Metastatic colorectal cancer (stage 4)

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was reviewed on April 13, 2022.

Cancer cells may break away from a tumor in the colon or rectum and spread to other parts of the body through the bloodstream or lymphatic system. These cells may settle and form new tumors on a different organ. Even though the cancer has spread to a new organ, it is still named after the part of the body where it originated. So colorectal cancer that spreads, or metastasizes, to the lungs, liver or any other organ is called metastatic colorectal cancer or stage 4 colorectal cancer.

Approximately 35 percent of colorectal cancers are diagnosed before the cancer has spread beyond the site of origin. About 36 percent of colorectal cancers are diagnosed when the cancer has spread to nearby lymph nodes, and 23 percent are diagnosed after the cancer has spread to distant tissues or organs.

Stage 4 colorectal cancer metastatic sites

The most common site of metastases for colorectal cancer, which includes colon cancer or rectal cancer is the liver. Colorectal cancer cells may also spread to the lungs, bones, brain or spinal cord. If a patient has been treated for colorectal cancer and cancer cells have been found in these areas, it may be a sign that the original colorectal cancer has spread. Metastatic colorectal cancer is different from recurrent colorectal cancer. Recurrent colorectal cancer is cancer that returns to the same part of the colon or rectum after treatment, rather than spreading to other parts of the body.

Treatment for stage 4 colorectal cancer

Treatment options may vary depending on where the cancer has spread, but they may include surgeryradiation therapychemotherapy and/or targeted therapy.

Treatment for metastatic colorectal cancer that spreads to the liver

Since the colon and rectum are so close to the liver, the liver is the most common site for colorectal cancer to spread.

While treatments for such cases are not generally considered curative, they may help improve quality of life. If the cancer has spread to the liver, the most commonly used treatment options include those listed below.


If the cancer has only spread to a small area of the liver, it may sometimes be removed surgically. Often, the liver tumor may be extracted at the same time as the colon cancer.


Chemotherapy may be used when the liver tumor is too large to be removed surgically. The care team will let the patient know exactly which chemotherapy drugs are appropriate for his or her cancer type. In some cases, a pump is inserted inside the body that delivers chemotherapy directly to the liver tumor. This is known as hepatic artery infusion.

Targeted therapies

Targeted therapies may be used in conjunction with chemotherapy or on their own. Like chemotherapy, targeted therapy drugs also enter the body via the bloodstream, but can more specifically target proteins and genes that are involved with the growth of cancer cells.

Ablation and embolization

Metastatic colorectal cancer in the liver can also be treated through ablation or embolization. Radiofrequency ablation (RFA) uses high-frequency radio waves to kill cancer cells. With embolization, the care team injects a substance straight into the artery in the liver to halt or greatly reduce its blood flow.


If applicable to the genetic makeup of a person's cancer type, immunotherapy for colorectal cancer may be an option. This treatment involves a medication that helps the body’s immune system identify and destroy cancer cells.

Clinical trials

Researchers are constantly working on ways to improve treatments for patients with metastatic or stage 4 colorectal cancer in the liver. For example, liver transplants may be an option for some patients with metastatic colon cancer.

To learn about newer treatment options being tested, speak with the care team about clinical trials. These may present opportunities to receive brand-new medical treatments and the highest quality of care, while also contributing to medical research.

Metastatic (stage 4) colorectal cancer survival rate

The prognosis for stage 4 colorectal cancer varies for each patient, as each person’s medical circumstances are unique. For colorectal cancer that has spread to regional lymph nodes, the five-year relative survival rate is 73.4 percent, according to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program.


For patients with metastatic colorectal cancer that has spread to distant parts of the body, the five-year relative survival rate is 15.6 percent, according to SEER data. Survival rates are further broken down based on the site of the cancer.


Stage 4 colon cancer survival rate


The average five-year relative survival rate for metastatic colon cancer is 72 percent for regional cancer and 13 percent for distant cancer, according to the American Cancer Society (ACS).

Stage 4 rectal cancer survival rate

For patients with metastatic rectal cancer, the five-year survival rate estimate is 74 percent for regional cancer and 17 percent for distant cancer, according to the ACS.

Keep in mind that the survival rate for metastatic colorectal cancer depends on a variety of factors, including the patient's age, overall health and the extent of the disease, so always talk to the care team about the patient's individual prognosis.

Next topic: What are the stages of colorectal cancer?

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Show references
  • American Cancer Society (2023, Jan. 26). Treatment of Colon Cancer, by Stage.
  • American Cancer Society (2020, June 29). Ablation and Embolization for Colorectal Cancer.
  • UC Health (2020, June 10). Region’s First Liver Transplant for Isolated Metastatic Colon Cancer.
  • American Cancer Society (2023, March 1). Survival Rates for Colorectal Cancer.