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Understanding Stage 4 Cancer
Stage 4 cancer is an advanced cancer. That means the cancer has spread to different areas of your body. Treatment options depend on the type of cancer and may be able to slow the growth of the cancer and improve quality of life.
Most cancer is often described in terms of stages. These stages are usually grouped numerically from 0 to 4, with stage 4 being an advanced cancer. Stages offer information about a cancer's size, location, how far it has spread, and whether it has affected nearby organs or tissues.
Cancer stages are determined by using physical exams, imaging scans, and other tests that can offer information about a cancer's status.
A cancer's stage can also help a medical team decide on a course of treatment and determine how successful a certain treatment might be. For example, an early stage cancer might respond best to surgery and radiation, while a stage 4 cancer might respond better to chemotherapy or targeted therapy.
While cancer staging is important, many factors will affect your outlook. Your age and overall health, how the cancer responds to treatment, and the characteristics of specific cancers all play a role in the outcome.
Stage 4 cancer, or metastatic cancer, is an advanced cancer. This usually means that the cancer has spread beyond its original location into nearby organs or other distant parts of the body.
Although this advanced stage of cancer requires expert care, people may live for several years after treatment. The outlook and treatment options for people with cancer differ based on the specific type of cancer. These differences also affect the overall survival rate.
At stage 4, treatment options depend on the type and location of the cancer, a person's overall health, and the cancer's overall response to treatment. Typically, the goal of stage 4 treatment is to:
Most cancers are typically grouped in stages from 0 to 4, with 4 indicating the most advanced stage of cancer. In general terms, the stages of cancer are:
The cancer stages above are determined after identifying a cancer's TNM stage. The TNM system specifics are different for each type of cancer, but it uses letters and numbers to describe:
Additionally, some cancer types are categorized by grade, usually going from grade 1 to either grade 3 or grade 4. A cancer's grade describes to what degree cancer cells look like healthy cells, with a higher grade indicating a more advanced cancer.
Healthy cell tissue often contains many types of cell groups together. If cancerous tissue looks like healthy tissue with many different cell groups, it's considered a low grade tumor. If the cancerous tissue looks very different from healthy tissue, it's considered a high grade tumor.
Cancer with a higher grade is usually thought to be at risk of spreading more quickly. Different cancer types will have different ways of assigning grades.
The treatment and outlook for people with stage 4 cancer depend on the specific type of cancer being treated. In general, the goals of stage 4 cancer treatment are to stop or slow the cancer's spread, manage cancer symptoms or complications, and improve a person's quality of life.
There are several treatment options available for stage 4 cancer. These methods can either be used individually or as combined treatments, depending on the nature of the cancer.
Survival rates for stage 4 cancer depend on the type of cancer, its grade, how well the cancer responds to treatment, your age, and your overall health.
Here are general stage 4 relative survival rates for common cancer types:
Stage 4 cancer is an advanced cancer. It means that the cancer has spread beyond its original location and into other areas of the body. Stage 4 cancer isn't usually curable, but treatment may improve overall survival and quality of life.
Treatment options and survival rates for stage 4 cancer greatly depend on the type of cancer, how well it responds to treatment, a person's overall health, and several other factors. Treating stage 4 cancer can include a combination of therapies such as surgery, chemotherapy, radiation, immunotherapy, or targeted therapy.
Each type of cancer is different. Work closely with your healthcare team to understand all your options.
Man Diagnosed With Stage 4 Colon Cancer At 29 Shares Symptoms: 'It Hit Me Pretty Hard'
When Brendan Menapace ate, he felt "terrible" and wanted to nap. He noticed blood in his stool and visited his doctor.
Having the support of his partner, family and friends made it easier for Brendan Menapace grapple with his stage 4 colorectal cancer diagnosis at age 29. (Courtesy Brendan Menapace)
"I just turned 29, so I didn't really think colon cancer," the now 30-year-old tells TODAY.Com. "All the symptoms really got worse, so I knew something was wrong, and (I needed) to find an answer." After testing, Menapace learned he had stage 4 colorectal cancer.
