Stage 4 Pancreatic Cancer

Stage 4 pancreatic cancer is an advanced stage of pancreatic cancer in which the tumor metastasizes to other organs. 53% of diagnosed pancreatic cancer cases are in the 4th stage. It is not possible to fully cure, but treatments increase the life expectancy of the patient while improving their quality of life.

Stage 4 pancreatic cancer is a stage in which pancreatic cancer metastasizes to organs such as the intestine, lung, liver and stomach. At this stage, the 5-year survival rate is approximately 3%. On average, most patients survive one year after diagnosis. The nature and spread of the cancer limit the available treatment options.

What is Pancreatic Cancer?

The pancreas is the internal and external gland located at the back of the stomach. It controls the blood’s level of insulin and glucose obtained from foods consumed. It produces enzymes for the digestion of food. In addition, it has many important functions such as breaking down proteins and digesting fatty substances. Uncontrolled growth of cells in this organ causes pancreatic cancer. It is a rapidly spreading and aggressive cancer type.

Once diagnosed, the management of pancreatic cancer often depends on its stage 4 pancreatic cancer timeline, where the disease has typically spread to other organs and the prognosis becomes more challenging. Treatment options for pancreatic cancer vary depending on the types of cancers and the specific characteristics of the tumor. The mainstay treatments include radiation therapy, surgery, and chemotherapy, which are often combined to improve outcomes. 

Pancreatic cancers treatment can also involve newer modalities such as targeted therapy and immunotherapy, which are frequently explored in clinical trials aiming to find more effective solutions with fewer side effects. Each treatment, however, comes with its own set of challenges, particularly when the cancer affects parts of the body beyond the pancreas, complicating the management and requiring a multidisciplinary approach.

Types of Pancreatic Cancer

The most common type of pancreatic cancer is pancreatic adenocarcinoma. Most of the pancreas is made up of exocrine cells. Exocrine glands produce pancreatic enzymes to break down fats from food. Abnormal growth of exocrine cells causes a pancreatic exocrine tumor. Pancreatic Adenocarcinoma makes up 95% of pancreatic cancer cases.

Endocrine cells, on the other hand, are less common in the pancreas but have very important functions. It controls the sugar level in the blood by producing insulin and glucagon hormones. Uncontrolled growth of these cells causes a pancreatic neuroendocrine tumor. In addition to these two common pancreatic cancers, there are also less common types. These types are listed below:

• Ampullary cancer
• Adenosquamous carcinomas
• Squamous cell carcinoma
• Signet ring carcinomas
• Undifferentiated carcinomas

The treatment journey for patients diagnosed with pancreatic adenocarcinoma, the most common form of pancreatic cancer, varies based on the stage of the disease. For patients facing a stage 4 pancreatic cancer timeline, options may become more limited and focused on palliative care. The main treatment option for earlier stages might involve a combination of surgery and chemotherapy, aimed at reducing the cancer cells and controlling spread. Despite the aggressiveness of pancreatic cancer, ongoing research and new cancer treatment protocols continue to offer hope to patients and contribute to the pool of cancer survivor stories.

Stage 4 Pancreatic Cancer Symptoms

Pancreatic cancer is known as the “silent disease”. The absence of any significant symptoms in the early stages often causes the diagnosis to be made at the final stage.

Since the tumor causes obstruction in the bile duct, yellowing of the skin and eyes, and darkening of the urine (urine) may occur due to Jaundice.

Pancreatic cancer symptoms may vary depending on the patient’s condition, but the most common symptoms are:

• Swelling in the arms and legs
• Burning sensation and bloating in the stomach
• Loss of appetite and weight loss
• Pain in the abdomen and back area
• Nausea and vomiting

Stages of Pancreatic Cancer

Pancreatic cancer is classified into 4 different stages after its earliest stage, stage 0. A staging system called the American Joint Committee on Cancer (AJCC) TNM system is used. This system’s evaluation is based on the size and spread of the cancer. The TNM definition contains the following values:

• Tumor (T): The size of the tumor and its expansion into the vessels outside the pancreas.
• Lymph Nodes (N): Spread of tumor to lymph nodes
• Metastasized (M): Spread of cancer cells into lymph nodes and other organs such as the liver, peritoneum, lungs, and bones

Using these values, pancreatic cancer is divided into 4 stages:

• Stage 0: Cancer cells are found in duct cells and have not gone deep into the tissues. Carcinoma can be defined as in situ. No splashes to lymph nodes or distant parts of the body.
• Stage IA: Tumor smaller than 2 cm is seen in the pancreas. It has not yet spread out of the pancreas or to the lymph nodes.
• Stage IB: The tumor in the pancreas has reached between 2 cm and 4 cm. It is not seen outside the pancreas.
• Stage IIA: The tumor has become larger than 4 cm, but it is not found in lymph nodes.
• Stage IIB: The tumor has become larger than 4 cm and has spread to the lymph nodes. At this stage, tumors are found in at most 3 lymph nodes. It has not metastasized to other organs.
• Stage III: The tumor is seen in 4 or more regional lymph nodes or has spread to nearby arteries and veins. It is not seen in other organs.
• Stage IV: Cancer cells have spread to other organs such as liver, lungs and bones.

Separate treatments are recommended for each stage of pancreatic cancer. Stage 4 pancreatic cancer is the most difficult stage to treat.

Stage 4 Pancreatic Cancer Treatments

Stage 4 pancreatic cancer treatments cannot cure the disease, but rather, aim to prolong the life of the patient, suppress symptoms and improve their quality of life.

Chemotherapy

Chemotherapy is the main treatment method used for stage 4 pancreatic cancer. It is the use of drugs to kill cancer cells. It aims to extend the life span of the patient. The drugs can be taken orally or intravenously. Gemcitabine and combinations with other drugs are used for pancreatic cancer.

Chemoradiation Therapy

Chemoradiation is the combination of chemotherapy and radiation therapy. It is used to slow the growth of the tumor in the pancreas. It does not affect metastasized organs such as liver and lungs. It can also be applied to shrink the tumor after pancreatic surgery.

Surgery

Surgical intervention can be performed to alleviate pancreatic cancer symptoms. As the pancreatic tumor grows, it can block the bile duct. In these cases, duct bypass surgery directly connects the bile duct to the small intestine to get around the blockage.  Another option is a stent can be placed to keep the bile duct open.

The tumor can prevent food from reaching the excretory system from the stomach. In this case, gastric bypass connects the stomach directly to the intestines.

Stage 4 Pancreatic Cancer Clinical Trials

Pancreatic cancers treatment involves a combination of strategies tailored to the individual patient, depending on the specific characteristics of their cancer. These treatments can range from surgery to remove the tumor, radiation therapy to kill cancer cells and reduce tumors, to systemic therapies such as chemotherapy and targeted therapies. Due to the aggressive nature of pancreatic cancer, which often spread to other organs, a multi-disciplinary approach is crucial to managing the disease effectively.

Understanding the types of cancers within the pancreas is essential for determining the most effective treatment protocols. For instance, adenocarcinoma, the most common type of pancreatic cancer, generally requires different treatment strategies than neuroendocrine tumors of the pancreas. Each type responds differently to various therapies, influencing how doctors plan the treatment course.

Additionally, the causes of pancreatic cancer are not fully understood, but factors such as smoking, chronic pancreatitis, and genetic predispositions are known risk factors. Recognizing the early symptoms such as jaundice, abdominal pain, unexplained weight loss, and changes in stool can be critical for early diagnosis and treatment, which can significantly impact the prognosis.

Pancreatic cancer is a difficult type of cancer to treat. Researchers and various organizations continue to search for more effective solutions for this disease. It aims to improve existing treatments, reduce side effects, and develop new therapy methods for pancreatic cancer patients. Massive Bio determines the research study that best suits you among hundreds of clinical trials and brings you together with these clinics. If you are looking for a clinical research suitable for your disease, you can contact us.