Stage 4 cancer chemotherapy

Stage 4 cancer chemotherapy DEFAULT

What is the outlook for stage 4 cancer?

Stage 4 cancer is the severest form of cancer. It has the highest risk of mortality. However, stage 4 cancer is not always terminal.

In this article, we discuss what stage 4 cancer is, the survival rate for different types of cancer, and what support is available for people with cancer.

What is stage 4 cancer?

Cancer is a group of diseases that cause rapid cell growth. Cancerous cells grow and reproduce uncontrollably in certain parts of the body. As a cancerous tumor grows, the cells can spread to other areas of the body.

Doctors typically use a to determine how severe the cancer is. Splitting cancers into stages is one factor that helps doctors determine the best treatment approaches.

A range of tests is useful in determining the stage of cancer. They include:

Doctors take different factors into account to determine what stage a cancer is at. Common factors include:

  • how large the primary tumor is and its location in the body
  • whether the tumor has spread to the lymph nodes
  • how far cancer has spread to other parts of the body, a process called metastasis

Doctors may also consider other factors, such as the cell type, results of biopsies, or the person’s age. Together, this information determines whether cancer is less advanced (stage 1) or very advanced (stage 4), or in between.

Stage 4 cancer is the most severe form of cancer. Metastatic cancer is another name for stage 4 cancer because the disease has usually spread far in the body, or metastasized.

Is stage 4 cancer always terminal?

More severe cancers are more likely to be terminal. However, that is never a certainty. For example, the American Cancer Society say the 5-year survival rate for breast cancer that spreads to distant body parts is , or 86% when it only spreads locally.

Determining the severity of cancer and its stage is a complex process. Doctors are still learning about all the factors that affect how cancer develops and affects the body.

How long can someone live with stage 4 cancer?

Doctors usually give a prognosis for cancer in terms of an estimated survival rate over 5 years. These survival rates are a rough guide based on data from thousands of other people with a similar cancer and stage.

Survival rates vary depending on the location or type of cancer. Despite how far cancer spreads, doctors will still refer to the type of cancer by where it started.

The stage 4 survival rates for some of the most common forms of cancers include the following:


Breast cancer is the most common form of cancer in the U.S., with over million new cases of female breast cancer in

The American Cancer Society say the estimated 5-year survival rate for breast cancer that spreads to distant body parts is .


There are two main types of lung cancer: small cell and non-small cell lung cancer. Most cases are , in which the cancerous cells are larger.

According to the , the average 5-year survival rate for people diagnosed with non-small cell lung cancer that has spread to distant parts of the body is 6%. For small cell lung cancer, there is a 3% 5-year survival rate under the same scenario.


Colorectal cancer affects the colon or rectal areas and is generally treatable in its early stages. There were around new cases of colorectal cancer in the U.S. in

The American Cancer Society say the 5-year survival rate for colorectal cancer that has spread to distant parts of the body is .


Prostate cancer is the form of cancer among men in the U.S. It affects the prostate, a small gland in the pelvis. If cancer spreads to distant body parts, the American Cancer Society give the 5-year survival rate as .

Stage 4 cancer treatments

The treatment for stage 4 cancer will vary depending on the type of cancer and how far it has spread. Some treatments aim to improve the person’s quality of life and control symptoms. Others aim to stop cancer growth.

Treatments at this stage might :

  • chemotherapy, although it can become too risky when cancer spreads far
  • radiation therapy, which can shrink tumors and help with symptoms
  • immunotherapy, which helps the body’s immune system fight the cancer
  • surgery to remove the cancer
  • targeted therapy, which aims to slow tumor growth

Cancer support

Cancer can take an enormous emotional toll on a person and their friends and family. There are many different options for people to receive support when dealing with cancer.

The provide many resources for those seeking support, including:

  • information centers
  • options for places to stay during treatment
  • programs to transport people to treatment locations
  • hair loss and mastectomy products
  • support groups

They also provide online networks, apps, and communities to support people with cancer and those around them.


Stage 4 cancer is the severest form of cancer. Doctors use several factors to classify cancer stage, including the size and locations of tumors.

When cancer spreads far from its original location, the chances of survival decrease. However, stage 4 cancer is not always terminal.

Different types of cancer have different rates of survival in stage 4. Many other factors also affect survival, such as age and lifestyle. While survival statistics are a helpful guide, every case will be different.


The Role of Chemotherapy at the End of Life

1. Temel JS, Jackson VA, Billings JA, et al. Phase II study: integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients. J Clin Oncol. ;25(17)– [PubMed] [Google Scholar]

2. Martoni AA, Tanneberger S, Mutri V. Cancer chemotherapy near the end of life: the time has come to set guidelines for its appropriate use. Tumori. ;93(5)– [PubMed] [Google Scholar]

3. Teno JM. Advance directives: time to move on. Ann Intern Med. ;(2)– [PubMed] [Google Scholar]

4. Koedoot CG, Oort FJ, de Haan RJ, Bakker PJ, de Graeff A, de Haes JC. The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are: palliative chemotherapy and watchful-waiting. Eur J Cancer. ;40(2)– [PubMed] [Google Scholar]

5. Sullivan AM, Lakoma MD, Matsuyama RK, Rosenblatt L, Arnold RM, Block SD. Diagnosing and discussing imminent death in the hospital: a secondary analysis of physician interviews. J Palliat Med. ;10(4)– [PubMed] [Google Scholar]

6. Mackillop WJ, Stewart WE, Ginsburg AD, Stewart SS. Cancer patients&#x; perceptions of their disease and its treatment. Br J Cancer. ;58(3)–[PMC free article] [PubMed] [Google Scholar]

7. Chow E, Andersson L, Wong R, et al. Patients with advanced cancer: a survey of the understanding of their illness and expectations from palliative radiotherapy for symptomatic metastases. Clin Oncol (R Coll Radiol) ;13(3)– [PubMed] [Google Scholar]

8. Helft PR. Necessary collusion: prognostic communication with advanced cancer patients. J Clin Oncol. ;23(13)– [PubMed] [Google Scholar]

9. Matsuyama R, Reddy S, Smith TJ. Why do patients choose chemotherapy near the end of life? a review of the perspective of those facing death from cancer. J Clin Oncol. ;24(21)– [PubMed] [Google Scholar]

Silvestri G, Pritchard R, Welch HG. Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ. ;()–[PMC free article] [PubMed] [Google Scholar]

Agrawal M, Grady C, Fairclough DL, Meropol NJ, Maynard K, Emanuel EJ. Patients&#x; decision-making process regarding participation in phase I oncology research. J Clin Oncol. ;24(27)– [PubMed] [Google Scholar]

The AM, Hak T, Koeter G, van der Wal G. Collusion in doctor-patient communication about imminent death: an ethnographic study. West J Med. ;(4)–[PMC free article] [PubMed] [Google Scholar]

Lee SJ, Fairclough D, Antin JH, Weeks JC. Discrepancies between patient and physician estimates for the success of stem cell transplantation. JAMA. ;(8)– [PubMed] [Google Scholar]

Lee SJ, Loberiza FR, Rizzo JD, Soiffer RJ, Antin JH, Weeks JC. Optimistic expectations and survival after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. ;9(6)– [PubMed] [Google Scholar]

Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med. ;(12)– [PubMed] [Google Scholar]