"It was definitely surprising," he says. "It hit me pretty hard."
"Textbook" symptomsIn the summer of 2021, Menapace experienced pelvic pain, constipation, bloating and fatigue.
"I would eat and then pretty much immediately would want to lay down," he says. "I felt terrible."
He also noticed blood in his stool and couldn't sit for more than an hour and a half, which he noticed while driving to vacation. After eating, he would feel so awful that he felt drowsy.
"In retrospect, it was pretty much the textbook things they say to look out for," he says.
He visited a doctor who sent him for a colonoscopy in early October 2021. As soon as Menapace woke, he knew it was bad.
"They told me as I was waking up," he says. "There was a plan pretty much immediately."
Two weeks after his test, he started chemotherapy from the end of October until January. Then he underwent 20 radiation sessions to his pelvis until March.
"From there, basically things had shrunk enough that surgery was viable," he says. "But chemo and radiation take a toll on your body, so I was in pretty rough shape."
In May, doctors surgically removed his rectum, part of his colon and lymph nodes, and he received a temporary ileostomy bag as his colon recovered. In July, doctors reversed his ileostomy, and by October, a PET scan showed no evidence of disease.
"Until you hit that five-year mark, you're not considered cured or cancer-free," Menapace says. "Because of the way it spread, it wasn't as simple as just cutting out the tumor or declaring me cancer-free."
Brendan Menapace underwent chemotherapy, radiation and extensive surgery to treat his stage 4 colorectal cancer. (Courtesy Brendan Menapace)
Colon cancer in young peopleA recently published report from the American Cancer Society shows that the rates of colon cancer in young people are increasing. The reason for the increase remains a mystery.
Story continues
"Rates were globally going down in older patients with screening, and we also thought this was one of those cancers that are cancers of aging, which is why you didn't screen somebody until they were 50," Dr. Ursina Teitelbaum, a medical oncologist at Penn Medicine, tells TODAY.Com. "Now we're seeing this trend towards younger and also more left-sided — the descending colon, sigmoid colon and rectum particularly — and we don't really know why."
Teitelbaum says older patients tend to have more cancer on the right side, which is the ascending colon. It's unclear why younger patients see more left-sided problems. But it leads to certain symptoms.
"If it's on the left side or in the rectum, you may have pain with bowel movements or abdominal pain in general. You might have a change in what we see in the caliber of your stool. Instead of a normal-formed stool, you might have a skinny stool," she says. "This is a funny point of conversation because people get uncomfortable talking about their bowel movements. But it's actually really important to pay attention."
Other symptoms include:
Weight loss
Fatigue
Blood in stool
Shortness of breath
Pelvic pain
"I have one younger patient who was a very competitive biker who noticed instead of 100 miles a week, he could only bike 50 miles a week," she says. "It turned out he had rectal cancer and (was) slowly losing blood, and that was the reason."
Brendan Menapace's last chemotherapy treatment lasted for 46 hours and he carried it around in a fanny pack. (Courtesy Brendan Menapace)
Some people feel embarrassed to talk about their bowel movements, even with their doctors, meaning they don't get help as quickly as possible. Other barriers can make it tough for younger people to get a colonoscopy, too, further delaying treatment.
"A lot of younger patients, people in their 30s, 40s, might not even have a primary care physician. They don't have any medical problems. They are perfectly healthy," Teitelbaum explains. "There are other things that are difficult with (colonoscopies). You have to find someone to give you a ride. … You have to take a day off work. You have to have insurance. You have to be able to afford a prep. So, there are a lot of barriers."
Current screening recommendations for colon cancer are, starting at 45, people need to undergo a colonoscopy every 10 years, which recently changed from 50. Teitelbaum believes that both patients and primary care physicians need to be aware that colorectal cancer can occur to younger people.
"The key for now is education and that's not just educating people that are younger, but educating their health care providers that if someone comes in with blood in their stool or some of the symptoms, they might need to move screening for colorectal cancer higher on the differential," she says. "Part of the problems is that hemorrhoids (are) really a common condition."
