Stage 4 colon cancer represents the fifth and most advanced stage. This condition is also referred to as metastatic or advanced bowel cancer. Stage 4 bowel cancer is the most advanced form of the disease, where cancer has spread beyond the colon or rectum to distant organs, such as the liver, lungs, or peritoneum. This stage presents significant challenges in management, prognosis, and treatment options.
Besides symptoms related to the abdomen and digestion, you may also notice symptoms associated with the areas where the cancer has spread. At this stage, treatment may concentrate on relieving symptoms.
This article examines everything about stage 4 bowel cancer and what you may expect if diagnosed with stage 4 colon cancer.
What is Stage 4 Bowel Cancer?
Advanced bowel cancer refers to a stage where cancer has disseminated from the bowel to other organs in the body. It may also be referred to as secondary, metastatic, or stage 4 bowel cancer.
Bowel cancer can metastasise when fragments of the tumour detach from the bowel and migrate to another area of the body. The tumour located in the bowel is identified as the primary tumour. The tumour that forms in a different area of the body is referred to as a secondary tumour or metastasis. The liver, lungs, and peritoneum (a thin membrane that envelops the abdominal organs) are the most frequent areas for the spread of bowel cancer.
In less common cases, it may also extend to other body parts like the bones, ovaries, and brain. Even when the cancer has metastasised to other body parts, it is still categorised as bowel cancer, and the involved cells remain bowel cancer cells.
Stages of Bowel Cancer Stage Four
Stage 4 colorectal cancer is broken down into three sub-stages: 4A, 4B, and 4C.
Stage 4A: In this stage, the cancer has spread to one distant area or organ, like the liver, but has not reached the lining of the abdomen (the peritoneum). The cancer spreads through the lymphatic system or the blood.
Stage 4B: Here, the cancer has spread to two or more distant organs but has not affected the abdominal lining.
Stage 4C: In this stage, the cancer has spread to distant organs and also to the lining of the abdomen (the peritoneum).
Symptoms of Stage Four Bowel Cancer
Symptoms of stage 4 colon cancer are typically more intense and apparent compared to earlier stages.
At this advanced stage, you may experience:
- Constipation
- Diarrhoea
- Changes in stool colour or shape
- Rectal bleeding
- Abdominal pain or cramping
- Fatigue
- Unexplained weight loss
- A persistent sensation that your bowels aren’t fully emptying
If the cancer has spread to other parts of the body, additional symptoms may include:
- Difficulty breathing
- Headaches
- Bone pain or fractures
- Jaundice (yellowing of the skin and eyes)
- Swelling in certain areas of the body
Diagnosis of Bowel Cancer Stage 4
Diagnosing colon cancer isn’t always quick—it takes time because doctors need to run several tests to find and confirm cancer. If they do detect cancer, they’ll do additional tests to check if it has spread to other parts of the body.
Here are some common tests used to diagnose colon cancer:
- Physical exam – A doctor checks for any unusual lumps or signs of illness.
- Blood tests – To look for markers that might indicate cancer.
- Colonoscopy – A procedure where a small camera is used to examine the inside of the rectum and colon.
- Biopsy – A small sample of tissue is taken and analysed in a lab to confirm cancer.
- Molecular testing – Helps identify specific traits of the tumour that may affect treatment options.
- Imaging tests (CT, PET, ultrasound, MRI scans) – These scans check if cancer has spread to other areas.
- Chest X-ray – Used to see if the cancer has reached the lungs.
Once all necessary tests are done, the doctor will explain the diagnosis and what it means for the patient.
Treatments of Bowel Cancer Stage Four
Stage 4 colon cancer is harder to treat than earlier stages, but there are still many options to help manage symptoms and extend life. At this stage, treatments focus on controlling the cancer rather than curing it.
Surgery
Surgery alone is unlikely to cure colon cancer that has spread to distant organs like the liver or brain. However, removing part of the colon along with small cancerous growths in other areas can help improve symptoms and may extend life.
Chemotherapy
Chemotherapy is one of the main treatments for stage 4 colon cancer. In some cases, doctors may recommend chemotherapy before surgery to shrink tumours, making them easier to remove. This is known as neoadjuvant chemotherapy.