Santoso JT, Engle DB, Schaffer L, Wan JY. Cancer diagnosis and treatment: communication accuracy between patients and their physicians. Cancer J. ;12(1)– [PubMed] [Google Scholar]

Glare P, Virik K, Jones M, et al. A systematic review of physicians&#x; survival predictions in terminally ill cancer patients. BMJ. ;()–[PMC free article] [PubMed] [Google Scholar]

Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. ;20(19)– [PubMed] [Google Scholar]

Meropol NJ, Weinfurt KP, Burnett CB, et al. Perceptions of patients and physicians regarding phase I cancer clinical trials: implications for physician-patient communication. J Clin Oncol. ;21(13)– [PubMed] [Google Scholar]

Mallinger JB, Shields CG, Griggs JJ, et al. Stability of decisional role preference over the course of cancer therapy. Psychooncology. ;15(4)– [PubMed] [Google Scholar]

Grunfeld EA, Maher EJ, Browne S, et al. Advanced breast cancer patients&#x; perceptions of decision making for palliative chemotherapy. J Clin Oncol. ;24(7)– [PubMed] [Google Scholar]

Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ. ;()–[PMC free article] [PubMed] [Google Scholar]

Balmer CE, Thomas P, Osborne RJ. Who wants second-line, palliative chemotherapy? Psychooncology. ;10(5)– [PubMed] [Google Scholar]

Brundage MD, Feldman-Stewart D, Cosby R, et al. Cancer patients&#x; attitudes toward treatment options for advanced non-small cell lung cancer: implications for patient education and decision support. Patient Educ Couns. ;45(2)– [PubMed] [Google Scholar]

Bremnes RM, Andersen K, Wist EA. Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. Eur J Cancer. ;31A(12)– [PubMed] [Google Scholar]

Tamburini M, Buccheri G, Brunelli C, Ferrigno D. The difficult choice of chemotherapy in patients with unresectable non-small-cell lung cancer. Support Care Cancer. ;8(3)– [PubMed] [Google Scholar]

Hirose T, Horichi N, Ohmori T, et al. Patients preferences in chemotherapy for advanced non-small-cell lung cancer. Intern Med. ;44(2)– [PubMed] [Google Scholar]

Koedoot CG, de Haan RJ, Stiggelbout AM, et al. Palliative chemotherapy or best supportive care? a prospective study explaining patients&#x; treatment preference and choice. Br J Cancer. ;89(12)–[PMC free article] [PubMed] [Google Scholar]

Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. ;22(2)– [PubMed] [Google Scholar]

Murillo JR, Jr, Koeller J. Chemotherapy given near the end of life by community oncologists for advanced non-small cell lung cancer. Oncologist. ;11(10)– [PubMed] [Google Scholar]

Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. ;33(3)– [PubMed] [Google Scholar]

American Society of Clinical Oncology Outcomes Working Group. Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol. ;14(2)– [PubMed] [Google Scholar]

Smith TJ, Khatcheressian J, Lyman GH, et al. Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. ;24(19)– [PubMed] [Google Scholar]

Pfister DG, Johnson DH, Azzoli CG, et al. American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: Update J Clin Oncol. ;22(2)– [PubMed] [Google Scholar]

Shepherd FA, Dancey J, Ramlau R, et al. Prospective randomized trial of doce-taxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol. ;18 (10)– [PubMed] [Google Scholar]

Dancey J, Shepherd FA, Gralla RJ, Kim YS. Quality of life assessment of second-line docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy: results of a prospective, randomized phase III trial. Lung Cancer. ;43(2)– [PubMed] [Google Scholar]

Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. ;(2)– [PubMed] [Google Scholar]

Goldberg RM, Rothenberg ML, Van Cutsem E, et al. The continuum of care: a paradigm for the management of metastatic colorectal cancer. Oncologist. ;12(1)– [PubMed] [Google Scholar]

Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitox-antrone plus prednisone for advanced prostate cancer. N Engl J Med. ;(15)– [PubMed] [Google Scholar]

Massarelli E, Andre F, Liu DD, et al. A retrospective analysis of the outcome of patients who have received two prior chemotherapy regimens including platinum and docetaxel for recurrent non-small-cell lung cancer. Lung Cancer. ;39(1)– [PubMed] [Google Scholar]

Hayes DF. An overview of treatment for locally advanced recurrent, and metastatic breast cancer. In: Rose BF, editor. UptoDate. Waltham, MA: UpToDate; [Google Scholar]

Collins R, Fenwick E, Trowman R, et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer. Health Technol Assess. ;11(2):iii–iv. xv–xviii, 1– [PubMed] [Google Scholar]

El Demery M, Pouessel D, Avances C, et al. What is the objective of second-line chemotherapy after failure of first-line chemotherapy in hormone-resistant metastatic prostate? Prog Urol. ;16(3)– [PubMed] [Google Scholar]

Casarett DJ, Quill TE. I&#x;m not ready for hospice : strategies for timely and effective hospice discussions. Ann Intern Med. ;(6)– [PubMed] [Google Scholar]

Wright AA, Katz IT. Letting go of the rope&#x;aggressive treatment, hospice care, and open access. N Engl J Med. ;(4)– [PubMed] [Google Scholar]

Bruera E, Sweeney C, Willey J, et al. Breast cancer patient perception of the helpfulness of a prompt sheet versus a general information sheet during outpatient consultation: a randomized, controlled trial. J Pain Symptom Manage. ;25(5)– [PubMed] [Google Scholar]

Brown RF, Butow PN, Dunn SM, Tattersall MH. Promoting patient participation and shortening cancer consultations: a randomised trial. Br J Cancer. ;85(9)–[PMC free article] [PubMed] [Google Scholar]

Glynne-Jones R, Ostler P, Lumley-Graybow S, et al. Can I look at my list? an evaluation of a &#x;prompt sheet&#x; within an oncology outpatient clinic. Clin Oncol (R Coll Radiol) ;18(5)– [PubMed] [Google Scholar]

Smith TJ. The art of oncology: when the tumor is not the target. tell it like it is. J Clin Oncol. ;18(19)– [PubMed] [Google Scholar]

Eisenberg PD. Caring for patients at the end of life. Ann Intern Med. ;(6) 1 paragraph. [PubMed] [Google Scholar]

Hagerty RG, Butow PN, Ellis PM, et al. Communicating with realism and hope: incurable cancer patients&#x; views on the disclosure of prognosis [published correction appears in J Clin Oncol. ;23(15)] J Clin Oncol. ;23(6)– [PubMed] [Google Scholar]

Kirk P, Kirk I, Kristjanson LJ. What do patients receiving palliative care for cancer and their families want to be told? a Canadian and Australian qualitative study. BMJ. ;()[PMC free article] [PubMed] [Google Scholar]

Whelan TM, O&#x;Brien MA, Villasis-Keever M, et al. Impact of Cancer-Related Decision Aids. Rockville, MD: Agency for Healthcare Research and Quality; Jul, Evidence Report/Technology Assessment AHRQ publication no E [Google Scholar]

Peele PB, Siminoff LA, Xu Y, Ravdin PM. Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information. Med Decis Making. ;25(3)– [PubMed] [Google Scholar]

Siminoff LA, Gordon NH, Silverman P, Budd T, Ravdin PM. A decision aid to assist in adjuvant therapy choices for breast cancer. Psychooncology. ;15(11)– [PubMed] [Google Scholar]

