
People with pancreatic cancer are living longer thanks to improved treatment approaches. New and improved treatment methods are helping people with pancreatic cancer live longer.[18]
