Stage 4 Pancreatic Cancer

What Is Stage 4 Pancreatic Cancer?

When malignant or cancerous cells start forming in the tissues of the pancreas, the disease is known as pancreatic cancer. Stage 4 is the most advanced stage of pancreatic cancer in which the tumor, which can be of any size, has spread to distant parts of the body, for example, the liver, lungs, or other organs. [¹]

Pancreatic cancer is very difficult to diagnose in its earliest stages because the organ is located deep in the abdomen, and the cancerous growth cannot be felt during routine medical checkups.

Pancreatic cancer doesn’t show many symptoms in its early stages, and when symptoms are present, they are similar to those produced by other non-cancerous conditions. [²]

What Are the Subtypes of Stage 4 Pancreatic Cancer?

There are no subtypes of stage 4 pancreatic cancer. It is an advanced or metastatic cancer that has already invaded the lymph nodes and spread to other organs of the body. The stage 4 tumor can be of any size. Most people are diagnosed with pancreatic cancer when they have already reached stage 4. Those individuals who are diagnosed earlier can also develop this advanced stage of pancreatic cancer if cancer spreads.

Stage 4 Pancreatic Cancer Staging and Diagnosis

Pancreatic Cancer Staging

In general, the TNM system is used to describe and classify cancers, including pancreatic cancer, where:

• T (tumor) describes the size and location of the tumor
• N (nodes) indicates whether or not it has spread to nearby lymph nodes
• M (metastasis) describes if and how far cancer has spread from its origin

The TNM staging system is used to classify pancreatic tumors to determine whether or not an individual is fit to receive surgery. Many doctors do not encourage performing surgery on pancreatic cancer patients because cancer can rapidly spread to other body parts. An advanced-stage pancreatic cancer is usually inoperable, which is why it is not classified into sub-stages according to the TNM system. [³]

How Common Is Stage 4 Pancreatic Cancer?

Pancreatic cancer is not found until it has progressed to later stages and starts showing symptoms. This is the stage when cancer has advanced to distant sites within the body and can no longer be treated with surgery.

52% of people who are diagnosed with pancreatic cancer find that cancer has spread to distant parts of the body. The late diagnosis dramatically lowers the survival rates of these people. [⁴]

Pancreatic cancer is a rare type of cancer and accounts for just 3% of all cancer cases in the USA. This cancer causes almost 7% of all deaths caused by cancer. [⁵]

How Is Stage 4 Pancreatic Cancer Diagnosed?

When doctors diagnose pancreatic cancer, they plan to identify the location and size of the tumor and whether or not cancer has spread outside the pancreas. People with early-stage pancreatic cancer can show general symptoms like pain in the abdomen and weight loss, or sometimes jaundice, pancreatitis, and changes in the stool.

Regular tests and health checkups cannot detect pancreatic cancer. So when doctors suspect that a patient has advanced-stage pancreatic cancer, they order many imaging tests and biopsies to determine the stage of pancreatic cancer.

Stage 4 pancreatic cancer is diagnosed by;

Physical Examination

Advanced-stage pancreatic cancer can produce a distinctive symptom called “ascites,” which is a fluid buildup in the abdomen. A doctor feels the abdomen for abnormal changes and to see if the patient has pain in the upper part of the abdomen.

CT Scan

A CT scan takes detailed images of the inside of the abdomen and then shows the presence of any tumors or other abnormalities. ASCO recommends that people who are diagnosed with metastatic pancreatic cancer (stage 4 pancreatic cancer) should get computed tomography done of their abdomen, chest, and pelvis. This clinical practice is helpful in evaluating the extent of metastasis. [⁶]

PET Scan

A PET scan is sometimes paired with a CT scan or MRI. PET scans are efficient in determining the metabolic activity of the cancerous cells and are often used for diagnosing pancreatic cancer. The tracer used in PET scans for pancreatic cancer is taken up by the cancer cells, which are then detected by the PET scanner.

ERCP

Endoscopic retrograde cholangiopancreatography is a procedure that involves inserting a thin endoscope via the mouth and stomach into the small intestine. A catheter is then passed through it into the pancreatic ducts. This procedure is more common to place metal stents across the bile duct than for diagnosing pancreatic cancer.