Leighl NB, Shepherd H, Butow P, et al. When the goal is not cure: a randomized trial of a patient decision aid in advanced colorectal cancer. J Clin Oncol. ;25(suppl 18)[Google Scholar]

Neff P, Lyckholm L, Smith T. Truth or consequences: what to do when the patient doesn&#x;t want to know. J Clin Oncol. ;20(13)– [PubMed] [Google Scholar]

Shanafelt TD, Loprinzi C, Marks R, Novotny P, Sloan J. Are chemotherapy response rates related to treatment-induced survival prolongations in patients with advanced cancer? J Clin Oncol. ;22(10)– [PubMed] [Google Scholar]

Smith TJ, Schnipper LJ. The American Society of Clinical Oncology program to improve end-of-life care. J Palliat Med. ;1(3)– [PubMed] [Google Scholar]

Christakis NA, Iwashyna TJ. The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Soc Sci Med. ;57(3)– [PubMed] [Google Scholar]

Schockett ER, Teno JM, Miller SC, Stuart B. Late referral to hospice and bereaved family member perception of quality of end-of-life care. J Pain Symptom Manage. ;30(5)– [PubMed] [Google Scholar]

Teno JM, Shu JE, Casarett D, Spence C, Rhodes R, Connor S. Timing of referral to hospice and quality of care: length of stay and bereaved family members&#x; perceptions of the timing of hospice referral. J Pain Symptom Manage. ;34(2)– [PubMed] [Google Scholar]

Rabow MW, Schanche K, Petersen J, Dibble SL, McPhee SJ. Patient perceptions of an outpatient palliative care intervention: It had been on my mind before, but I did not know how to start talking about death &#x; J Pain Symptom Manage. ;26(5)– [PubMed] [Google Scholar]

Casarett D, Crowley R, Stevenson C, Xie S, Teno J. Making difficult decisions about hospice enrollment: what do patients and families want to know? J Am Geriatr Soc. ;53(2)– [PubMed] [Google Scholar]

Casarett DJ, Crowley RL, Hirschman KB. How should clinicians describe hospice to patients and families? J Am Geriatr Soc. ;52(11)– [PubMed] [Google Scholar]

Brickner L, Scannell K, Marquet S, Ackerson L. Barriers to hospice care and referrals: survey of physicians&#x; knowledge, attitudes, and perceptions in a health maintenance organization. J Palliat Med. ;7(3)– [PubMed] [Google Scholar]

Casarett D, Karlawish J, Morales K, Crowley R, Mirsch T, Asch DA. Improving the use of hospice services in nursing homes: a randomized controlled trial. JAMA. ;(2)– [PubMed] [Google Scholar]

Lamont EB, Siegler M. Paradoxes in cancer patients&#x; advance care planning. J Palliat Med. ;3(1)– [PubMed] [Google Scholar]

Foley K, Gellband H, editors. Improving Palliative Care for Cancer. Washington, DC: National Academy Press; [Google Scholar]

Back A. Patient-physician communication in oncology: what does the evidence show? Oncology (Williston Park) ;20(1)– [PubMed] [Google Scholar]

Rabinowitz T, Peirson R. Nothing is wrong, doctor : understanding and managing denial in patients with cancer. Cancer Invest. ;24(1)– [PubMed] [Google Scholar]

Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. ;(9)– [PubMed] [Google Scholar]

Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. ;(23)– [PubMed] [Google Scholar]

Smith RC, Zimny GH. Physicians&#x; emotional reactions to patients. Psychosomatics. ;29(4)– [PubMed] [Google Scholar]

Creagan ET. Burnout and balance: how to go the distance in the 21st century. Cancer Control. ;11(4)– [PubMed] [Google Scholar]

Tobias JS, Souhami RL. Fully informed consent can be needlessly cruel. BMJ. ;()–[PMC free article] [PubMed] [Google Scholar]

Fallowfield L. Participation of patients in decisions about treatment for cancer. BMJ. ;()[PMC free article] [PubMed] [Google Scholar]

Emanuel LL, Ferris FD, von Gunten CF, Von Roenn J. Education in Palliative and End of Life Care for Oncology [CD-ROM] Chicago, IL: EPEC-O; NIH publication 07&#x; [Google Scholar]

Mack JW, Wolfe J, Cook EF, Grier HE, Cleary PD, Weeks JC. Hope and prognostic disclosure. J Clin Oncol. ;25(35)– [PubMed] [Google Scholar]

Finn J, Pienta K, Parzuchowski J. Palliative care project: bridging cancer treatment and hospice care. Proc Am Soc Clin Oncol. ;[Google Scholar]

Pitorak EF, Armour M, Sivec HD. [Accessed May 12, ];Project Safe Conduct integrates palliative goals into comprehensive cancer care: an interview with Elizabeth Ford Pitorak and Meri Armour. [PubMed]

Bakitas M, Stevens M, Ahles T, et al. Project ENABLE: a palliative care demonstration project for advanced cancer patients in three settings. J Palliat Med. ;7(2)– [PubMed] [Google Scholar]

Elsayem A, Swint K, Fisch MJ, et al. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol. ;22(10)– [PubMed] [Google Scholar]

Meyers FJ, Linder J, Beckett L, Christensen S, Blais J, Gandara DR. Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care. J Pain Symptom Manage. ;28(6)– [PubMed] [Google Scholar]

Gade G, Venohr I, Conner D, et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med. ;11(2)– [PubMed] [Google Scholar]

Passik SD, Ruggles C, Brown G, et al. Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program? Palliat Support Care. ;2(4)– [PubMed] [Google Scholar]

Schrag D. The price tag on progress&#x;chemotherapy for colorectal cancer. N Engl J Med. ;(4)– [PubMed] [Google Scholar]

Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol. ;25(2)– [PubMed] [Google Scholar]

Hillner BE, Schrag D, Sargent DJ, Fuchs CS, Goldberg RM. Cost-effectiveness projections of oxaliplatin and infusional fluorouracil versus irinotecan and bolus fluorouracil in first-line therapy for metastatic colorectal carcinoma. Cancer. ;(9)– [PubMed] [Google Scholar]

Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med. ;(4)– [PubMed] [Google Scholar]

Smith TJ, Girtman J, Riggins J. Why academic divisions of hematology/oncology are in trouble and some suggestions for resolution. J Clin Oncol. ;19(1)– [PubMed] [Google Scholar]

Jacobson M, O&#x;Malley AJ, Earle CC, Pakes J, Gaccione P, Newhouse JP. Does reimbursement influence chemotherapy treatment for cancer patients? Health Aff (Millwood) ;25(2)– [PubMed] [Google Scholar]

Smith TJ, Coyne P, Cassel B, Penberthy L, Hopson A, Hager MA. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med. ;6(5)– [PubMed] [Google Scholar]

Campbell DE, Lynn J, Louis TA, Shugarman LR. Medicare program expenditures associated with hospice use. Ann Intern Med. ;(4)– [PubMed] [Google Scholar]

Benner SE, Fetting JH, Brenner MH. A stopping rule for standard chemotherapy for metastatic breast cancer: lessons from a survey of Maryland medical oncologists. Cancer Invest. ;12(5)– [PubMed] [Google Scholar]

Smith TJ, Bodurtha JN. Ethical considerations in oncology: balancing the interests of patients, oncologists, and society. J Clin Oncol. ;13(9)– [PubMed] [Google Scholar]

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Does End-Stage Chemotherapy Improve Quality of Life?

