Stage 4 Pancreatic Cancer: Overview and More

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In stage 4 pancreatic cancer, abnormal cells that have become a pancreatic tumor have spread through the bloodstream and form tumors in distant parts of the body, such as the bones or lungs. Also called metastatic pancreatic cancer.

Stage 4 pancreatic cancer is incurable, but palliative care and treatment can help improve quality of life and survival time.

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The American Cancer Society predicts that 60,430 people will be diagnosed with pancreatic cancer in 2021 and 48,220 will die from it. More than half of all people diagnosed with pancreatic cancer are diagnosed at an advanced stage, and the vast majority do not live until five years after diagnosis.

This article examines the two types of pancreatic cancer, their stages, and symptoms. It also explains how healthcare professionals identify and treat stage 4 pancreatic cancer and offers some ideas on how to deal with this diagnosis.

What does stage 4 pancreatic cancer mean?

Healthcare providers use the stages of cancer to describe how the cancer has grown or spread. Stage 4 is the most advanced and by definition means that the cancer has spread throughout the body (metastasized).

A system for staging cancer, called the TNM system , has three components:

  • T (tumor): Depending on the size and spread of the tumor, the T score ranges from T0 to T4. In stage 4 pancreatic cancer, the primary tumor can have any T classification.
  • N (lymph nodes): Stage 4 pancreatic cancer can be classified as N1 (cancer has spread to one or three regional lymph nodes ) or N2 (cancer is in four or more regional lymph nodes). Lymph nodes are structures throughout the body that help filter foreign matter. Your participation makes it easier for cancer to spread to other places.
  • M (metastasis): Metastasis is the spread of cancer to distant organs and lymph nodes. There are only two stages M – M0 or M1. Any pancreatic cancer with an M1 classification is considered stage 4.

Pancreatic cancer most often spreads in the abdominal cavity, which surrounds the organs of the abdomen. It can also spread to the liver, lungs, brain, and bones.

While some healthcare providers use the TNM staging system, others use four categories that describe how far the cancer has spread. Stage 4 is classified as "metastatic."

Your stage versus your actual diagnosis

In fact, if you have a stage 2 pancreatic tumor that has spread throughout your body, you now have a stage 4 tumor. However, this is not exactly what your lab report says.

On paper, the stage of the cancer will always be the same as it was at the time of diagnosis, even if it progresses and spreads. This is so that doctors can understand the progression of your disease. If the stage of the cancer is changed, a new stage will be added to the original stage (labeled "r").

For example, a stage 2 pancreatic tumor can be diagnosed based on a T1, N1, M0 evaluation. If this tumor metastasizes (meaning it is now stage 4) but is otherwise unchanged, it will be classified as T1, N1, rM1. This tells the doctor that your stage 2 tumor has spread to distant parts of your body.

Is stage 4 pancreatic cancer terminal cancer?

Stage 4 pancreatic cancer is incurable and does not have a good prognosis. However, not all cases are defined as end-stage cancer. Terminal means that the patient is actively dying and usually dies within a few months. Stage 4 pancreatic cancer is best described as advanced or advanced stage.

Symptoms of stage 4 pancreatic cancer

One of the reasons pancreatic cancer is diagnosed late is because it is easy to miss.

Although symptoms of an early stage of the disease are possible, they are not common. When they do happen, they are relatively light.

In contrast, symptoms of pancreatic cancer generally only occur when the disease has spread to other organs. So many symptoms are associated with complications caused by metastasis.

For instance:

  • Blood clots : Deep vein thrombosis ( DVT ) can be the first sign of pancreatic cancer. A blood clot in the extremities can cause pain, swelling, and redness.
  • Jaundice : the yellowing of the eyes and skin is caused by the accumulation of bilirubin. This can happen because some nearby pancreatic tumors press against the bile duct and cause a blockage. Other symptoms of jaundice include dark urine, light or oily stools, and itchy skin.
  • Enlarged gallbladder or liver : This is also associated with a build-up of bile.
  • Abdominal or back pain : Tumors that press on other organs or nerves can cause pain.
  • Weight loss and poor appetite : It is common in many cancers, especially pancreatic cancers.
  • Nausea and vomiting : This is due to the pressure of the tumor on the stomach.
  • Diabetes : If cancer damages the insulin-producing cells in the pancreas, it can lead to diabetes.

Be sure to talk to your doctor if you have any of these problems.

Diagnostics

About 95% of pancreatic cancers start in cells that produce digestive enzymes. They are called pancreatic adenocarcinomas (PAC) .

The remaining 5% of cases involve cells that help regulate blood sugar levels. They are called pancreatic neuroendocrine tumors (PNET) and generally have a better prognosis with a 93% 5-year survival rate when there is no spread to other parts of the body.

Staging pancreatic cancer requires many tests and procedures to determine how large the original tumor is and how far it has spread. The tests may differ depending on whether the lab is running for PAC or PNET.

First, blood tests are used to monitor your general health, enzyme tests, and blood cell tests. These tests can detect:

  • High levels of the enzyme amylase in the blood, which may indicate PAC.
  • Abnormal levels of hormones in the blood, including insulin, glucagon, and various peptides, are signs of PNET.
  • Liver function tests , which can help determine the extent of liver cancer.

