Stage 4, or "stage IV", means that the cancer has spread from where it started to distant parts of the body, such as the liver, lungs, bones or brain [1, 2]. Most stage 4 cancers can be treated: the goal of treatment is often to stop or slow the cancer and to improve quality of life, and some people live for years with cancer that is well controlled [2]. A few cancers, such as testicular cancer and Hodgkin lymphoma, are cured most of the time even when they have spread [4, 5].
Key points
- Stage 4 is the same as cancer that has spread (metastatic cancer), and it keeps the name of the original cancer: breast cancer that has spread to the lungs is stage 4 breast cancer, not lung cancer [2].
- Stage 4 is not always the end of the road: in the United States, the number of people who live for 5 years with cancer that has spread has almost doubled since the 1990s [3].
- Life expectancy at stage 4 differs greatly with the type of cancer and the genetic features of the tumour; with targeted drugs and immunotherapy, many patients live for years [7, 8, 9].
- Ask for palliative care (control of pain and other symptoms) from the start, alongside cancer treatment; in one study, patients' quality of life improved and they even lived longer [10].
What does stage 4 cancer mean?
Doctors use the "stage" to describe how large a cancer is and how far it has reached. Stage 0 means that abnormal cells have not yet spread into nearby tissue; in stages 1 to 3 cancer is present, and the higher the number, the larger the tumour and the further it has spread into nearby tissues; and stage 4 means that the cancer has spread to distant parts of the body [1]. In medical reports, this is also shown as "M1" [1]. Some cancers, such as blood cancers and brain and spinal cord tumours, have their own staging systems [1].
A cancer that has spread keeps the name of the original cancer: breast cancer that has reached the lungs is "stage 4 breast cancer" and is treated like breast cancer, not like lung cancer [2]. The stage given at diagnosis always stays the same, even if the cancer later grows or shrinks with treatment [1]. Read more: What are the stages of cancer? and What is metastasis and can it be treated?
Stage 3 vs stage 4 cancer: what is the difference?
In stage 3, the cancer is usually larger or has reached nearby tissues and lymph nodes, but it has not yet spread to distant organs; in stage 4, it has reached distant organs [1]. The difference shows in the chances of survival too: in the United States, for all cancers together, of every 10 people whose cancer had reached the lymph nodes or nearby tissues, about 7 were alive 5 years later; and of every 10 people whose cancer had spread to distant organs, 3 to 4 were [3].
Can stage 4 or advanced cancer be treated or cured?
Yes; there are treatments for most cancers that have spread [2]. Treatment at stage 4 has one of these three goals, and sometimes all three together:
Cure, in some cancers
A few cancers are often cured completely even when they have spread:
- Testicular cancer: one of the most curable cancers even after it has spread [4]. In a study of nearly 10,000 men with non-seminoma testicular cancer that had spread and who received chemotherapy, more than 9 in 10 in the group with the best outlook, and even 2 in 3 in the group with the worst outlook, were alive 5 years later [4].
- Advanced Hodgkin lymphoma: in a large study of adults up to the age of 60, almost everyone was alive 4 years later, and in more than 9 in 10 the disease had not come back or grown [5].
- Bowel cancer that has spread only to the liver or lungs: if all the tumours can be removed with surgery, about 3 to 4 in 10 carefully selected patients are cured completely [6].
Long-term control
Better quality of life and symptom control
Some treatments improve quality of life by easing symptoms such as pain. This is called "palliative care", and it can be given at any point during cancer treatment [2].
If the cancer has spread to only a few limited spots, treating those spots is sometimes possible [13]; read about this in What is metastasis? For the cancers with the best chance of cure, see also: Can cancer be cured?
Is stage 4 cancer terminal?
Not always. "Stage 4" tells you how far the cancer has spread; it does not tell you how long any one person will live [1, 2]. Some people live for years with cancer that has spread but is under control [2]. In the United States, the number of people who live for 5 years with cancer that has spread has almost doubled since the 1990s, and the greatest progress has been in lung cancer, melanoma, rectal cancer and stomach cancer [3].
Even so, the goal of treatment at stage 4 is often to control the disease rather than to get rid of it completely [2]; talking openly about this goal helps you make decisions that fit your own wishes. If the cancer no longer responds to treatment, many patients prefer care that focuses on comfort and peace; this, too, is a valuable treatment choice [3].
Stage 4 cancer life expectancy: how long can you live?
The answer is different for each type of cancer. For example, in the United States, about 4 in 10 people with prostate cancer that has spread, and about 3 to 4 in 10 with breast cancer or melanoma that has spread, are alive 5 years later; but 1 to 2 in 10 with bowel cancer, about 1 in 10 with lung cancer and fewer than 1 in 10 with stomach or liver cancer that has spread [3]. Within one type of cancer, too, the genetic features of the tumour and a treatment that matches them make a big difference [7, 8, 9]:
| Cancer that has spread | Treatment in the study | What was shown |
|---|---|---|
| HER2-positive breast cancer | Two anti-HER2 drugs plus chemotherapy | Half of the patients lived for more than four and a half years; 8 years later, nearly 4 in 10 were alive [7] |
| Lung cancer with an EGFR mutation | The targeted tablet osimertinib | Half of the patients lived for more than 3 years [8] |
| Melanoma | Immunotherapy | With nivolumab, half of the patients lived for more than 3 years, and with the combination of nivolumab and ipilimumab nearly 6 years; almost everyone whose disease had not progressed after 3 years had still not died of melanoma 10 years later [9] |
| Non-seminoma testicular cancer | Chemotherapy | Nearly 9 in 10 men were alive 5 years later; one of the most curable cancers after spread [4] |
These figures describe large groups of patients and cannot predict what will happen to one person. "Half of the patients lived longer than …" means that the other half lived for a shorter time, and some for much longer.