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The question of when to stop treatment for people with metastatic disease that continues to grow despite all efforts is a gut-wrenching choice. It’s very hard to make the transition from fighting the disease to beginning to think about how to prepare for the end of life. The challenge is extremely painful for both the person diagnosed with cancer and her/his loved ones.

In many cases, people with end-stage metastatic cancer are offered chemotherapy to ease pain and improve their quality of life. When chemotherapy is given for these reasons, it’s called palliative chemotherapy. Still, not much research has looked at whether palliative chemotherapy for end-stage disease actually does improve quality of life.

A study suggests that few people benefit from end-of-life chemotherapy and many people have worse quality of life after receiving it.

The study was published online on July 23, by JAMA Oncology. Read the abstract of “Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.”

Guidelines from the American Society of Clinical Oncology (ASCO) recommend that palliative chemotherapy not be given to people diagnosed with growing metastatic disease who are very sick and bedridden and who can’t take care of their own daily needs. For people diagnosed with growing metastatic cancer who are in relatively good health and self-sufficient, ASCO guidelines recommend trying palliative chemotherapy to ease pain or help the person live longer.

ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments that are supported by much credible research and experience.

In this study, the researchers followed people diagnosed with end-stage metastatic cancer between and who were told they had 6 months or less to live:

  • about 55% of the people in the study were men and 45% were women
  • % were white, % were Black, and % were Latino

The people had been diagnosed with a number of different metastatic cancers:

  • % had lung cancer
  • % had breast cancer
  • % had colon cancer
  • % had pancreatic cancer
  • % had other gastrointestinal cancer
  • % had another type of cancer

The people in the study were followed until they died.

At the beginning of the study, the researchers asked the people in the study about their quality of life as well as their level of well-being, both physically and psychologically. The researchers also asked the caregiver most familiar with the person’s well-being to do the same assessment. After a person died, the researchers asked the caregiver to rate the person’s quality of life in the last week of life. The caregivers’ assessments were considered accurate because their assessments matched the people’s self-assessments when the study started.

About half the people in the study opted for palliative chemotherapy, including 28 of 42 people diagnosed with metastatic breast cancer.

For people who were the sickest and had a lower quality of life when the study started, the caregiver rating of their last week of life was about the same whether or not the people had received palliative chemotherapy. So the end-of-life chemotherapy didn’t seem to improve quality of life for these people.

For people who were in relatively good health and had better quality of life when the study started, more than half (56%) had worse quality of life in their final week of life after receiving palliative chemotherapy. To compare, 31% of people who had better quality of life when the study started who didn’t receive palliative chemotherapy had worse quality of life in their final week of life. So palliative chemotherapy seemed to decrease quality of life for people who were in relatively good health at the beginning of the study.

The researchers said that it was likely the side effects of chemotherapy, including nausea, diarrhea, and fatigue, that decreased quality of life for the relatively healthy people.

There was no difference in survival between the people who got palliative chemotherapy and people who didn’t.

In a companion editorial, Charles D. Blanke, M.D., FACP, FASCO, and Erik K. Fromme, M.D., MCR, FAAHPM, both of Oregon Health and Science University, wrote, “In reality, only two major reasons exist for administering chemotherapy to most patients with metastatic cancer: to help them live longer and/or to help them live better. In exchange for treatment-related toxic effects (as well as substantial time, expense, and inconvenience), chemotherapy can prolong survival for patients with a variety of -- though not all -- solid tumors. Chemotherapy may also improve quality of life for patients by reducing symptoms caused by a malignancy. In this issue of JAMA Oncology, Prigerson and colleagues report some troubling trial results: chemotherapy administered to patients with cancer near the end of life achieved neither goal.

"Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment," Blanke and Fromme continued. "Patients with end-stage cancer are encouraged by friends and family to keep fighting, but the battle analogy itself can portray the dying patient as a loser and should be discouraged. Costs aside, we feel the last 6 months of life are not best spent in an oncology treatment unit or at home suffering the toxic effects of largely ineffectual therapies for the majority of patients."

It’s important to know that all the people in the study were diagnosed between and , before some newer cancer chemotherapy medicines with fewer side effects were developed.

“Doctors have been learning who not to treat, and I think this captures what we did 10 years ago,” said Thomas Gribbin, M.D., an oncologist in Michigan, in an interview in the New York Times. “A lot of the chemicals we would use today are not necessarily toxic to every organ in your body. And we have improvement in how we manage side effects.”

Treatment decisions for end-stage cancer are extremely personal and individualized. What is right for one person may be completely wrong for another person. It’s important to talk to your doctor, your family, and other loved ones. There are no hard and fast rules. Some people prefer to receive treatment up until the last day of their lives, while others will stop and prefer to spend the last weeks or months of their lives with their families, with their pain and other symptoms controlled, but without having to deal with being in treatment anymore.

By keeping the lines of communication open with your doctors, you can explain what you want and your doctors can help you achieve it.

For more information on living with metastatic breast cancer, including taking breaks from treatment and stopping treatment, visit the Recurrent and Metastatic Breast Cancer pages.

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Published on July 28, at AM


What Is Stage 4 Cancer?

Doctors deliver a cancer diagnosis with a description of the disease’s stage and level of metastasis. Stage 4 cancer, also known as metastatic cancer, is the most advanced stage. It is the least likely to be cured and is unlikely to end up in remission. 

That doesn’t mean it’s automatically a death sentence—many stage 4 cancer patients live for many years—but the prognosis is not likely to be good. The disease’s course can vary significantly by the cancer type, its genetic makeup, the extent of metastasis, and other factors—including the patient’s general health and wellness. 

This stage 4 cancer overview will help you understand what this diagnosis means for you or your loved one. Read on for more specific details about what stage 4 cancer is, what metastasis means, and the specifics of diagnosis, treatment, and outcomes. 


A stage 4 cancer diagnosis means that cancer has metastasized. Metastasis is the spread of cancer cells beyond the original tumor to other organs and the body’s lymph nodes.

Lymph nodes are small tissues spread throughout the body that filter and hold white blood cells, the body’s immune cells. They’re linked by a network of vessels (the lymphatic system) that connects to the blood vessels to make up the circulatory system.

Cancerous tumors are clumps of the body’s cells that have grown uncontrollably because of changes in their genes. They act differently than healthy cells, and sometimes some will detach from the tumor, push through the walls of the tissues, and escape into the bloodstream.

These escapees use the blood and lymph vessels to travel to the lymph nodes, where they can burrow into the tissue and set up shop and grow into a new mass. Cells can then escape these masses, jump back into the lymph system and blood vessels, and restart the process—continuing to spread to other lymph nodes and even solid organs. 

Understanding and evaluating cancer’s spread is the basis on which researchers established the TNM—tumor, nodes, and metastasis—classification system to identify, group, and be able to compare the extent to which cancer has grown in any patient and between patients.

For anyone who has been or has had a loved one diagnosed with stage 4 cancer, understanding the stages of cancer, what they mean, and how stage 4 compares to other cancer stages is extremely important. Staging affects patients’ survival rates, treatment options, eligibility for clinical trials, and remission potential.