Targeted Therapy
Targeted therapies are sometimes used alongside chemotherapy. These treatments focus on attacking specific proteins in cancer cells while minimising harm to healthy cells.
Types of targeted therapies include:
- VEGF inhibitors (e.g., bevacizumab/Avastin, ramucirumab/Cyramza) – Block the VEGF protein to stop new blood vessels from feeding the tumour.
- EGFR inhibitors (e.g., cetuximab/Erbitux) – Target the EGFR protein inside cancer cells to slow their growth.
- Anti-PD-1 antibodies (e.g., pembrolizumab/Keytruda, nivolumab/Opdivo) – Help the immune system recognise and fight cancer cells.
The best treatment depends on a person’s health and any previous treatments they’ve received.
Radiation Therapy
Radiation therapy is sometimes used in late-stage colon cancer to help reduce pain and discomfort. While it might temporarily shrink a tumour, it does not usually cure cancer.
Hepatic Artery Infusion
For patients whose cancer has spread to the liver, hepatic artery infusion may be an option. This treatment delivers chemotherapy directly into the liver’s main artery, targeting cancer cells while sparing healthy liver tissue.
Ablation and Embolisation
These treatments are used when small tumours (less than 4 cm) appear in the lungs or liver.
- Ablation—Uses radio waves, microwaves, or alcohol injections (percutaneous ethanol injection, PEI) to destroy cancer cells without damaging nearby tissue.
- Embolisation—Involves injecting substances into blood vessels to block or limit blood flow to tumours in the liver, starving them of nutrients.
Palliative Care
When cancer has spread extensively, surgery and other treatments may no longer be effective. In such cases, some patients choose palliative care, which focuses on comfort rather than aggressive treatment.
Palliative care helps manage pain and other symptoms to improve quality of life, allowing patients to feel as comfortable as possible for as long as they can.
Metastatic Stage 4 Bowel Cancer Survival Rate
The prognosis for stage 4 colorectal cancer varies from person to person, as each individual’s medical situation is unique. According to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, the five-year relative survival rate for colorectal cancer that has spread to nearby lymph nodes is 73.4%.
For cases where the cancer has metastasised to distant organs, the five-year relative survival rate drops to 15.6%, with survival rates differing based on the specific site of cancer spread.
Final Thoughts
A stage 4 bowel cancer diagnosis is undoubtedly overwhelming, but advancements in medicine offer hope for extended survival and improved quality of life. While the prognosis remains guarded, each patient’s journey is unique, and ongoing research continues to bring new possibilities. Support from doctors, caregivers, and communities plays a vital role in guiding this challenging stage of cancer.
Frequently Asked Questions
1. Is Stage 4 colon cancer curable?
It’s very uncommon for stage 4 colon cancer to be completely cured. Treatment options depend on where the cancer has spread, how serious it is, and how big the tumours are. Doctors might suggest a mix of surgery, chemotherapy, targeted therapy, or procedures to destroy cancerous tumours.
2. How long will someone with stage 4 cancer live?
Stage 4 cancer often spreads to many parts of the body, so life expectancy can be just a few weeks or a few months. However, in rare cases, some people might live several months or even a year, whether they receive treatment or not.
3. What is the deadliest cancer?
Lung cancer is the deadliest type of cancer, leading to more deaths than any other kind.
4. How can you reduce your risk of cancer?
Smoking: Smoking causes over 85% of lung cancer deaths.
5. Early detection: Catching cancer early can save lives.
Screening: Getting screened can help find cancer in its early stages.
6. Is chemotherapy worth it for stage 4 cancer?
Chemotherapy might be a treatment option for stage 4 cancer, but whether it’s a good choice depends on the type of cancer, its stage, and the overall health of the patient.
7. Is stage 4 cancer painful?
Like with other stages, cancer can cause pain in stage 4. This might happen if cancer affects nearby tissues or if tumours press on bones, nerves, or organs. Some tumours produce chemicals that can cause pain or trigger the body to feel pain.
