What Does Stage 4 Cancer Generally Mean?

The Final Stage of Cancer: What Happens in Stage 4?

Stage 4 is the most advanced stage of cancer, which means it has spread from where it started to other parts of the body. It might have reached distant organs, tissues, or distant lymph nodes. The spread can happen through the blood or lymphatic system.

At this point, cancer is considered more difficult to treat. Rather than focusing on curing cancer, doctors provide treatments to slow down the growth, relieve symptoms, and help patients live longer and have a better quality of life. 

Stage 4 cancer or metastatic cancer refers to the most advanced stage of the disease when the cancerous cells have spread across different parts of the body.

Oncologists use "cancer staging" to simplify the diagnosis process and treatment. These stages range from 0 to 4, 4 being a malignant stage. Based on the stage, the location of the cancer, its size, and how far it has spread can be determined. This process also helps researchers to determine different treatment patterns and outcomes. 

What are the Symptoms of Stage 4 Cancer?

Depending on the cancer type a patient has, the symptoms vary. Here are some significant common symptoms of stage 4 cancer:

• The cancer spreads to bones, causing patients to feel immense pain, and they become prone to fractures.
• Stage 4 cancer patients often feel shortness of breath if cancerous cells have reached their lungs.
• If cancer has spread to the brain, headaches, dizziness, and seizures occur.
• Cancer spreading to the liver causes swelling in the belly or jaundice.

Key Features of 4th-Stage Cancer

Here is a breakdown of the main features of stage 4 cancer:

Widespread Metastasis

The most important characteristic of stage 4 cancer is that it has spread beyond the original site where the cancer had started to grow. This can include:

• Liver
• Lungs
• Brain
• Bones
• Distant lymph nodes

For example, if someone has stage 4 breast cancer, it may have spread to the lungs or bones. In lung cancer, it might spread to the brain or liver.

Severe Symptoms

Symptoms of stage 4 cancer vary depending on where the cancer has spread. However, some common symptoms include:

• Constant tiredness that does not go away with rest.
• Pain and fracture if the cancer has spread to bones or nerves.
• Unexplained weight loss even without changes in diet or exercise.
• Difficulty in breathing, especially if cancer is in the lungs.
• Neurological symptoms like headaches, confusion, or seizures, if they are in the brain.

Treatment Challenges

While early-stage cancers may be treated with surgery, stage 4 cancer usually requires a combination of treatments. These treatments include:

• Chemotherapy
• Radiation therapy
• Targeted therapy
• Immunotherapy
• Palliative care

The goal of treatment may not always be to cure the cancer but rather to manage the symptoms, slow down the spread, and improve the quality of life of the patients.

Palliative and Supportive Care

Palliative care focuses on comfort rather than cure. It can begin alongside active treatment such as chemotherapy. Palliative care helps to manage:

• Pain
• Nausea
• Fatigue
• Emotional distress

Palliative care can become an option when treatments no longer control the cancer or symptoms.

Different Types of Stage 4 Cancers and Their Features

Different types of cancer behave differently when they reach stage 4. Let's dive deep into that:

Stage 4 Breast Cancer

• In stage 4 breast cancer, the cancer has spread beyond the breast, underarms, and internal lymph nodes to other distant body parts. It can spread to the liver, lungs, bones, or brain. Symptoms may include bone pain, breathing problems, or neurological issues.

Stage 4 Lung Cancer

• In stage 4 lung cancer, the cancer has spread beyond the lungs to other parts of the body.  The cancer often spreads to the brain, bones, liver, or adrenal glands. Coughing, shortness of breath, and chest pain are common symptoms of stage 4 lung cancer.

Stage 4 Colorectal Cancer

• Stage 4 colorectal cancer usually spreads to one or more organs that are distant from the colon, such as the liver, lungs, or peritoneum (abdominal lining). Abdominal pain, fatigue, and bowel issues are some common symptoms of stage 4 colorectal cancer. Surgery may be possible along with chemotherapy for some patients dealing with this.

Stage 4 Prostate Cancer

• In prostate cancer, the cancer can be found in other parts of the body even if the prostate is removed. Metastatic prostate cancer commonly spreads to bones, adrenal glands, liver, or lungs. The common symptoms may include bone pain, especially in the hips, back, or ribs.

Stage 4 Melanoma

• In stage 4 melanoma, cancer cells have spread from the skin and nearby lymph nodes to distant organs, remote lymph nodes, and other areas of the skin. This cancer can be found in the bones, liver, brain or lungs of our body.

Why do Healthcare Experts Stage Cancer?

According to the WHO (World Health Organisation), rapid lifestyle changes and environmental factors have been contributing factors to the rising number of cancer patients. The National Cancer Registry Programme (NCRP) states that the number of cancer patients in India is likely to increase in the future.

Here is why healthcare professionals stage cancer:

1. To Keep Pace with the Evolution of Cancer Treatment

• Since cancer is a complicated disease, staging it assists healthcare professionals in having a shared guideline. Based on this shared guideline, they ensure that the starting point of their treatment remains intact while the treatment options keep changing over time.

2. Help Patients Get an Idea of What to Expect

• When patients find out that they have cancer, they start to panic. Having an idea of which stage a patient is in offers them an idea of what to expect in the upcoming days. It also helps healthcare providers to develop an accurate prognosis.

How is Cancer Staged?

To stage cancer, experts focus on factors like the size, location and growth rate of the tumour. Healthcare experts use multiple systems to determine the stages of cancer. One such system is as follows:

TNS system

• Using the TNS system is a widespread cancer staging treatment. It helps to classify the extent of the cancer cells.
• T stands for tumour-sized and spread only in the nearby parts of the body.
• N shows whether there is involvement of lymph nodes or not.
• M refers to metastasis, meaning cancer has reached a distant part of the body.

How do Healthcare Professionals Determine the Stages of Cancer?

Here are a few ways through which healthcare professionals determine cancer stages:

• Imaging tests like X-rays, Ultrasound, CT scans, PET scans, and MRIs.
• Endoscopy exams are performed using a thin, lighted tube that is placed into the body to look for cancer cells.
• Lab tests, where blood tests determine which stage of cancer a patient is in.
• A biopsy is where a doctor removes a piece of the mass to confirm if a patient has cancerous cells.

Is Stage 4 Cancer Curable?

Usually, stage 4 cancer is not completely curable. Therefore, at this point, healthcare providers highlight lifestyle transformation to extend life expectancy. Besides that, the patients can continue their treatments through immunotherapy, chemotherapy and palliative care to get relief from pain.

Identifying which stage of cancer a patient is in helps the patient and their healthcare providers understand what to expect and how to proceed. Even though stage 4 cancer is not curable completely, there are examples where lifestyle modification has helped patients to live a long and happy life. The evolution of cancer treatment through advanced research and scientific progression is instigating hope for a cancer-free future.