TNM Classification

Doctors use a classification system developed by the American Joint Committee on Cancer, called the TNM system, to assess a patient’s cancer stage. While the actual breakdown of letters and numbers differs depending on cancer location, the stages have the same three components:

  • T in the classification defines the tumor itself. The T rating ranges from 0 to 4 based on the mass’s size and its spread into the tissue or surrounding organs. The patient’s prognosis is worse if the tumor is bigger and has spread.
  • N defines the spread to the lymph nodes. The N classification runs from 0 to 3. Lymph nodes are important for cancer prognosis, because spread there makes it easier for the cancer to move on to other parts of the body. The further the spread, the higher the N classification number.
  • M stands for metastasis, the spread of cancer to far-flung parts of the body. There are only two M stages—0 or 1. Metastasis to other solid organs means a worse prognosis, since there are more places for the cancer cells to hide from treatment.

An M score of 1 automatically classifies cancer as stage 4, but the T and N classifications also factor into the overall prognosis.

Metastatic cancer does not mean one thing or have one course. The characteristics of the primary tumor, the extent and location of the metastases, and the type and grade of cancer all contribute to determining a patient’s prognosis.

Some cancers have sub-stages within stage 4, typically labeled stage 4A and stage 4B.  For example, stage 4 prostate cancer includes stage 4A, in which cancer has spread to local (also called regional) lymph nodes; and stage 4B, in which spread is more distant and could include metastases in the bones or farther-flung lymph nodes.

Cancers from one location metastasize in similar ways. Here are some examples of common cancers and where their stage 4 malignancies are commonly found.

  • Breast cancer:Bones, brain, liver, and lungs
  • Lung cancer:Adrenal glands, bones, brain, liver, and the other lung
  • Prostate cancer:Adrenal glands, bone, liver, and lungs
  • Colorectal cancer:Liver, lungs, and peritoneum
  • Melanoma:Bones, brain, liver, lung, skin, and muscle.

When cancer metastasizes to another part of the body, doctors still stage it based on its original location. For example, a doctor would stage breast cancer that has spread to the liver and lymph nodes as stage 4 breast cancer with liver metastasis, not stage 4 liver cancer.

Other Classification Systems

Some cancers have specialized staging systems instead of, or alongside, the TNM staging. Some use the familiar stage 1 through 4 ratings, but others use different labeling systems. 

Cervical cancers use a system from the International Federation of Gynecologists and Obstetricians. Blood cancers use the Lugano staging system or, for chronic lymphocytic leukemia, the Rai staging system.

Some more unique cancers also have unique rating systems. Small-cell lung cancers are “limited” or “extensive” based on how far they've spread. The Binet staging system used for chronic lymphocytic leukemia, has three stages: A, B, and C.

Cancers of the brain and central nervous system rarely spread beyond those organs, so they don’t have a formal staging system—instead, doctors use grades to classify tumors.

Grading a Tumor

Another term you might hear is the tumor’s grade—the grade factors into the cancer’s diagnosis, treatment, and staging. After surgery or a biopsy, the doctors will examine the cancerous cells and tissues in the lab and give them a grade by comparing how they look to normal cells.

From this information, the cancer cells get one of three grades: Grade 1 (low grade), grade 2 (intermediate grade), or grade 3 (high grade). A higher-stage cancer is usually also a higher-grade cancer.

If a tumor is low-grade, its cells usually look relatively normal or well-differentiated, and they are typically slower-growing. A high-grade tumor is likely to be more aggressive, look less like a normal cell, and spread quickly. Doctors call these undifferentiated or poorly differentiated tumor cells because they lack the features and structures of normal cells and tissues.


Staging begins when the cancer is officially diagnosed. The patient will probably undergo many tests and procedures during the staging process. These will vary by type of tumor, and they won’t all apply for every cancer. 

There are several standard types of tests that are common when diagnosing and staging cancers:

  • A biopsy is when a doctor cuts off a small piece of the potential tumor. They then look at it under the microscope to determine if it’s cancerous and, if so, give it a grade. These tissue samples can be from anywhere on the body, such as the skin, bone marrow, or breast.
  • Imaging tests, like X-ray, CT, MRI, ultrasound, and PET scans, peer inside the body to visualize a tumor and determine how it affects other organs and blood flow. Without cutting a patient open, these images give the doctor a better idea of a cancer’s size and makeup.
  • Lab tests analyze the proteins and other molecules found in the patient’s blood, bodily fluids, or biopsied tissue samples. Tumor markers and genetic screening of tumor samples can help doctors choose the best treatments, and general blood testing helps monitor the patient’s all-around health.  
  • Endoscopy uses a tube or wire with a small camera to visualize the internal organs—for example, a colonoscopy, bronchoscopy, or laparoscopy. The doctors will use the tube to take pictures and even biopsy a sample. 


A stage 4 cancer diagnosis usually means that the cancer is incurable. In most cases, treatment aims to prolong survival and improve quality of life. Because the cancer has spread throughout the body, it is extremely unlikely that doctors can eradicate it, even with a combination of surgery, chemotherapy, and radiation. 

With rare exceptions, surgery is not a part of stage 4 cancer treatment. That doesn't mean that surgery is entirely out of the question—if the metastases are small and few, surgeons may remove them along with the primary tumor to prolong life and slow the disease’s progression. 

Sometimes, surgery followed by a procedure called hyperthermic intraperitoneal chemotherapy (HIPEC) may increase survival times and disease-free survival by as much as 60%. In this procedure—used when tumors have spread to the abdomen’s lining only—doctors will bathe the body’s core in a heated chemotherapy solution to fight back metastases.

Similarly, newer targeted therapies and immunotherapies can slow stage 4 disease progression when conventional drug therapies no longer work. With advanced genomic testing and immunostaining, doctors can now determine if cancer cells with specific proteins or genetic mutations are “treatable” with targeted drugs, with some able to double survival times in people with diseases like chronic myeloid leukemia.

Today, doctors can treat stage 4 cancers of many kinds with immunotherapeutic drugs, which use antibodies or the patient’s own immune system to attack tumor cells. Immunotherapies exist that can target cancer of the bladder, breast, brain, cervical, colon and rectum, esophagus, head and neck, kidney, liver, lung, ovaries, pancreas, prostate, skin, stomach, uterus, and blood (leukemia, lymphoma, and multiple myeloma).

Some stage 4 cancers (like breast cancer) can go into remission. Remission is when the signs and symptoms of cancer have gone away to the point where doctors declare the patient successfully treated.

Like survival rates, remission rates for stage 4 cancer vary, but remission is not common. Even if a stage 4 cancer patient goes into remission, the cancer will probably come back. In cases like these, doctors prefer to describe stage 4 remission as no evidence of disease (NED).

Palliative Care

One thing that can help patients is a palliative care team. If treatments that might cure the cancer aren’t available, many therapies can improve quality of life. This is called palliative care. These specialized doctors, nurses, and social workers work with seriously ill patients to relieve symptoms and treatment side effects.

It does not mean hospice or end-of-life care; instead, these treatments help improve patients’ stress levels, pain, and discomfort. Beyond caring for the patient’s mental health and making them comfortable, palliative care may include radiation therapy to reduce tumor size and symptoms.

No matter what cancer stage, palliative care can help—it is a treatment modality applied to both life-limiting and non-life-limiting conditions.

Although stage 4 cancer may not be curable, it doesn’t mean that you have terminal cancer. The word terminal is a vague term and one that suggests active dying, usually within months.

Because many people can live for years with stage 4 cancer, the disease is better described as advanced or late-stage until signs of end-stage disease develop.


The prognosis of stage 4 cancer can vary dramatically by the type of cancer. Some stage 4 cancers are more aggressive or have fewer treatment options, while others may be less aggressive and have more treatment options.

