Pancreatic cancer is difficult to diagnose early because the pancreas isn’t located in an area of the body where a growth could be felt during a regular exam. It also doesn’t usually cause symptoms until the cancer has spread to other areas of the body.
Stage 4 pancreatic cancer means the cancer has spread to other organs, typically the liver or the lungs. Cancer can’t be cured at this point, but there are still treatment options.
Treatment during this stage is focused on extending life and improving the quality of life.
This treatment uses drugs that kill cancer cells or stop them from dividing. Chemotherapy is given either by a pill or intravenously through a vein.
Gemcitabine (Gemzar) is the most commonly used drug for late-stage pancreatic cancer. You may get this drug alone, or combined with other drugs such as albumin-bound paclitaxel (Abraxane), erlotinib (Tarceva), or capecitabine (Xeloda).
Chemotherapy may also be given in combination with radiation (this is called chemoradiation), a procedure that kills cancer cells with high-energy rays. Some common side effects are hair loss, fatigue, and increased risk for infection.
As a tumor grows, it can put pressure on nearby nerves and organs. This can cause pain and discomfort. Your doctor might give you an injection of pain medicine, or they might cut the nerves that are causing the pain sensation.
This treatment doesn’t cure the cancer, but it can make you feel more comfortable.
Surgery at this stage can’t remove the cancer, because it has spread too far. However, it can relieve any blockages the tumor has created. There are three kinds of surgery that may be done for stage 4 pancreatic cancer:
Bile duct bypass surgery
Bypass surgery is an option if the tumor is blocking the common bile duct.
The liver normally releases a substance called bile, which helps with digestion. Bile is stored in the gallbladder. It then travels through the common bile duct to the intestines. From there, it’s removed from the body in the stool.
When a tumor blocks the small intestine, bile can build up in the body and cause jaundice, which is the yellowing of the skin and eyes.
Bypass surgery connects the bile duct or gallbladder directly to the small intestine to get around the blockage. This procedure is known as a choledochojejunostomy.
A stent is a thin metal tube that’s placed inside the blocked bile duct to open it up so that bile can drain. The bile may drain to the outside of the body, or into the small intestine. A stent can also be used to keep the small intestine open if the cancer is blocking it.
You may need to have another surgery to place a new stent after a few months, since the tumor can eventually grow and block the stent.
Gastric bypass surgery
Gastric bypass is surgery that attaches the stomach directly to the small intestine. It can be used to bypass a tumor that’s blocking food from leaving your stomach (referred to as gastric outlet obstruction) and reaching your intestine.
The available treatments for stage 4 cancer generally won’t stop your cancer from growing. But don’t give up hope if your doctor says there are no other treatments left to try. Researchers are testing new cancer therapies in clinical trials.
When you enroll in one of these trials, you’ll have a chance to test a new treatment that isn’t yet available to the general public. The study you’re in might eventually lead to a new breakthrough therapy for pancreatic cancer.
According to the American Cancer Society’s estimates for 2019, about 57,000 people in the United States will be diagnosed with pancreatic cancer and 46,000 people are expected to die of it.
The median survival rate for stage 4 pancreatic cancer is between two and six months. But keep in mind that an outlook for an individual depends on many factors. Your medical team can provide more accurate information based on your personal health.
Older people are as likely to respond well to treatment as younger ones, though life expectancy among older people with stage 4 pancreatic cancer is shorter. This is especially true if a person’s health is further complicated by other conditions, like diabetes and high blood pressure.
Getting treatment for a late-stage cancer can be confusing and stressful. If you start to feel overwhelmed, ask your medical team, family, friends, and counselors for help and support.