How to Deal With Stage 4 Colon Cancer Symptoms and Prognosis

Managing Pain and Discomfort While Deciding on a Course of Treatment

Stage 4 colon cancer, also known as metastatic colon cancer, is an advanced cancer that has spread beyond the colon. However, stage 4 colon cancer symptoms like diarrhea, constipation, and pain can often be treated and managed.

The five-year survival rate for stage 4 colon cancer is 13%. While it can be hard to confront the diagnosis, it’s important to discuss your prognosis with your healthcare provider. Knowing your options and what to expect can help you develop a treatment plan.

This article discusses how to deal with stage 4 colon cancer symptoms and prognosis. It covers different treatment options and answers questions you and your loved ones may have.

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What Is Stage 4 Colon Cancer?

Stage 4 colon cancer is the most advanced stage of the colon cancer. It is also known as metastatic colon cancer.

By definition, stage 4 colon cancers are those which have traveled beyond the colon (metastasized).

There are several different regions in which this occurs. Not all stage 4 colon cancers are alike, so sometimes statistics regarding survival can be misleading.

Stage 4 colon cancer is further classified into three stages based on how it has spread:

  • Stage 4A: Cancer has spread to one area or organ that is not near the colon.
  • Stage 4B: Cancer has spread to more than one area or organ that is not near the colon.
  • Stage 4C: Cancer has spread to the tissue that lines the wall of the abdomen and possibly other areas or organs.

Symptoms of Stage 4 Colon Cancer

Stage 4 colon cancer symptoms include:

  • Abdominal pain
  • Blood in the stool that looks dark brown or black
  • Constipation, diarrhea, narrowing of the stool, and other persistent bowel changes
  • Weight loss without trying
  • Rectal bleeding with bright red blood
  • Unexplained fatigue

You may have additional symptoms depending on where the cancer has spread, such as the liver, lung, brain, or bones.

For example, if the disease has spread to the liver, potential symptoms can include jaundice and swelling of the belly. If colon cancer has spread to the lung, it can cause shortness of breath.

Many people with stage 4 cancer also experience anxiety and depression.

Managing Colon Cancer Symptoms

Symptoms of stage 4 colon cancer can often be managed with medications.

Constipation can be treated with stool softeners and laxatives. Weight loss can be managed with nutritional support, including a feeding tube. Fatigue from anemia can be treated with iron supplements and blood transfusions.

Pain is often a big concern for people with stage 4 cancer. Cancer pain is commonly managed with the following:

  • Pain medicines (prescription, over-the-counter drugs, and complementary medicines)
  • Tricyclic antidepressants or anticonvulsants (for nerve-based pain)
  • Interventional procedures (epidurals, nerve blocks)
  • Physical or occupational therapy
  • Counseling and biofeedback

Diagnosis

Stage 4 colon cancer is diagnosed using imaging studies and lab tests, including:

  • Biopsy
  • Colonoscopy
  • DNA stool test
  • Sigmoidoscopy 
  • Virtual colonoscopy

Tests used to determine if colon cancer has metastasized (spread) include: 

  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan
  • Chest X-ray
  • Surgery
  • Lymph node biopsy
  • Complete blood count (CBC)
  • Carcinoembryonic antigen (CEA) assay 

Deciding on Treatment

For most people, stage 4 colon cancer is not considered curable. However, it can almost always be treated. People can live many months and even years with stage 4 colon cancer.

The amount of itme a person lives after the diagnosis depends on many things, including where the cancer has spread and how the individual responds to available treatments.

The most common site to which colon cancer spreads is the liver (liver metastases). It may also spread to the lungs, the brain, and the peritoneum (the membranes which surround the abdominal cavity) as well as other areas.

While making decisions, it's important to note that there has been a new approach to treating colon cancer in recent years.

In the past, stage 4 colon cancers were all treated the same, no matter where the cancer had spread. This has changed.

Now, when a person has only a few or small areas of metastases, treatment of the metastases may be considered. Single or only a few metastases are referred to as "oligometastatic"; the term "oligo" means few.

For those who have metastatic colon cancer with only a few metastases to the liver or lungs, removing the metastases can sometimes increase the chance of long-term survival.

For many people, however, these treatments are not possible, and the focus of treatment becomes trying to control cancer to extend life while emphasizing the quality of life.

Learning About Your Prognosis

Among the first things you will discuss with your healthcare team is how much information you want about your prognosis. Prognosis refers to the possible course of the disease and how much time you have to live.

Some people want very specific information regarding how long they might live with stage 4 colon cancer. Other people prefer not to know these details.

Even if you want as much information as possible, keep in mind that predicting how long someone will live with stage 4 colon cancer is not exact. Some people live much longer than expected. Others live for a shorter time.

Your healthcare provider may give you a range of time that they expect you will live. This is their best guess, which is based on your particular case.

The most important thing to know is that you can learn as much or as little as you want about your prognosis. It is up to you and you can communicate that to your healthcare team.

What Does Your Family Want to Know?

When making your decision about details, of course, it can be important to think about those who love you and may help care for you.

Many family members want complete information about how long a loved one may live after being diagnosed with stage 4 colon cancer. Other family members may find this information very upsetting. They may not want to hear it.

Make sure your healthcare provider knows who in your family wants (or needs) complete information and who does not.

