10 Dec, 2025
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10 Dec, 2025
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This article is medically reviewed by Dr. Biplab Mishra, Consultant - GI Oncosurgery, HCG Aastha Cancer Centre, Ahmedabad.
Being diagnosed with stage 4 pancreatic cancer is overwhelming.
“How serious is stage 4 pancreatic cancer?” is a common question asked by our patients.
A comprehensive understanding of the seriousness of the disease allows patients and their family members to make informed decisions. It is important to understand the diagnosis, available management approaches, and ways to relieve symptoms.
Metastatic pancreatic cancer is the stage of pancreatic cancer in which the cancer is not localized and spreads to distant organs, such as the lungs, liver, or peritoneum. This is an advanced stage of pancreatic cancer.
For metastatic pancreatic cancer, surgery is usually not advised because it does not improve survival and carries significant morbidity.
Most pancreatic cancers are diagnosed in their advanced stages because early-stage symptoms usually mimic the symptoms of less serious diseases and thus are often ignored. Patients with stage IV (metastatic) cancer have a poor prognosis. The median survival duration is usually < 1 year.
Researchers who studied the stage 4 pancreatic cancer survival rate by age suggest a relatively higher survival rate in otherwise healthy young people.
A multimodal treatment approach, including chemotherapy, targeted therapy, and palliative and supportive care, is usually prescribed to relieve the symptoms and prolong survival.
The process of spreading the pancreatic cancer to distant organs usually involves complex steps, and the process is known as metastasis.
For metastatic pancreatic cancer to develop, tumor cells initially detach from the primary pancreatic tumor by undergoing epithelial-to-mesenchymal transition. This transition allows them to lose their adhesive properties and provides enhanced mobility and invasiveness.
These malignant cells degrade the surrounding extracellular matrix to invade the nearby tissues. These cancer cells circulate through the bloodstream after invading the lymphatic or blood vessels.
Lymphatic involvement refers to the spread to regional and distant lymph nodes. Hematogenous spread leads primarily to the liver via the portal venous system and lungs. Perineural invasion allows cancer cells to spread along nerve sheaths beyond the pancreas. Direct extension occurs locally to adjacent organs like the duodenum, stomach, colon, or major blood vessels.
Stage IV pancreatic cancer will need a relatively aggressive treatment regimen when compared to early-stage pancreatic cancers.
The symptoms of metastatic pancreatic cancer are due to the primary tumor and its spread to the distant organs, such as the bones, lungs, liver, or peritoneum. Commonly observed stage 4 pancreatic cancer symptoms include:
Determining the stage of cancer is important to provide optimal treatment by creating an appropriate treatment strategy. It improves overall disease outcomes.
The oncologists usually use two types of staging systems to detect stage IV pancreatic cancer. The number system indicates stages I-IV, and the TNM system includes tumor, node, and metastasis.
The number system categorizes the cancer based on its spread. Stage IV suggests that the cancer is no longer localized and has spread to the distant organs, such as the liver or the lung.
The TNM system provides a detailed classification: T (tumor) is suggestive of the size and extent of the tumor, N (node) assesses regional lymph node involvement, and M (metastasis) indicates whether distant metastasis is present.
Being diagnosed with stage IV suggests that the tumor is of any size, has any lymph node involvement, and has metastasized to distant organs. To confirm the staging, oncologists use various imaging techniques, such as CT Pancreatic protocol, MRI, and PET-CT scans, along with biopsy.
Upon receiving a conclusive diagnosis of pancreatic cancer, it is normal for patients to have questions like, “How long will I live with stage 4 pancreatic cancer?” or “What are the treatment options available?”
Treatment for stage IV (metastatic) pancreatic cancer requires an aggressive and comprehensive treatment plan. The treatments usually aim to prolong survival and alleviate symptoms. The chances of a cure at this stage are very low. The pancreatic cancer stage 4 treatment options include:
Chemotherapy: Chemotherapy (Folfirinox and Gemcitabine with Nab-Paclitaxel) is the main treatment for patients diagnosed with stage IV (metastatic) pancreatic cancer. These drugs slow the tumor growth, reduce symptoms, and improve survival. Chemotherapy targets the rapidly dividing cells throughout the body.
Targeted therapy: This therapy targets specific genetic mutations or pathways that are vital for tumor growth and proliferation. For instance, PARP inhibitors are used in patients with BRCA mutations. KRAS G12C inhibitors like sotorasib and NTRK fusion inhibitors like Larotrectinib are emerging therapies. Because of the targeted approach, the side effects of targeted therapy are usually fewer than those of conventional chemotherapy.
Immunotherapy: Immunotherapy is an emerging option in the management of stage IV (metastatic) pancreatic cancer. Pembrolizumab is used for MSI-H/dMMR cancers. However, its use is relatively limited in this clinical setting. It enhances the body's ability to recognize and attack cancer cells.
Supportive Care: Pain management with opioids, nerve blocks, and patient-controlled analgesia is recommended. Nutritional support with pancreatic enzyme supplementation for malabsorption and dietary counseling. Endoscopic stenting for relieving jaundice and pruritus. Treatment of nausea, vomiting, constipation, and diarrhea. Finally, psychological and emotional support.
Surgery: It has a palliative role to relieve symptoms caused by primary tumors, such as biliary or gastric outlet obstruction, but it is not curative.
Radiation therapy: For pain and local control in symptomatic metastatic sites.
Stage IV (metastatic) pancreatic cancer focuses on palliative and supportive care to improve the overall quality of life. Through palliative care, oncologists focus on reducing symptoms, such as jaundice, pain, digestive issues, and nausea. The management strategy involves medications, nerve blocks, and stent placement (to relieve bile duct obstruction).
Supportive care includes psychological counseling, nutritional support, and managing treatment side effects. The multidisciplinary team closely coordinates with patients to customize palliative and supportive care to maximize benefits.
As curative treatment is usually not possible at this stage, the primary aim of care is to reduce discomfort and prolong survival. It is important to integrate palliative care early in this clinical setting to optimize patient outcomes.
Stage IV (metastatic) pancreatic cancer is an advanced form of pancreatic cancer. It is characterized by the spread of cancer beyond the pancreas to the distant organs, such as the lungs, liver, bones, and peritoneum. The symptoms include back and abdominal pain, weight loss, nausea, and organ-specific symptoms, such as respiratory problems and bone pain.
Oncologists determine this stage using various imaging techniques. Staging is done with the TNM system. The primary treatment is chemotherapy. Patients may also be prescribed immunotherapy to manage disease progression and alleviate symptoms.
Palliative and supportive care are optimized to relieve symptoms and enhance the quality of life in patients diagnosed with metastatic pancreatic cancer.
Dr. Biplab Mishrar
Consultant - GI Oncosurgery
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FSSO (USA).
Dr. Biplab Mishra is a highly skilled and dynamic surgical oncology consultant with over 12 years of experience in the surgical management of different types of cancer. He is available for consultations at HCG Aastha Cancer Centre, a leading cancer hospital in Ahmedabad.
With a special focus on robotic surgery and other minimally invasive techniques, Dr. Mishra and his team excel in performing a broad range of oncological resections with outstanding clinical outcomes. A strong advocate of the patient-first philosophy, he prioritizes detailed discussions with his patients to ensure their safety, comfort, and overall well-being throughout their treatment.
Before HCG, he was associated with IGH Superspecialty Hospital (Rourkela) and Wockhardt Hospital (Mumbai).
Appointment Link: Book an Appointment with Dr. Biplab Mishra.