Finding colon cancer earlier often means surgery alone can remove it. As it metastisizes, it becomes harder to treated.
"Once it spreads beyond to the liver, the chance of it being curable is much lower," she says. "That said, I am happy to say most of the time, even when it's not curable, it's treatable."
With colonoscopies, doctors can detect precancerous polyps and remove them before they become cancer.
"You can intervene and remove a polyp before it becomes cancerous," she says. "That said, not every polyp will become cancerous. So, it's a balancing act."
Brendan Menapace experienced neuropathy when he underwent chemotherapy but is lucky that it stopped after treatment ended. (Courtesy Brendan Menapace)
'Huge learning curve'While Menapace received chemotherapy, he experienced neuropathy, numbness and tingling from nerve damage. As soon as treatment stopped, these symptoms went away. He has had to adjust to not having a rectum.
"It has been a huge learning curve and just the trauma to my colon and lower digestive system — things are never going to be the same," he says. "There's a new normal that I'm working toward and that takes a lot of work in its own right. I have to be careful eating."
He returned to work and exercise, resuming as much of a "normal life" as he can.
"When I leave the house, I have to know where a bathroom is. … It's something in the back of my head, and I have to think about something that I never had to before," he says. "It's hard to fathom the idea of something being different forever."
With the help of his partner, friends, family and therapy, Menapace is trying to grapple with the changes he faces due to cancer. He encourages others to talk about their symptoms with their doctors, no matter how strange it might feel.
"You're trained not to talk about your poop. You're trained not to talk about your butt. This is not (what you talk about) in polite society. At first, I would rely on euphemisms and be kind of fake and make jokes," he says. "If you're not detailed on what you're going through, you're not going to paint the right picture for your care team. You're not going to get the right care."
This article was originally published on TODAY.Com
Man Diagnosed With Stage 4 Colon Cancer At 29 Shares Symptoms And Treatment Journey
When Brendan Menapace ate, he felt "terrible" and wanted to nap. He noticed blood in his stool and visited his doctor.
Having the support of his partner, family and friends made it easier for Brendan Menapace grapple with his stage 4 colorectal cancer diagnosis at age 29.Courtesy Brendan Menapace "I just turned 29, so I didn't really think colon cancer," the now 30-year-old tells TODAY.Com. "All the symptoms really got worse, so I knew something was wrong, and (I needed) to find an answer." After testing, Menapace learned he had stage 4 colorectal cancer.
"It was definitely surprising," he says. "It hit me pretty hard."
"Textbook" symptomsIn the summer of 2021, Menapace experienced pelvic pain, constipation, bloating and fatigue.
"I would eat and then pretty much immediately would want to lay down," he says. "I felt terrible."
He also noticed blood in his stool and couldn't sit for more than an hour and a half, which he noticed while driving to vacation. After eating, he would feel so awful that he felt drowsy.
"In retrospect, it was pretty much the textbook things they say to look out for," he says.
He visited a doctor who sent him for a colonoscopy in early October 2021. As soon as Menapace woke, he knew it was bad.
"They told me as I was waking up," he says. "There was a plan pretty much immediately."
Two weeks after his test, he started chemotherapy from the end of October until January. Then he underwent 20 radiation sessions to his pelvis until March.
"From there, basically things had shrunk enough that surgery was viable," he says. "But chemo and radiation take a toll on your body, so I was in pretty rough shape."
In May, doctors surgically removed his rectum, part of his colon and lymph nodes, and he received a temporary ileostomy bag as his colon recovered. In July, doctors reversed his ileostomy, and by October, a PET scan showed no evidence of disease.
"Until you hit that five-year mark, you're not considered cured or cancer-free," Menapace says. "Because of the way it spread, it wasn't as simple as just cutting out the tumor or declaring me cancer-free."
Brendan Menapace underwent chemotherapy, radiation and extensive surgery to treat his stage 4 colorectal cancer.Courtesy Brendan Menapace Colon cancer in young people A recently published report from the American Cancer Society shows that the rates of colon cancer in young people are increasing. The reason for the increase remains a mystery.