For example, nearly 89% of people with stage 4 thyroid cancer live for at least five years, with many living 10 years or more. On the other hand, only around 8% of people with stage 4 mesothelioma will survive for five years or more.

Survival rates help doctors estimate how long a person with a specific diagnosis will survive. The cancer-specific survival rate is the portion of people with a particular diagnosis that survived until a set time. Doctors usually talk about survival in a five-year time frame, but you’ll also hear one-year, two-year, and year survival rates.

The National Cancer Institute has been collecting and publishing cancer statistics from 19 states in their Surveillance, Epidemiology, and End Results (SEER) Program database. The SEER database does not use the TNM staging system. Cancer registries like SEER typically use a three-stage approach:

  • Localized cancers are only in the area in which they first developed. 
  • Regionalcancers have spread to nearby lymph nodes, tissues, or organs.
  • Distant cancers have metastasized to remote parts of the body—these are stage 4 cancers.

The figures below show relative survival rates from the NCI’s SEER database, which monitors cancer incidence and outcomes. The numbers below for the top 12 cancers are the five-year survival rates (relative to similar people without cancer) for a “distant” diagnosis, between the years and

The exceptions are for lymphoma and leukemia, which doctors stage differently. The Non-Hodgkin lymphoma number is the stage IV survival, and the leukemia is the overall five-year relative survival rate (at any stage). 

Stage 4 Distant Cancer Survival Rates
 NumberLocation Survival Rate
1Breast (female)%
Lung and bronchus
4Colon and rectal %
Melanoma (skin)%
Non-Hodgkin lymphoma*
Kidney and renal pelvis
Uterine (endometrial)
10 Leukemia*%
11 Pancreas
12 Thyroid

As you can see, survival rates vary widely by cancer type, grade, genetics, and other traits. A patient’s performance status (PS) also plays a significant role in prognosis and outcomes.

The PS score is a way to define a patient’s ability to perform everyday tasks and uses a classification scale from the Eastern Cooperative Oncology Group (ECOG) of 0 to 5. Other traits—including age, general health, and if the patient is an active or previous smoker—can also affect prognosis.

Can the Cancer Stage Change?

Once diagnosed, a cancer’s stage never changes. Even if the patient improves or gets worse, their cancer is the same as when diagnosed. 

Once diagnosed with stage 4 cancer, you will always have stage 4 cancer. That doesn’t mean that you cannot sustain a long period of disease-free survival.

Part of the reason for this is statistical—stages help scientists track and reevaluate survival statistics and treatment protocols.  But they also let doctors track the efficacy of treatments for your stage.

Doctors use cancer stages to compare patients with similar diagnoses, to more easily study the effectiveness of treatments, to track a person’s cancer progression, and as a way to estimate survival rates for specific cancers. 

Part of the confusion regarding staging status arises from the fact the disease is sometimes re-staged. Re-staging determines if there has been a progression or remission of the disease.

If cancer is re-staged or recurs (marked with an r), doctors keep the initial staging diagnosis and add a new stage to the patient’s diagnosis. New staging diagnoses get differentiated with letters—like c for clinical, p for pathological (after surgery), or y for after treatment.

For instance, stage 2 breast cancer that suddenly spreads to the lungs is “stage 2 breast cancer with lung metastases” rather than stage 4 breast cancer. Similarly, if stage 4 breast cancer meets the definition of remission after treatment, they describe it as “stage 4 breast cancer with no evidence of disease.”

The only exception to this rule is when a patient develops a second primary cancer (one that’s not derived from the first cancer). In this case, the new tumor would be staged and graded separately from the first. Doctors would also compare the cancers’ genes to determine if they’re related.

A Word From Verywell

A cancer diagnosis is a life-changing event, especially when the diagnosis is later-stage cancer. However, stage 4 cancer isn’t a death sentence.

Though survival rates for some cancers are low, they are ever-improving, and doctors and researchers are continually discovering and testing new targeted drugs and immunotherapies. They may be far different in the near future than they are today.

For example, during the s to s, survival rates in women with breast cancer barely budged. But between and , they changed dramatically: average life expectancy nearly doubled from 32 months to 57 months. With rapid advances in next-generation targeted therapies and immunotherapies, those gains are likely to continue.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. National Cancer Institute. Metastatic cancer: When cancer spreads. Updated November 10,

  2. American Cancer Society. Cancer staging. Updated June 18,

  3. National Cancer Institute. Stage IV prostate cancer.

  4. Salvo G, Odetto D, Pareja R, Frumovitz M, Ramirez PT. Revised International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: A review of gaps and questions that remain.Int J Gynecol Cancer. Jun;30(6) doi/ijgc

  5. Zucca E, Pavanello F. ESMO E-LEARNING: The Lugano classification recommendations for Hodgkin's and non-Hodgkin's Lymphoma: staging, response assessment, and follow up. European Society For Medical Oncology.

  6. Koffman B. Rai staging of CLL (chronic lymphocytic leukemia). Chronic Lymphocytic Leukemia Society. Updated March 16,

  7. American Cancer Society. Small cell lung cancer stages. Updated October 1,

  8. American Cancer Society. How is chronic leukemia staged? Updated May 10,

  9. National Cancer Institute. Tumor grade. Updated May 3,

  10. Wu Q, Wu Q, Xu J, Cheng X, Wang X, Lu W, Li X. Efficacy of hyperthermic intraperitoneal chemotherapy in patients with epithelial ovarian cancer: a meta-analysis. Int J Hyperthermia. ;36(1) doi/

  11. Bozic I, Allen B, Nowak MA. Dynamics of targeted cancer therapy. Trends Mol Med. ;18(6) doi/j.molmed

  12. National Cancer Institute. Remission.

  13. Bishop AJ, Ensor J, Moulder SL, et al. Prognosis for patients with metastatic breast cancer who achieve a no-evidence-of-disease status after systemic or local therapy.Cancer. ;(24) doi/cncr

  14. Get Palliative Care. What is palliative care?

  15. National Cancer Institute. Palliative care in cancer. Updated October 20,

  16. National Cancer Institute. Surveillance, Epidemiology, and End Results Program.

  17. National Cancer Institute. Understanding cancer prognosis. Updated June 17,

  18. Eastern Cooperative Oncology Group. ECOG performance status.

  19. Roswell Park. 4 things you might not know about cancer staging. December 30,

  20. Caswell-Jin JL, Plevritis SK, Tian L, et al. Change in survival in metastatic breast cancer with treatment advances: Meta-analysis and systematic review.JNCI Cancer Spectr. ;2(4):pky doi/jncics/pky


4 cancer chemotherapy stage

Chemotherapy is the use of drugs to destroy cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. However, the drugs used for chemotherapy are powerful, and they can still cause damage to healthy cells. This damage causes the side effects that are linked with chemotherapy.

Different types of chemotherapy

Treatment with these powerful drugs is called standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.

How does chemotherapy treat cancer?

Doctors use chemotherapy in different ways at different times. These include:

  • Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant chemotherapy.

  • After surgery or radiation therapy to destroy any remaining cancer cells. This is called adjuvant chemotherapy.

  • As the only treatment. For example, to treat cancers of the blood or lymphatic system, such as leukemia and lymphoma.

  • For cancer that comes back after treatment, called recurrent cancer.