Your healthcare provider can make a note in your chart describing your goals for information sharing about your cancer treatment. This way, everyone on the healthcare team will be on the same page during appointments.

Being diagnosed with stage 4 colon cancer can make you feel out of control. Knowing your options regarding information sharing about your cancer, your treatment decisions, and end-of-life care decisions will help you move forward at a difficult time.

Survival With Stage 4 Colon Cancer

Predictions about survival with stage 4 colon cancer are based on statistics, and people are not numbers. In addition, survival statistics are, by definition, always a few years old.

The 5-year survival rate for a disease will give you an estimate of how long someone may have lived who was diagnosed five years ago.

How someone does today with colon cancer may be very different than how someone may have done even just five years ago.

With recent advances in cancer treatment and many new cancer drugs, such as targeted therapies and immunotherapy, being studied in clinical trials, these numbers are expected to change.

It's important to understand this changing course of cancer medicine when you make your decisions.

If you talk to someone, perhaps a neighbor or another family member, who dealt with colon cancer in the past, the approach to treatment may be very different now.

When people comment on others who have had the disease (which will almost certainly occur), you may want to gently remind them (or at least remind yourself) that treatments are changing.

Better treatments are available for colon cancer than we had even two years ago, and long-term survival rates—even with stage 4 disease—are improving.

The current 5-year survival rate for stage 4 colon cancer, according to the American Cancer Society, is 13%. However, a 2017 study found survival rates for those with stage 4 colon cancer that metastasized to the liver and were candidates for removal of the liver metastases at the same time as colon surgery improved to up to 70%.

More people are living longer with stage 4 colon cancer than ever before. If you have colon cancer with liver metastases that are treatable, there are many people who are living proof that sometimes stage 4 colon cancer is survivable.

MD Anderson Cancer Center has a colon cancer survival calculator which takes into account cancer stage, cancer grade, age, ethnicity, and sex,

Of course, even with these variables, survival can vary considerably based on other medical conditions you may have, the specific treatments you receive, and the molecular profile of your tumor.

When to Stop Treatment

While we have better treatments than in the past, and sometimes can even treat metastases, we know that many people with stage 4 colon cancer will reach a time at which the risks and side effects of treatment outweigh the benefits.

The advent of new treatments is a double-edged sword. These newer treatments can extend life and provide options not available just a few short years ago.

In the past, we often simply ran out of treatments to offer, but today we have reached a point in which the choice to discontinue treatments often needs to be an active decision. If you are at this point in your journey, make sure to ask a lot of questions and carefully contemplate the answers.

In addition to having to make decisions about when to stop treatment, people can consider taking part in clinical trials—some of which have been changing the outlook for stage 4 colon cancer considerably. It's important to learn all you can about your cancer.

Palliative Care

If you've decided to stop active treatment for your cancer, it does not mean that you will not have any treatments.

Palliative care for colon cancer addresses comfort rather than cure but may, at times, include radiation therapy, chemotherapy, or even surgery.

Pain management is very important, as well as treatments aimed at reducing abdominal symptoms (such as constipation or bowel obstructions), lack of appetite, anemia, and anxiety and depression, all of which can accompany an advanced cancer diagnosis.

Hospice Care

It can be difficult to bring up a discussion about hospice care. Cancer patients and their families may hope to protect each other by ignoring this discussion. Even healthcare providers are reluctant to bring up the issue.

What is important to know, however, is that choosing hospice care does not mean that you are giving up. With hospice care, people are still treated.

Instead of focusing on treatments to attack cancer, hospice care focuses on treatments to control the symptoms of cancer and hopefully improve your quality of life.

Many people admit that after choosing hospice care, they wish they had done so earlier. In order to receive hospice care, you will need a note from your healthcare provider estimating that you have six months or less to live.

If you live beyond the six months period, that's wonderful! You are never "penalized" for choosing hospice care too soon, and at that time you could choose to renew your hospice care for another six months, if you need it.

Hospice care does not mean you are giving up hope. It means that you are choosing to hope for the best quality of life possible in the days you have left.

Finding Support

Your healthcare team may include a surgeon and a radiation oncologist, along with your medical oncologist. And palliative care specialists are often called upon to help people cope with symptoms of the disease.

Of course, the most important member of your cancer care team is you.

Becoming involved in a colon cancer support community—ideally, one in which you can communicate with other people coping with stage 4 cancer—offers a source of support and can be invaluable in learning about the latest research on the disease.

If you have chosen to stop treatment, expect people to respect your decision. This has to be your decision alone, and unfortunately, many people are begged by loved ones to continue treatment even when the side effects far outweigh any benefits.

That said, reach out to your friends and family for support. Not everyone is comfortable being around a person with advanced cancer, and your relationships may change; some close friends may distance themselves while new friends become closer.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Ohio State University. Colon cancer stages.

  3. National Cancer Institute. Metastatic cancer: When cancer spreads.

  4. National Cancer Institute. Colon cancer treatment (PDQ) – Health Professional Version. Stage IV and recurrent colon cancer treatment.

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Additional Reading

By Suzanne Dixon, MPH, RD
Suzanne Dixon, MPH, MS, RDN, is an award-winning registered dietitian and epidemiologist, as well as an expert in cancer prevention and management.