Tumor markers in your blood can tell your doctor about your cancer. In pancreatic cancer, lower levels of the tumor marker CA 19-9 correlate with better results.

Imaging tests, such as computed tomography (CT) and magnetic resonance imaging (MRI) , can help healthcare providers see a possible tumor and determine if the tumor is affecting other organs and blood flow, and how.

For pancreatic cancer:

  • Multiphase CT scan or CT scan of the pancreas can help visualize the tumor.
  • Ultrasound waves can help analyze the tumor. Endoscopic ultrasound may be more accurate, but it does involve inserting a tube down the throat.
  • Angiography examines the blood vessels around the pancreas and other abdominal organs. This can be done with X-rays or MRIs to see how the cancer has affected the blood vessels.
  • Magnetic resonance cholangiopancreatography uses an MRI machine to noninvasively examine the bile and pancreatic ducts.
  • For endoscopic retrograde cholangiopancreatography (ERCP) , a tube must be passed through the esophagus into the stomach. It is generally used by healthcare professionals to take photographs, take biopsies, or even perform other procedures, such as placing a stent.

A biopsy is when a doctor cuts out a small piece of a possible tumor and looks at it under a microscope to make sure it is cancer. For pancreatic cancer, a doctor can do this after imaging or during surgery.

Summary

About 95% of pancreatic cancers are called pancreatic adenocarcinomas or PACs. The remaining 5% are pancreatic neuroendocrine tumors or PNET. They have two different origins in the pancreas, are diagnosed and treated differently, and can have very different results. Blood tests, images, and biopsy results can be used for diagnosis.

Watch out

Healthcare providers cannot cure stage 4 pancreatic cancer, but they can treat it. The goal of stage 4 pancreatic cancer treatment is to increase life expectancy and reduce symptoms. This could be surgery, chemotherapy, radiation therapy, and / or new drugs, all of which are described here.

Palliative care that relieves symptoms and stress can help improve quality of life for as long as possible.

If you've been diagnosed with stage 4 pancreatic cancer, it's always a good idea to see another specialist. Find a healthcare provider at a National Cancer Institute (NCI) registered cancer center to make sure you are up to date with the latest treatments.

Operation

Since stage 4 pancreatic cancer has spread throughout the body, surgery to completely remove it is not possible. However, healthcare providers can operate on a pancreatic tumor to improve quality of life or relieve pain.

Types of pancreatic cancer surgery include:

  • Whipple operation : removes the head of the pancreas, gallbladder, parts of the stomach and small intestine.
  • Total pancreatectomy : removes the entire pancreas along with the gallbladder, bile duct, spleen, and parts of the stomach, small intestine, and nearby lymph nodes.
  • Distal pancreatic resection: removes only the body and tail of the pancreas, but can also remove the spleen if the tumor invades it.
  • Biliary or gastric bypass: guide the structures of the digestive system through the blockage caused by the tumor. It is performed as palliative care to relieve symptoms and improve the passage of food through the body.
  • Stenting – A stent is inserted to remove accumulated fluids from the blocked area and relieve symptoms. Stents can be placed in the bile ducts or in the duodenum, part of the small intestine.

Chemotherapy

Chemotherapy can improve quality of life and relieve cancer symptoms. It kills cancer cells, but it does it with toxic chemicals and without any criteria. This means that all rapidly dividing cells in the body (eg skin cells, hair cells) can be affected as a result.

There are many chemotherapy drugs available. Here are some of the most commonly used to treat pancreatic adenocarcinoma, by far the most common type of pancreatic cancer:

  • Gemzar (gemcitabine)
  • Abraxane (paclitaxel associated with albumin)
  • 5-fluorouracil
  • Oxaliplatin
  • Irinotecan

Radiation

Radiation kills cancer cells with beams of energy, either locally with an implant or externally. Health care providers often use radiation in combination with chemotherapy to reduce swelling.

Radiation also carries the risk of side effects , including skin changes and hair loss.

Immunotherapy

Immunotherapy supports the immune system in fighting cancer. There are different types, each of which does it differently.

For example, keytruda (pembrolizumab) is a type known as monoclonal antibodies. Some cancer cells have a protein that allows them to trick the immune system and leave them alone, allowing them to grow without interruption. Keytruda helps prevent this, so cancer cells are "exposed" and can be attacked, stopping or slowing their growth.

However, not everyone can use immunotherapy. Only about 1% of pancreatic cancers have specific genetic changes that are the target of current therapies. Most people are also not screened for pancreatic cancer. Genetic testing can benefit people who have a history of familial pancreatic cancer (PFC) because it is associated with a set of specific genetic mutations.

In pancreatic cancer, immunotherapy is rarely used.

Targeted therapy

Targeted therapies are drugs specifically designed to attack cancer cells. Some are designed specifically for adenocarcinoma of the pancreas. Treatments that block the action of the enzyme tyrosine kinase and can help slow cancer growth include:

  • Linparza (olaparib)
  • Rozlitrek (entrectinib)
  • Tarceva (erlotinib)
  • Vitrakvi (larotrectinib)

Clinical trials

You can access other (often experimental) treatment options through clinical trials.

