Stage 4 Pancreatic Cancer: What To Expect

Jul 22, 2023

When a person has stage 4 pancreatic cancer, it means that the cells that grew into a tumor in the pancreas have spread in the bloodstream. The cells start to make tumors in other parts of the body, such as the bones or lungs. This stage is also called metastatic pancreatic cancer.

Stage 4 pancreatic cancer cannot be cured. However, there are treatments that can help a person at this stage of cancer feel better (palliative care).

This article talks about the two types of pancreatic cancer. You will learn about the stages and symptoms of each. You will also learn about how doctors find and treat stage 4 pancreatic cancer, as well as some tips for coping with the disease.

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The American Cancer Society stated that about 60,430 people would be diagnosed with pancreatic cancer in 2021. About 48,220 people were expected to die from this type of cancer.

More than half of the people diagnosed with pancreatic cancer find out late. They only learn that they have cancer after the cells have started to spread. This is called late-stage diagnosis. Most people will not live longer than five years after they get diagnosed.

The pancreas is a small organ near the stomach. It makes a substance that helps the body digest food and control blood sugar. These substances are called enzymes.

Doctors use stages when they talk about how cancer has grown or spread. Stage 4 is the last stage. It means that cancer cells have spread to other parts of the body. When this happens, cancer is called metastatic.

One way to stage cancer is called the TNM system. It has 3 parts:

If you have a stage 2 pancreatic tumor that spreads somewhere else in your body, you will have a stage 4 tumor. Your doctor might not write that in your medical record, though.

On paper, the stage of your cancer will always be what it was when you were diagnosed—even if it spreads. Doctors write it down this way because it helps them understand how your cancer is progressing as time goes on.

When the cancer changes, the stage might change. This is called re-staging. When this happens, the new stage will be added to the first one. Your doctor will put an "r" next to it when they write it.

Here is an example: If you have a stage 2 pancreatic tumor your doctor might have given it a T1, N1, M0 rating. If the tumor spreads but does not change in any other ways, your doctor would rate it as T1, N1, rM1.

This rating shows a doctor that a stage 2 tumor has spread to other parts of the body. When they see the rM1 for the rating, they will know the cancer is at stage 4.

Terminal cancer cannot be cured or treated. A person with terminal cancer is actively dying and will usually not live for more than a few months.

Stage 4 pancreatic cancer is not always called terminal. While the cancer is at an advance or late stage, some people do live longer than a few months with it.

One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.

The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.

Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:

About 95% of pancreatic cancers come from the cells that make digestive enzymes. These are called pancreatic adenocarcinomas (PACs).

The other 5% come from the cells that help regulate blood sugar. They are called pancreatic neuroendocrine tumors (PNETs). People with this type of pancreatic cancer usually live longer. If the cancer does not spread to other parts of the body, about 93% of people will live at least five years after they are diagnosed.

To stage pancreatic cancers, doctors need to figure out how big the first tumor is and how far it has spread. There are different tests they can use to look for each type of cancer.

Blood Tests

Your doctor might start by looking at a sample of your blood. They will look for things like:

There are also signs in your blood that can help a doctor understand the tumors you have. They are called tumor markers.

For example, people with pancreatic cancer who have lower levels of a tumor marker called CA 19-9 may live longer than people who have higher levels.

Imaging Tests

There are also tests that use machines to see inside your body. One is called computed tomography (CT) and another is magnetic resonance imaging (MRI). These tests can help your doctor look for a tumor. It can also show them if a tumor is pressing on your organs.

If you have pancreatic cancer your doctor might have you do these tests:

Procedures

Endoscopic retrograde cholangiopancreatography (ERCP) lets your doctor take pictures of the inside of your body. You will be asleep (under anesthesia) and they will put a special tube with a camera on it down your throat and into your stomach.

The tube can also help your doctor take out small pieces of tissue to look at with a microscope. This is called a biopsy which can help doctors diagnose cancer.