"Rates were globally going down in older patients with screening, and we also thought this was one of those cancers that are cancers of aging, which is why you didn't screen somebody until they were 50," Dr. Ursina Teitelbaum, a medical oncologist at Penn Medicine, tells TODAY.Com. "Now we're seeing this trend towards younger and also more left-sided — the descending colon, sigmoid colon and rectum particularly — and we don't really know why."
Teitelbaum says older patients tend to have more cancer on the right side, which is the ascending colon. It's unclear why younger patients see more left-sided problems. But it leads to certain symptoms.
"If it's on the left side or in the rectum, you may have pain with bowel movements or abdominal pain in general. You might have a change in what we see in the caliber of your stool. Instead of a normal-formed stool, you might have a skinny stool," she says. "This is a funny point of conversation because people get uncomfortable talking about their bowel movements. But it's actually really important to pay attention."
Other symptoms include:
"I have one younger patient who was a very competitive biker who noticed instead of 100 miles a week, he could only bike 50 miles a week," she says. "It turned out he had rectal cancer and (was) slowly losing blood, and that was the reason."
Brendan Menapace's last chemotherapy treatment lasted for 46 hours and he carried it around in a fanny pack.Courtesy Brendan Menapace Some people feel embarrassed to talk about their bowel movements, even with their doctors, meaning they don't get help as quickly as possible. Other barriers can make it tough for younger people to get a colonoscopy, too, further delaying treatment.
"A lot of younger patients, people in their 30s, 40s, might not even have a primary care physician. They don't have any medical problems. They are perfectly healthy," Teitelbaum explains. "There are other things that are difficult with (colonoscopies). You have to find someone to give you a ride. … You have to take a day off work. You have to have insurance. You have to be able to afford a prep. So, there are a lot of barriers."
Current screening recommendations for colon cancer are, starting at 45, people need to undergo a colonoscopy every 10 years, which recently changed from 50. Teitelbaum believes that both patients and primary care physicians need to be aware that colorectal cancer can occur to younger people.
"The key for now is education and that's not just educating people that are younger, but educating their health care providers that if someone comes in with blood in their stool or some of the symptoms, they might need to move screening for colorectal cancer higher on the differential," she says. "Part of the problems is that hemorrhoids (are) really a common condition."
Finding colon cancer earlier often means surgery alone can remove it. As it metastisizes, it becomes harder to treated.
"Once it spreads beyond to the liver, the chance of it being curable is much lower," she says. "That said, I am happy to say most of the time, even when it's not curable, it's treatable."
With colonoscopies, doctors can detect precancerous polyps and remove them before they become cancer.
"You can intervene and remove a polyp before it becomes cancerous," she says. "That said, not every polyp will become cancerous. So, it's a balancing act."
Brendan Menapace experienced neuropathy when he underwent chemotherapy but is lucky that it stopped after treatment ended.Courtesy Brendan Menapace 'Huge learning curve' While Menapace received chemotherapy, he experienced neuropathy, numbness and tingling from nerve damage. As soon as treatment stopped, these symptoms went away. He has had to adjust to not having a rectum.
"It has been a huge learning curve and just the trauma to my colon and lower digestive system — things are never going to be the same," he says. "There's a new normal that I'm working toward and that takes a lot of work in its own right. I have to be careful eating."
He returned to work and exercise, resuming as much of a "normal life" as he can.
"When I leave the house, I have to know where a bathroom is. … It's something in the back of my head, and I have to think about something that I never had to before," he says. "It's hard to fathom the idea of something being different forever."
With the help of his partner, friends, family and therapy, Menapace is trying to grapple with the changes he faces due to cancer. He encourages others to talk about their symptoms with their doctors, no matter how strange it might feel.
"You're trained not to talk about your poop. You're trained not to talk about your butt. This is not (what you talk about) in polite society. At first, I would rely on euphemisms and be kind of fake and make jokes," he says. "If you're not detailed on what you're going through, you're not going to paint the right picture for your care team. You're not going to get the right care."
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