Clinical trials are the way researchers test new drugs and treatments. They complement what is already known about treating disease and can help future patients survive longer.

If you are interested in participating in a study, first talk to your doctor to get as much information as you can about your diagnosis. Then, to find a clinical trial, check the National Cancer Institute Clinical Trials Database and other national databases.

Clinical trials will include new treatments that might not otherwise be available. There is no promise that they will perform better than others, or that they will perform at all, but there is always that opportunity.

Palliative care

It is also important that patients with stage 4 pancreas work with the palliative care team. When treatment does not cure cancer , palliative care methods can improve quality of life. Specialist physicians, nurses, social workers, and other health care providers are working to alleviate cancer symptoms in critically ill patients.

Palliative care is not hospice or end-of-life care; These treatments reduce patients' stress levels and reduce daily discomfort and pain. These may include radiation therapy to shrink the tumor and reduce symptoms. For pancreatic cancer, a palliative care plan may include injections or nerve cuts to treat pain caused by pancreatic cancer.

Summary

Surgery cannot remove a stage 4 pancreatic tumor, but it can be done to improve quality of life. Chemotherapy, radiation therapy, and drugs that target the unique aspects of certain tumors can also be used. Clinical trials offer access to options that are still being investigated. Adding palliative care can help relieve symptoms and relieve stress.

Forecast

Stage 4 pancreatic cancer is aggressive and has several treatment options. Even after treatment, survival is low for more than one to two years. Survival rates help healthcare providers estimate how long a person will live with a diagnosis given how well others have fared with the diagnosis.

Cancer-related survival is the percentage of people with a specific diagnosis who survived up to a specific time. NCI's Surveillance Epidemiology and End Results (SEER) database includes cancer survival statistics for 19 states.

The SEER database does not use the TNM staging system. Instead, they use a three-stage approach, in which stage 4 cancer is classified as either distant cancer or cancer with metastasis to distant parts of the body.

According to SEER, the five-year survival rate for patients diagnosed with distant pancreatic cancer is 3%. This means that 3% of people with metastatic pancreatic cancer are alive five years after diagnosis.

This number depends on age. Patients diagnosed at a younger age are more likely to survive. For example, people under the age of 50 with a diagnosis of distant adenocarcinoma of the pancreas have a 10.5% chance of surviving at least five years.

Survival rates in the table below refer specifically to PAC.

Distant Pancreatic Cancer Survival Rates by Age
Age Survival percentage
Everything 3.0%
Up to 50 10.5%
50-64 3.9%
65 years or older 1.7%
Source: SEER database

According to one study, the 5-year overall survival rate for PNET is 51.3%.

However, survival depends on many factors, including whether the tumor can be removed surgically.

  • The five-year survival rate for people with PNET that has not spread to other parts of the body is 93% from where it started.
  • If the tumor has spread to nearby tissues or regional lymph nodes, the 5-year survival rate is 77%.
  • If the tumor has spread to distant parts of the body, the survival rate is 25%.

There are some limitations to survival. Some people live much longer than the data shows. The rates also do not accurately reflect the impact of advances in care, as they are based on figures from 2010 to 2016.

Summary

Stage 4 pancreatic cancer is a difficult diagnosis. Because cancer is often found in this late stage and after it has spread, it is associated with lower survival rates. However, there is much that healthcare professionals can do to improve the quality of life for people with pancreatic cancer, and new treatments are constantly emerging. Make sure you and your team discuss all the options.

Front facing

The 3% survival rate is undoubtedly hard to hear. Coping with this is critical to quality of life.

Some strategies that can help include:

  • Discuss the options with your hospice team if you are in pain.
  • Receive mental health care to cope with the stress of diagnosis and treatment.
  • Make sure you eat the right foods and have the right medications to help you digest your food. Pancreatic cancer patients often need enzyme supplements to improve digestion.
  • Eat a generally healthy diet and be active if you can. They affect your performance status , an assessment of how easily a patient performs daily tasks, which can affect overall survival and quality of life.
  • Make a will and plan what life will be like for family and loved ones after you leave.
  • Spend time with friends and family.

If you or a loved one has been diagnosed with stage 4 pancreatic cancer, don't be afraid to ask your community for support. You can:

Summary

When it comes to the prognosis for stage 4 pancreatic cancer, you can't do without the numbers. Most people will not live to be five years old, although the outlook may be better for younger people and for people diagnosed with PNET type of this cancer.

It is important to know what type of pancreatic cancer you have, what treatments are available, what to expect during treatment, and to take the next steps that you think are best for you.

Facts matter, but the quality of your life and your sense of well-being are also important. Be sure to familiarize yourself with your palliative care options and keep friends and family close by as they support you during difficult times.

Get the word of drug information

Stage 4 pancreatic cancer is one of the most difficult diagnoses that can be made. Focus on educating yourself and protecting your own concern. Reach out to family and friends to help you move forward. It's time to lean on your support network.

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