Pancreatic cancer stage 4 is the stage in which pancreatic cancer is most commonly diagnosed in patients. The reason for this is that pancreatic cancer does not show obvious symptoms until this stage. At this stage, the cancer begins to spread to other organs. Usually these organs are the liver and lungs. Those in the risk group for pancreatic cancer are diabetics, smokers and overweight, as well as those with family history.
In pancreatic cancer stage 4, rather than curing the cancer, doctors focus to prolong and improve the patient’s quality of life in general. However, there are some treatments available and there is a possibility of success to a certain extent. Because of this, clinical trials using novel agents is always encouraged for pancreatic cancer patients.
Pancreatic Cancer Stage 4 – What are the Symptoms?
As we mentioned earlier, because the symptoms are not distinguishable, most patients are diagnosed when they are in advanced, pancreatic cancer stage 4. In this respect, it also happens to be called the “silent disease”.
The most common symptoms are:
- Weakness, appetite and weight loss, nausea, vomiting
- Yellow discoloration of the skin due to obstruction of the bile duct and the inability of bile to flow into the intestine, darkening in the color of the urine, lighting in the color of the stool
- Severe pain, especially in the upper abdomen and back
- Abnormal blood sugar levels and signs of new onset diabetes
Which Treatments Can Be Applied?
Pancreatic cancer has different stages, 1, 2, 3 and 4. These stages refer to the spread of cancer throughout the body. Stage 1 when the tumor is located at the organ it came from and has not moved, and stage 4 is the highest, when it has spread to other organs. Depending on the stage of the cancer, a treatment method will be followed. Another factor that determines the treatment is the degree of the tumor, which is how aggressive the cells look under the microscope. The grade rating referring is expressed as a number between 1 and 3. The lower the number, the cancerous cells are less aggressive looking.
When the cancer has metastasized (spread throughout the body), surgery is also no longer an option. In these cases, chemotherapy is the main treatment used to help slow the growth and shrink tumors, but it is not a cure. There are different combinations of drugs used for patients, but each have their advantages and disadvantages, and current available treatments may not be effective for all patients.
Now let’s look at what treatments can be applied for pancreatic cancer stage 4.
Chemotherapy, Immunotherapy and Targeted Therapies
Chemotherapy is usually a combination of drugs that can be given intravenously or as a pill. The main goal is to kill cancer cells. The most common drugs for pancreatic cancer stage 4 are gemcitabine, nab-paclitaxel, capecitabine, oxaliplatin, 5-fluorouracil, and liposomal irinotecan.
Sometimes you can treat certain cancer areas that are painful with radiation, either with photons or protons. The purpose of radiation therapy is to kill cancer cells with these rays.
Immunotherapy is using medications that activate your immune system to attack the cancer on its own. Usually it is only indicated in pancreatic cancer if the tumor has biomarker called MSI or microsatellite instability.
Targeted therapies are usually drugs that block a gene or protein that is abnormal and it is driving the growth of the tumor, and you need genomic testing on your tumor to find those abnormalities. Also, if there is a family history of pancreatic or breast cancer, you may be tested for BRCA genes, and if a mutation is present, you may be eligible for drugs called PARP inhibitors (Olaparib).
Pancreatic cancer stage 4 cannot be stopped by surgical interventions, but surgery may be required to address some other problems caused by the tumor. The most common operations are:
- Bile Duct By-pass Surgery: There is a possibility that the tumor may close the bile duct. When this channel is closed, bile accumulates inside the body and cannot be excreted through feces. With this surgery, the bile duct is attached to the small intestine.
- Stent: The stent operation is performed with a tube placed to keep the small intestine open. This operation may need to be repeated due to the growth of the tumor.
- Gastric By-Pass Surgery: It is a surgical intervention to connect the stomach to the small intestine. It is performed when there is a tumor in the patient’s stomach that prevents the nutrients from going to the intestine after digestion.
The growth of the tumor can cause severe pain in the body. The pains that occur, as a result of pressure on the nerves, can be unbearable. To prevent this, pain relief needles can be applied or nerves causing pain can be cut or radiated.
Pancreatic Cancer Stage 4 Survival Rate
According to the statistics provided by the American Center for Disease Control and Protection, the pancreatic cancer stage 4 survival rate is 5.8%, up to 5 years. The most important reason for this, as we mentioned earlier, is because the symptoms appear after the cancer has spread, therefore the cancer is often diagnosed in the last stage. In fact, pancreatic cancer is most often discovered when the patient lies on the operating table for another purpose.
Surgical interventions in pancreatic cancer stage 4 cannot eliminate the disease. Surgical removal of the tumor, that leaps into the liver, does not provide any benefit.
Because of these statistics, enrollment in cancer research and clinical trials is strongly recommended, as well as genomic testing when tumor is stage 4. These clinical trials usually include standard treatments, in addition to the chance to get another drug that may boost the efficacy, and if proven to be beneficial, it may lead to its approval and access to all similar patients.