There are also other helpful things your doctor can do for you during this procedure. For example, if you have a blocked bile duct, your doctor can put a tube called a stent in your body to let the fluid drain out.

About 95% of pancreatic cancers are called pancreatic adenocarcinomas (PACs). The other 5% are pancreatic neuroendocrine tumors (PNETs). While they are both kinds of pancreatic cancer, they are different.

How the cancer is found and treated and the outcome depend on which type of pancreatic cancer you have.

Stage 4 pancreatic cancer cannot be cured. There are different choices a person can make about treatment at this point, but they are all focused on helping them feel better.

Some people will have surgery. Other people might have cancer treatment like chemotherapy and radiation. There are also new types of treatment that some people may try.

People with cancer may have surgery to take the tumors out. With stage 4 cancer, the cells have spread too much and it would not be possible to take them all out. However, a person with stage 4 pancreatic cancer may still have surgery to improve their symptoms.

There are a few types of surgery for pancreatic cancer, including:

Chemotherapy or "chemo" is a treatment that kills cancer cells with toxic chemicals. It also kills other types of cells that are not cancer, like your skin and hair cells. That's why some people lose their hair when they are having chemo.

There are different types of chemotherapy drugs that are used to treat pancreatic cancer, including:

Radiation therapy kills cancer cells with beams of energy. The beams can be directed to a certain place from inside the body using an implant. Radiation can also be done from the outside of the body.

Doctors may use chemotherapy and radiation at the same time to make a tumor smaller. Just like with chemo, radiation can have side effects, like hair loss and skin changes.

Immunotherapies help the immune system fight cancer. The different types of immunotherapy treatments help in their own way.

For example, some cancer cells have a protein that allows them to trick the immune system into leaving them alone. If the immune system is ignoring them, they can keep growing. A treatment called Keytruda (pembrolizumab) is a monoclonal antibody. It "exposes" the cancer cells and helps the immune system attack them. Once that happens, the cells will stop growing.

Immunotherapy can work well for some people with cancer, but it does not work for others. It is not used for very many people with pancreatic cancer. Only about 1% of them have the genetic changes that these treatments target. The treatment would not help the people who do not have those changes.

Doctors do not always look at the genes of people with pancreatic cancer. However, if someone has many people in their family who have had pancreatic cancer, they might get their genes tested to see if they have familial pancreatic cancer (FPC).

Targeted therapies only aim at cancer cells. Some only target pancreatic adenocarcinomas. These treatments stop an enzyme called tyrosine kinase from working. This can slow cancer's growth.

Examples of these therapies include:

Researchers test new drugs and treatments through clinical trials. The tests add to what is already known about treating the disease. The scientists take what they learn and try to find new ways to help people live longer or better in the future.

You have to meet certain criteria to join a clinical trial. If you are approved, you may have a chance to try a new treatment that you would not normally be able to get. Since they are still being tested, it's possible that they will not work. But it's also possible that they will.

You can ask your doctor if there are any clinical trials that you might be able to be part of. You can also look at the National Cancer Institute’s clinical trial database and other national databases together.

People living with stage 4 pancreatic will also work with a palliative care team. Doctors, nurses, social workers, and other healthcare providers work together to help people who are very sick with cancer feel better.

These treatments can help a person with cancer feel less stressed. They can also help a person manage pain and other symptoms. This might include having a treatment like radiation to make a tumor smaller. Sometimes, surgery can be done to cut the nerves to the pancreas to help a person not feel pain.

Palliative care is about helping a person living with cancer feel better. It's not the same as hospice or end-of-life care. Those treatments only happen in the last six months of a person's life. A person can have palliative care at any time during their illness.

Stage 4 pancreatic cancer is not curable. Instead, palliative care is used to help a person feel better. It helps them focus on lowering their stress and managing pain or other cancer symptoms. Surgery, medication, or chemo and radiation treatment can be part of palliative care. Some people choose to be part of a study to test new treatments.

Survival rates help healthcare providers estimate how long a person with a diagnosis will live. They make these guesses based on how well other people with the same diagnosis have done.