Biopsy

When pancreatic cancer spreads to other organs of the body, biopsy samples are also taken from other areas besides the pancreas, such as the liver. The samples can be taken through the skin or through a surgical process known as “laparotomy.”

Stage 4 Pancreatic Cancer Symptoms

The general symptoms of pancreatic cancer include;

• Jaundice
• Pale colored stools
• Dark colored urine
• Weight loss
• Loss of appetite
• Pain in the upper or middle portion of the abdomen or back
• Fatigue

The metastatic or stage 4 pancreatic cancer can also spread to other body parts and then shows the following symptoms;

If Cancer Has Affected the Lungs

• A persistent cough that worsens at night
• Chest infections
• Coughing up blood
• Breathlessness

If Cancer Has Affected the Liver

• Weight loss and feeling sick
• Ascites
• Discomfort in the right side of the abdomen
• Jaundice.

If Cancer Has Affected the Bones

• Gnawing backache
• Dehydration and abdominal pain due to hypercalcemia
• Weak bones
• Anemia, bruising, and bleeding. [⁷]

Stage 4 Pancreatic Cancer Treatment

Stage 4 Pancreatic Cancer Treatment Options

The common treatment for advanced-stage pancreatic cancer is chemotherapy. Since cancer has already spread to distant body sites, surgery is not recommended to remove pancreatic tumors.

Chemotherapy

Chemotherapy is used to shrink cancer cells and slow down their progression. This type of treatment helps advanced-stage pancreatic cancer patients live longer and have a better quality of life.

The FOLFIRINOX regimen is recommended by ASCO to treat patients with metastatic pancreatic cancer, considering their preference for treatment and support system.

Gemcitabine plus NAB-paclitaxel is also an active regimen used to treat patients with advanced-stage pancreatic cancer. [⁸]

Radiotherapy

Radiotherapy is also used to shrink the cancer cells and relieve symptoms when cancer has invaded other parts of the body. Radiotherapy for other parts of the body where pancreatic cancer has spread is another treatment option for stage 4 pancreatic cancer.

Stereotactic body radiotherapy, or SBRT, is also used to treat pancreatic cancer when the abdomen has already been treated with radiotherapy before. [⁹]

Palliative Chemotherapy

Palliative care focuses on relieving the symptoms produced by advanced-stage pancreatic cancer, such as pain and loss of appetite. When cancer has metastasized to distant body parts, a preferred choice of treatment is palliative chemotherapy which improves the symptoms and improves the quality of life of the patient.

Can Stage 4 Pancreatic Cancer Be Cured?

Pancreatic cancer at stage 4 is incurable. However, many treatment options are available that help patients live longer and a better life with lesser symptoms.

Prognosis: Stage 4 Pancreatic Cancer Survival Rate

Stage 4 Pancreatic Cancer Survival Rate

The five-year survival rate for people diagnosed with pancreatic cancer, which has metastasized to distant body parts, is 3%. This means that 3 out of 100 people live at least five years after their cancer is diagnosed. [⁴]

Stage 4 Pancreatic Cancer Recurrence Rate

Stage 4 pancreatic cancer has a poor prognosis and a five-year survival rate of only 1%. [¹⁰] Even when the curative surgery removes the tumor in the early stages of pancreatic cancer, there is an 80% chance that pancreatic cancer with recur. Cancer with lymph vessels involvement has a greater chance of developing tumor recurrence. [¹¹]

Stage 4 Pancreatic Cancer Growth Rate

Pancreatic cancers spread at a rapid rate and progress to an advanced stage in a short period of time. According to this study, [¹²] a T1-stage pancreatic cancer can grow into T4-stage cancer in just a year, which signifies that pancreatic cancers rapidly progress from early stages to advanced cancers.

Lifestyle Changes for Preventing and Managing Pancreatic Cancer

There is no way to prevent pancreatic cancer since the risk factors of this disease, such as family history, gender, race, and age, cannot be controlled. However, healthcare experts suggest that maintaining a healthy weight, limiting alcohol intake, and smoking cessation can reduce the risk of developing this cancer in your lifetime. [¹³]

Conclusion

Takeaway

Having a stage 4 pancreatic cancer diagnosis can be extremely stressful. However, many treatment options and much support are available to relieve the patients of the symptoms and thus improve their survival rates and quality of life.