  • For cancer that has spread to other parts of the body, called metastatic cancer.

The goals of chemotherapy

The goals of chemotherapy depend on the type of cancer and how far it has spread. Sometimes, the goal of treatment is to get rid of all the cancer and keep it from coming back. If this is not possible, you might receive chemotherapy to delay or slow cancer growth.

Delaying or slowing cancer growth with chemotherapy also helps manage symptoms caused by the cancer. Chemotherapy given with the goal of delaying cancer growth is sometimes called palliative chemotherapy.

Your chemotherapy plan

There are many drugs available to treat cancer. A doctor who specializes in treating cancer with medication, called a medical oncologist, will prescribe your chemotherapy. You may receive a combination of drugs, because this sometimes works better than only 1 drug.

The drugs, dose, and treatment schedule depend on many factors. These include:

  • The type of cancer

  • The tumor size, its location, and if or where it has spread. This is called the stage of cancer.

  • Your age and general health

  • Your body weight

  • How well you can cope with certain side effects

  • Any other medical conditions you have

  • Previous cancer treatments

Where is chemotherapy given?

Your health care team may give you chemotherapy at the clinic, doctor's office, or hospital. Some types of chemotherapy are given by mouth, and these can be taken at home.

How long does chemotherapy take?

Chemotherapy is often given for a specific time, such as 6 months or a year. Or you might receive chemotherapy for as long as it works.

Side effects from many drugs are too severe to give treatment every day. Doctors usually give these drugs with breaks, so you have time to rest and recover before the next treatment. This lets your healthy cells heal.

For example, you might get a dose of chemotherapy on the first day and then have 3 weeks of recovery time before repeating the treatment. Each 3-week period is called a treatment cycle. Several cycles make up a course of chemotherapy. A course usually lasts 3 months or more.

Some cancers are treated with less recovery time between cycles. This is called a dose-dense schedule. It can make chemotherapy more effective against some cancers. But it also increases the risk of side effects. Talk with your health care team about the best schedule for you.

How is chemotherapy given?

Chemotherapy may be given in several different ways, which are discussed below.

Intravenous (IV) chemotherapy. Many drugs require injection directly into a vein. This is called intravenous or IV chemotherapy. Treatment takes a few minutes to a few hours. Some IV drugs work better if you get them over a few days or weeks. You take them through a small pump you wear or carry. This is called continuous infusion chemotherapy.

Oral chemotherapy. You can take some drugs by mouth. They can be in a pill, capsule, or liquid. This means that you may be able to pick up your medication at the pharmacy and take it at home. Oral treatments for cancer are now more common. Some of these drugs are given daily, and others are given less often. For example, a drug may be given daily for 4 weeks followed by a 2-week break.

Injected chemotherapy. This is when you receive chemotherapy as a shot. The shot may be given in a muscle or injected under the skin. You may receive these shots in the arm, leg, or abdomen. Abdomen is the medical word for your belly.

Chemotherapy into an artery. An artery is a blood vessel that carries blood from your heart to another part of your body. Sometimes chemotherapy is injected into an artery that goes directly to the cancer. This is called intra-arterial or IA chemotherapy.

Chemotherapy into the peritoneum or abdomen. For some cancers, medication might be placed directly in your abdomen. This type of treatment works for cancers involving the peritoneum. The peritoneum covers the surface of the inside of the abdomen and surrounds the intestines, liver, and stomach. Ovarian cancer is one type of cancer that frequently spreads to the peritoneum.

Topical chemotherapy. You can take some types of chemotherapy in a cream you put on your skin. You get your medication at the pharmacy and take it at home.

Other drug treatments for cancer

The traditional drugs used for chemotherapy are an important part of treatment for many cancers. The drugs affect both cancer cells and healthy cells. But scientists have designed newer drugs that work more specifically to treat cancer. These treatments cause different side effects.

Doctors may use these newer cancer drugs as the only drug treatment. But they are often added to traditional chemotherapy. These types of treatment include:

Hormonal therapy. These treatments change the amount of hormones in your body. Hormones are chemicals your body makes naturally. They help control the activity of certain cells or organs. Doctors use hormonal therapy because hormone levels control several types of cancers. These include some breast and prostate cancers.

Targeted therapy. These treatments target and disable genes or proteins found in cancer cells that the cancer cells need to grow.

Immunotherapy. This type of treatment helps your body's natural defenses fight the cancer. Immunotherapy is now an important part of treatment for several types of cancer and will play an increasingly important role in treatment in the future.

Related Resources

What to Expect When Having Chemotherapy

Catheters and Ports in Cancer Treatment

Making Decisions About Cancer Treatment

More Information What is Chemotherapy?

National Cancer Institute: Chemotherapy to Treat Cancer

Stage 4 Colon Cancer Survivor Sandy Kyrkostas: NYP Gave Me Hope

Cancer stages

How to find support

With a stage 4 cancer diagnosis, getting the right support around you is key. Below are some ideas for where to begin in building your support system.

  • Your cancer care team: They are the hub of your cancer care and can serve as great resources. They know that your stress levels, nutrition and other medical issues all affect your cancer treatment. Ask open questions and let them know what you need, even if it’s services beyond what they provide. They can help make a referral for you or get you connected.
  • Counseling: Having time and space to process your feelings and emotions with a mental health professional may be a helpful way to manage the stress that comes with a stage 4 cancer diagnosis and treatment. Consider speaking with a counselor on your own, or with family or a partner, to explore how to manage this stressful time together.
  • Pain clinics and palliative care: Palliative care focuses on treating your symptoms rather than treating the disease. Symptoms of stage 4 cancer often include pain. Your treatment plan should include ways to help you be most comfortable, so speak with your care team about your pain and comfort levels. They may be able to provide additional services or refer you to specialized palliative care.
  • Look for support groups: If you have stage 4 cancer, you’re joining a host of others who are walking a similar path. You’re not alone, and participating in a support group may help you feel more connected and understood. The American Cancer Society has a tool to find local resources for cancer support in your area.

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Staging is a way to describe a cancer. The cancer's stage tells you where a cancer is located and its size, how far it has grown into nearby tissues, and if it has spread to nearby lymph nodes or other parts of the body. Before starting any cancer treatment, doctors may use physical exams, imaging scans, and other tests to determine a cancer's stage. Staging may not be completed until all the tests are finished.

Why does cancer stage matter?

Staging helps your doctor plan the best treatment. This may include choosing a type of surgery and whether or not to use chemotherapy or radiation therapy. Knowing the cancer stage lets your entire health care team talk about your diagnosis in the same way.

Doctors can also use staging to:

  • Understand the chance that the cancer will come back or spread after the original treatment.

  • Help forecast the prognosis, which is the chance of recovery

  • Help determine which cancer clinical trials may be open to you.

  • See how well a treatment worked

  • Compare how well new treatments work among large groups of people with the same diagnosis

When is cancer staging done?

Staging of a cancer can be done at different times in a person's medical care. Here are some information on when and how staging is done. You will notice that these descriptions refer to the "TNM category." This refers to the TNM system of cancer staging, which is explained in more detail further in this article.

Clinical staging. Clinical staging is staging that is done before any treatment begins. Your doctor uses information from physical exams, your medical history, and any x-rays, imaging, scans, or diagnostic tests that you had. They will also use the results of any biopsy that has been done of the cancer, lymph nodes, or other tissue. Clinical staging helps you and your doctor plan the initial steps in your treatment. Clinical staging is indicated with a small "c" before the TNM category.