The cancer-specific survival rate is the percentage of people with a type of cancer who survived until a set time. The NCI’s Surveillance, Epidemiology, and End Results (SEER) Program database include cancer survival statistics from 19 states.

The SEER database does not use the TNM staging system. It uses a 3-stage approach. Stage 4 cancer is classified as cancer that has spread to other parts of the body far from where the first tumor was. It can also be called "distant" cancer.

Stage 4 pancreatic cancer does not have many treatment options. Even with treatment, most people do not live for more than a year or two.

Based on SEER’s data, the five-year survival rate for people diagnosed with distant pancreatic cancer is 3%. That means 3% of people with metastatic pancreatic cancer are alive five years after they are diagnosed.

The number changes based on age. People who are diagnosed when they are younger are more likely to live longer. For example, someone who is 50 years old when they are diagnosed with distant pancreatic adenocarcinoma has a 10.5% chance of surviving at least five more years.

Here's a table that shows the survival rates for PACs.

PNET has an overall five-year survival rate of 51.3%.

Survival rates depend on different factors. For example, if the tumor can be taken out with surgery, a person might be more likely to live longer.

The numbers are not a sure thing. Some people live much longer than the estimates say. The rates are also figured out using numbers from several years ago—even a decade ago. In the meantime, there might have been discoveries or inventions that can help people with cancer live longer.

There are numbers that try to predict how long people with cancer will live, but they are not a sure thing.

That said, most people who are diagnosed when their cancer has spread do not live as long as people who were diagnosed earlier. On the other hand, people who are diagnosed at a younger age may live longer.

If you are diagnosed with stage 4 pancreatic cancer, hearing that it has a 3% survival rate can be devastating. Living with cancer day-to-day is often hard and can be scary. You will need to find ways to take care of yourself and cope with the challenges.

What each person with cancer wants and needs will be different. If you are not sure where to start, here are a few things that you can think about:

You and your loved ones are not alone. You can also reach out to your community and beyond for support.

Stage 4 pancreatic cancer is a very serious illness. It means that cancer has spread to other organs and cannot be cured.

People with stage 4 cancer might choose treatments that can help make the pain or other symptoms better. This is called palliative care. It can include surgery, medication, and treatments like chemo or radiation.

Most people do not live longer than five years after they are diagnosed. However, depending on their age and the type of cancer they have, they might live longer.

If you are told that you have stage 4 cancer, having to make choices about your care might be overwhelming. Know that you are not alone. Your doctor will talk with you about your options and help you understand what they will be like.

Talking to your loved ones about your wishes and plans for life after you die is part of coping with cancer. It's also a time for just being with your friends and family, focusing on things that make you happy.

You can also get support from your local community or even online. The Internet can let you connect with other people who are living with cancer. They may think or worry about a lot of the same things that you do. A mental health professional can also listen and help you cope with your feelings.

There are certain risk factors that can increase the likelihood of getting pancreatic cancer. Risk factors can include age, race or ethnicity, type 2 diabetes, gum disease, chronic pancreatitis (pancreas inflammation), chemical exposure, Helicobacter pylori infection, hepatitis C, gallstones, cirrhosis, gallbladder surgery, other types of cancer, blood type, smoking, obesity, excessive alcohol use, and genetics.

In the US, pancreatic cancer makes up around 3% of all types of cancer. In 2022, it is estimated that 32,970 men and 29,240 women (62,210 total) will receive a diagnosis of pancreatic cancer in the US.

Yes, you can live without a pancreas. However, other methods of addressing pancreatic cancer are usually favored over total organ removal. This is because people without a pancreas will develop diabetes, making them dependent on insulin as well as pancreatic enzyme pills.

The different types of pancreatic cancer include adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, colloid carcinoma, and neuroendocrine cancers. Most people diagnosed with pancreatic cancer have adenocarcinoma, which is cancer that originates in the lining of the pancreatic ducts.

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By Jennifer WelshJennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider.