Stage 4 pancreatic cancer

This page was reviewed under our medical and editorial policy by

Toufic Kachaamy, MD, Chief of Medicine, City of Hope Phoenix

This page was updated on March 8, 2024.

Pancreatic cancer, which occurs when cancer cells develop in the pancreas, is assigned a stage at the time of diagnosis.

A cancer’s stage number explains whether and where it’s spread. Because pancreatic cancer doesn’t often cause symptoms in the earlier stages, it may not be noticed by patients right away. That’s why pancreatic cancer often isn’t diagnosed until it’s advanced to a more aggressive stage.

This article will explore the following topics:

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What is stage 4 pancreatic cancer?

Stage 4 pancreatic cancer means the disease has spread to other areas of the body. A doctor may refer to this type of cancer as:

  • Stage 4 pancreatic cancer
  • Advanced pancreatic cancer
  • Metastatic pancreatic cancer

Stage 4 pancreatic cancer metastatic sites

Pancreatic cancer may spread to other parts of the body. Some of the most common sites it spreads to include:

  • Lungs
  • Liver
  • Peritoneum (lining of the abdomen)
  • Bones

Stage 4 pancreatic cancer may also spread to the lymph nodes, but this isn’t required for a cancer to be considered stage 4.

Even if this cancer spreads into other parts of the body, it’s still referred to as pancreatic cancer because the pancreas is where it originated.

Stage 4 pancreatic cancer symptoms

Patients with stage 4 pancreatic cancer may experience various symptoms compared to earlier signs of the disease. Symptoms may also vary based on where the cancer has spread, though it most commonly spreads to the liver.

General metastatic pancreatic cancer symptoms may include:

  • Stomach pain
  • Inexplicable weight loss
  • A feeling of being sick and tired
  • A fluid buildup in the abdomen
  • Jaundice, or the yellowing of the eyes and skin

When cancer has spread into the bones, symptoms may include:

  • Weaker bones more susceptible to breaks
  • Bone pain
  • Sore back
  • Anemia, bruising, bleeding or increased infections from low blood cell counts
  • Confusion, sickness, stomach pain, constipation or dehydration from increased blood calcium levels

If cancer is in the spine, it may cause symptoms to the lower body, including:

  • Leg weakness
  • Numbness or paralysis
  • Trouble holding in urination

These symptoms are caused by spinal cord compression and require immediate treatment.

When cancer has spread to the lungs, symptoms may include:

  • Difficulty breathing
  • A cough that worsens at night or produces blood
  • Pleural effusion, which occurs when fluid builds up between the chest wall and lungs
  • Chest infections

Not all advanced pancreatic cancer patients experience all symptoms, and the above symptoms may also be caused by other health issues. If patients notice any unexpected changes to their health, they should consult with their health care provider.

Stage 4 pancreatic cancer treatment

The main treatment for stage 4 pancreatic cancer is chemotherapy, which may be given with or without targeted therapy. Chemotherapy uses medication—consumed orally or given via an injection—designed to kill cancer cells and/or stop their growth.

Chemotherapy for pancreatic cancer may sometimes be combined with targeted therapies at this advanced stage. Targeted therapy uses medication to target specific molecules that cancer tumors need to grow. One such type is immunotherapy. Immunotherapy for pancreatic cancer helps the body’s immune system identify, target and destroy cancer cells.

In some patients, chemotherapy may be combined with clinical trials—research studies that help patients try newer treatment options. Patients undergoing clinical trials may receive access to treatments not yet widely available.

What to expect with metastatic stage 4 pancreatic cancer

For patients with metastatic pancreatic cancer, their cancer care team will talk them through what to expect and which side effects may occur during or after treatment.

Some patients may experience side effects from treatment, but these may be managed through medications. Patients may want to keep a side effect log of when and what they experience so they may share it with their treatment team.

Palliative therapy may also be used at any time during treatment to control symptoms and improve quality of life. Pancreatic palliative therapy options may include:

  • Radiation therapy, which may reduce discomfort by shrinking the tumor
  • Medication to ease nerve pain from a nerve blockage caused by a tumor
  • Surgery or stent placement in ducts or the small intestine to bypass a blockage

Emotional side effects may also occur during cancer treatment. Speaking to a counselor or oncology-trained behavioral therapist may help support mental health through the course of treatment.

Stage 4 pancreatic cancer survival rate

The prognosis for stage 4 pancreatic cancer varies for each patient, as each person’s medical circumstances are unique. For pancreatic cancer that has spread to regional lymph nodes, the five-year relative survival rate is 14.7 percent, according to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program.

For patients with metastatic pancreatic cancer that has spread to distant parts of the body, the five-year relative survival rate is 3.1 percent, according to SEER data.

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Show references
  • American Cancer Society (2019, Feb. 11). Signs and Symptoms of Pancreatic Cancer.
  • National Cancer Institute (2020, Dec. 11). Pancreatic Cancer Treatment (Adult) (PDQ®)–Patient Version.
  • American Cancer Society (2017, Dec. 18). Pancreatic Cancer Stages.
  • Cancer Research UK (2019, Oct. 3). Symptoms of Advanced Cancer.
  • American Society of Clinical Oncology (2022, July). Pancreatic Cancer: Types of Treatment.
  • American Society of Clinical Oncology (2022, July). Pancreatic Cancer: Coping With Treatment.
  • National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Cancer Stat Facts: Pancreatic Cancer.
  • American Society of Clinical Oncology (2021, June). Ascites or Fluid in the Abdomen.
  • American Society of Clinical Oncology (2021, September). Fluid Around the Lungs or Malignant Pleural Effusion.
  • American Cancer Society (2022, March 16). Bone Metastases.
  • American Cancer Society (2020, Sept. 10). Lung Metastases.
  • National Cancer Institute (2019, Sept. 24). Immunotherapy to Treat Cancer.
  • National Cancer Institute (2022, May 31). Targeted Therapy to Treat Cancer.
  • University of Rochester Medical Center: Health Encyclopedia. Bone Metastases: When Cancer Spreads to the Bones.