Stage 4 colon cancer is the fifth and most severe stage. In addition to abdominal and digestive symptoms, you may also experience symptoms related to where the cancer has spread. Treatment at this stage may focus on symptom relief.

Colon cancer occurs when cells in the large intestine (colon) grow uncontrollably and form a tumor.

If you receive a colon cancer diagnosis, your doctor will use the results of imaging and lab tests to understand whether the cancer has spread outside the colon to other parts of the body. This is called staging.

There are five stages of colon cancer. The first stage is stage 0, which is the earliest and most treatable. After stage 0, the stages range from 1–4.

Stage 4 means colon cancer has spread to distant organs, like the liver or lungs.

This article explores what you might expect if you have stage 4 colon cancer.

Symptoms of stage 4 colon cancer tend to be more severe and noticeable than in the earlier stages.

In stage 4 colon cancer, you might experience:

Depending on where colon cancer spreads in your body, you may also experience:

Stage 4 colon cancer is more difficult to treat than its earlier stages, but there are still many options. Given the cancer stage, these treatments aim to relieve symptoms and extend life rather than cure the cancer.


Surgery is unlikely to cure colon cancers that have already spread to distant organs like the liver or brain.

But surgery to remove a section of the colon containing the cancer and small metastases in other parts of the body could help you live longer and improve your symptoms.


Chemotherapy is often the main treatment for stage 4 colon cancer. Your doctor may also recommend chemotherapy before surgery to help shrink the tumors so they’re easier to remove. This is called neoadjuvant chemotherapy.

Targeted therapy

Your doctor may use targeted therapies in combination with chemotherapy. They aim to attack specific proteins inside cancer cells without harming healthy cells.

Targeted therapies used to treat colon cancer include:

  • VEGF inhibitors: Drugs such as bevacizumab (Avastin) and ramucirumab (Cyramza) block a protein called VEGF. These drugs stop new blood vessels from forming and feeding the tumor.
  • EGFR inhibitors: Drugs such as cetuximab (Erbitux) target a protein inside cancer cells called EGFR.
  • Anti-PD-1 antibodies: Medications such as pembrolizumab (Keytruda) and nivolumab (Opdivo) may help your immune system take a more active role in fighting the cancer.

The exact treatment choice depends on many factors, including any prior treatments you’ve received and your overall health.

Radiation therapy

Radiation therapy can also help shrink tumors causing pain or other symptoms. The goal of radiation treatment is to prevent or relieve symptoms, not to cure the cancer.

How to decide when to stop treatment for colon cancer

Treatment for stage 4 cancer typically aims to relieve symptoms and prolong your life but is unlikely to result in a cure. Some treatment options may cause symptoms that make your quality of life worse. It’s also possible that your treatment may stop working at some point.

At this time, it’s important to talk with your cancer care team and loved ones to decide whether continuing to treat the cancer is worth the potential discomfort. You can also get a second opinion from another doctor before deciding.

You might instead opt for palliative care to manage pain and reduce symptoms but not actually treat the cancer.

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Doctors typically express cancer outlook in terms of a 5-year relative survival rate. The 5-year survival rate is an estimate of the percentage of people with the disease who are still alive 5 years after diagnosis compared with people who don’t have the disease.

According to the American Cancer Society, the 5-year relative survival rate for people with colon cancer that has spread to distant parts of the body is 13%.

Your outlook also depends on your overall health, age, and other factors, like which parts of the body the cancer has spread to. New treatments may also improve the outlook over time.

Can you have stage 4 colon cancer and not know it?

By the time colon cancer reaches stage 4, most people will experience symptoms that would warrant a trip to the doctor. But every cancer is different.

It’s possible not to experience any symptoms of stage 4 colon cancer and not know you have it until a doctor diagnoses it during a screening test.

What does colon cancer pain feel like?

Colon cancer pain can be hard to differentiate from other conditions.

Pain could feel like abdominal aching or cramping that does not go away. You may also have diarrhea, constipation, or a feeling that your bowel does not empty completely.

In some cases, colon cancer can cause persistent pain in the lower back.

How long can you live with stage 4 colon cancer?

According to a 2023 research review that included 1,420 people with metastatic stage 4 colon cancer who received treatment between 2004 and 2019, the median survival for stage 4 colon cancer was about 22.6 months.

Median survival steadily improved for people who received a diagnosis in 2013–2015 (28.8 months) and 2016–2019 (32.4 months).

Median survival is the length of time from the date of diagnosis when half of the study participants are still alive.

Resources for support

Educational as well as emotional and mental health resources are available to help you better manage the stress of a colon cancer diagnosis.

Ask your doctor for a referral to a local support group, or you can reach out to the following organizations:

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Stage 4 colon cancer is the most advanced stage. Treatment at this stage is aimed at reducing symptoms and prolonging life.

As you navigate your treatment options, ask your doctor about palliative care. This type of care aims to improve the quality of life of people with serious illnesses and can help you emotionally cope with the diagnosis.