Pathological staging. Pathological staging is based on the same information as clinical staging, plus any new information gained during surgery if surgery was the first treatment for the cancer. Pathological staging is indicated with a small "p" before the TNM category.

Post-therapy staging. Post-therapy staging is used in cases where surgery is not the first treatment, but other treatments are given before surgery. These treatments can include radiation therapy or drug treatments like chemotherapy, immunotherapy, or hormone therapy. These treatments may be used before surgery to shrink the tumor to make surgery easier. It can also help doctors learn how well treatments work for the cancer to plan further treatment. Post-therapy staging is indicated with a "y" before the TNM category.

When doctors determine the stage of the cancer using the TNM system (see below), every cancer should be staged with clinical staging. After surgery or initial treatments before surgery, pathological staging and post-therapy staging should be used as well. Clinical staging is very important to help plan initial treatment, but pathological staging or post-therapy staging give the most information. This can help your health care team understand your prognosis.

What is the TNM staging system for cancer?

Doctors use the TNM staging system for most types of cancer. The TNM system uses letters and numbers to describe the tumor (T), lymph nodes (N), whether or not the cancer has spread or metastases (M). Each letter and number tell you something about the cancer. The specific definitions for each category are different for each type of cancer that is staged using this system. Learn more specific staging information for each type of cancer.

Tumor (T): The letter T and the number after it describe the tumor by answering these questions:

  • How large is the primary tumor?

  • Does it go into other tissues or organs in the same area?

  • Where is it located?

The letter T is followed by a letter, number, or combination of letters after it. This gives additional information about the tumor. The different letters and numbers that may see include:

  • TX means that there is no information about the tumor or it cannot be measured.

  • T0 means that there is no evidence of a tumor.

  • Tis refers to a tumor "in situ." This means that the tumor is only found in the cells where it started. It has not spread to any surrounding tissue.

  • T1-T4 describe the size and location of the tumor, on a scale of 1 to 4. A larger tumor or a tumor that has grown deeper into nearby tissue will get a higher number.

For some types of cancer, the T stage can be broken down into subcategories for even more detail. This is noted with a lowercase letter, like an "a" or "b", such as "T2b". What these letters mean depends on the type of cancer. A lowercase "m" can also be used to show that there are multiple tumors.

Node (N): The letter N and the number after it describe if cancer has affected the lymph nodes. The lymph nodes are small, bean-shaped organs that help fight infection. They are a common spot where cancer first spreads. This part of the staging system answers these questions:

  • Has the tumor spread to the lymph nodes?

  • If so, which lymph nodes and how many?

Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. The N category only refers to lymph nodes near the cancer (regional lymph nodes). Distant lymph nodes elsewhere in the body are included in the "M" category (see below).

After the letter N, there will be a number from 0 (zero) to 3. N0 means there are no lymph nodes with cancer. Most often, the more lymph nodes with cancer, the larger the number. But for some tumors, the location of the lymph nodes with cancer may determine the "N" category.

Metastasis (M): The letter M and the number after it describes if the cancer has spread. It answers these questions:

  • Has the cancer spread to other parts of the body?

  • If so, where and how much?

If cancer has not spread, the stage is M0. If the cancer has spread to other parts of the body, it is stage M1.

What other factors are used in cancer staging?

For some cancer types, factors other than the TNM categories can be included in the cancer's stage. They may include:

Grade. The grade describes how much cancer cells look like healthy cells. A pathologist will look at the cancer cells under a microscope. A pathologist is a doctor who specializes in evaluating cells, tissues, and organs to diagnose disease. They will compare the cancer tissue with healthy tissue. Healthy tissue often contains many types of cells groups together.

If the cancer looks like healthy tissue and has different cell groupings, it is called a differentiated or a low-grade tumor. If the cancer looks very different from healthy tissue, it is called a poorly differentiated or a high-grade tumor. The cancer's grade may help predict how quickly cancer will spread.

Cancer grade is recorded by the pathologist using the letter "G" with a number from 1 to 3 for most cancers and from 1 to 4 in some. In general, the lower the tumor's grade, the better the prognosis. Different types of cancer have different methods to assign a cancer grade.

Biomarkers. Biomarkers, also called tumor markers, are substances found in higher-than-normal levels in the cancer itself, or in blood, urine, or tissues of some people with cancer. Biomarkers can help figure out how likely some types of cancer are to spread. They can also help doctors choose the best treatment. For some cancers, certain tumor markers may be more helpful for staging than treatment planning. Learn more about testing for biomarkers.

Tumor genetics. Researchers have found ways to figure out the genes involved in many types of cancer. These genes may help predict if a cancer will spread or what treatments will work best. This information may help doctors target treatment to each person's cancer. Learn more about personalized and targeted therapies.

What is cancer stage grouping?

The information collected to determine the TNM stage is used to give a cancer stage specific to you. Most types of cancer have four stages: stage I (1) to IV (4). Some cancers also have a stage 0 (zero). Here is a general description of cancer stage groupings. (Please see the guide for a specific type of cancer for details about its detailed staging system.)

  • Stage 0. This stage describes cancer in situ. In situ means "in place." Stage 0 cancers are still located in the place they started. They have not spread to nearby tissues. This stage of cancer is often curable. Surgery can usually remove the entire tumor.

  • Stage I. This stage is usually a cancer that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.

  • Stage II and Stage III. In general, these 2 stages are cancers that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body.

  • Stage IV. This stage means that the cancer has spread to other organs or parts of the body. It may be also called advanced or metastatic cancer.

What is cancer restaging?

The stage of a cancer given at the time of diagnosis and initial treatments does not change. This is so doctors can understand a person's medical progress, help understand the prognosis, and learn how treatment affects many people.

However, if the cancer comes back or spreads, restaging can be done. This is described with a small "r." For example, rN1 is restaging of the lymph nodes. Usually some of the same tests that were done when the cancer was first diagnosed will be done again. After this, the doctor can assign the cancer a restage or "r stage."

What other staging systems are there?

The TNM staging is mainly used to describe cancers that form solid tumors, such as breast, colon, and lung cancers. Doctors use other staging systems to classify other types of cancer, such as:

  • Central nervous system tumors (brain tumors). Cancerous brain tumors do not normally spread outside the brain and spinal cord. Therefore, only the "T" description of the TNM system applies. No single staging system exists for central nervous system tumors. Learn more about brain tumor staging and prognostic factors.

  • Childhood cancers. The TNM system does not include childhood cancers. Doctors stage most childhood cancers using systems that are specific to that cancer.

  • Blood cancers. The TNM system does not describe blood cancers, such as leukemia, lymphoma, or multiple myeloma. That is because they usually do not form solid tumors. Each blood cancer has its own staging system.

Questions to ask the health care team

  • What tests will I need to have to determine my cancer's stage?

  • What is the stage of the cancer that I have? What does this mean?

  • How did you determine the cancer's stage?

  • What is the cancer's grade?

  • Does the tumor have any genetic mutations?

  • Are biomarkers used in determining the stage of my cancer or in defining my treatment? If so, what are those biomarkers, what are the results, and what does that mean?

  • What does the stage, grade, and biomarker testing mean for my treatment plan or my prognosis?

Related Resources

Cancer Stage: 5 Important Reasons to Know Yours

Reading a Pathology Report

After a Biopsy: Making the Diagnosis


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