That is why, before treatment starts, you should ask your doctor whether genetic testing of the tumour is needed for your cancer: What is targeted cancer therapy?, What is cancer immunotherapy? and Chemotherapy or targeted therapy? Read about the treatment of advanced disease for each cancer: HER2-positive breast cancer, hormone-receptor-positive breast cancer, EGFR-mutant lung cancer, Is lung cancer curable?, advanced melanoma, prostate cancer that has spread, advanced kidney cancer and MSI-H bowel cancer.
Palliative care from the start
Palliative care means easing pain and other symptoms and improving quality of life alongside cancer treatment; it is not only for the last days, and it can be given at any point during treatment [2]. In a study of patients newly diagnosed with lung cancer that had spread, those who received palliative care from the start alongside their usual treatment had a better quality of life and less depression; and although they received less intensive treatment in their last days, they also lived longer [10]. Ask your doctor to refer you to a palliative care or pain team. Read more: Cancer pain: it can be treated, do not put up with it and Anxiety, depression and fear of cancer coming back
What questions should I ask my oncologist?
- What is the goal of my treatment: cure, long-term control or easing symptoms?
- Do I need genetic testing of the tumour or any other test to choose my treatment?
- What are the benefits of this treatment, and what side effects might it have? What happens if I do not have it?
- How will we know whether the treatment is working, and how often will I be checked?
- Who will help me with pain and other symptoms, and whom should I call at night or at weekends?
- Is there a study I could take part in?
How much you want to know about statistics and your outlook is your choice; you can ask your doctor to tell you only what you want to know. Read more: What do cancer survival rates and life expectancy really mean? and A guide for families and carers of people with cancer
When should I call my doctor?
If you have cancer that has spread, do not wait for your next appointment in these situations:
- New weakness or numbness in the legs, difficulty walking, or loss of control of your bladder or bowels: the cancer may be pressing on the spinal cord; this is an emergency and needs to be checked straight away [11].
- New or worsening back pain, especially pain that gets worse when you cough, sneeze or strain, or that keeps you awake at night: tell your treatment team within 24 hours [11].
- A temperature of 38°C or higher, chills or other signs of infection during chemotherapy: contact your treatment team at once [12].
- New pain or pain that your current medicines do not ease [14], new breathlessness, confusion, or vomiting that stops you keeping down fluids and medicines.
In any emergency, such as severe breathlessness, chest pain or loss of consciousness, call your local emergency number.
Frequently asked questions
Can stage 4 cancer be cured?
In many cancers, the goal of treatment at stage 4 is long-term control rather than getting rid of the cancer completely [2]. But in a few cancers, such as testicular cancer and Hodgkin lymphoma, and in some people with bowel cancer that has spread only to the liver or lungs and can be removed with surgery, a cure is possible [4, 5, 6].
Is stage 4 cancer always fatal? Does it mean the last days of life?
Stage 4 is not the same as "the last days". Stage 4 only means that the cancer has reached distant parts of the body [1]; many patients live for years with cancer that is under control [2]. At the same time, stage 4 cancer is a serious illness; for example, in lung cancer that has spread, about 1 in 10 people are alive 5 years later [3].
Is chemotherapy or other treatment worth it at stage 4?
Yes; in many cancers that have spread, chemotherapy, targeted drugs and immunotherapy help people live longer [7, 8, 9], and some treatments ease symptoms [2]. Ask your doctor what the goal of treatment is in your case, and weigh up its benefits and side effects together. Read more: What are the side effects of chemotherapy?
If stage 4 cancer shrinks with treatment, does its stage go down?
No; the stage given at diagnosis always stays the same, even if the cancer changes later; new information is added to it [1]. If the cancer shrinks or disappears with treatment, your doctor will talk about a "response to treatment" or "remission".
Key results in metastatic disease (for doctors)
For physicians
| Disease and study | Population | Result |
|---|---|---|
| Metastatic NSGCT (IGCCCG Update) | 9,728 men treated with first-line cisplatin- and etoposide-based chemotherapy, 1990 to 2013 | 5-year OS: good prognosis 96%, intermediate 89% and poor 67% (overall 87%); 5-year PFS 90%, 78% and 54% (overall 78%); according to the authors, together with seminoma the most curable metastatic solid cancer in men [4] |
| Advanced classical Hodgkin lymphoma (HD21) | 1,500 adults aged up to 60; stage III or IV, or stage IIB with a large mediastinal mass or extranodal lesions | 4-year PFS 94.3% with BrECADD vs 90.9% with eBEACOPP (HR 0.66); 4-year OS 98.6% and 98.2% [5] |
| Resectable liver or lung metastases from colon cancer | Highly selected patients | Surgery is curative in 25% to 40%; 5-year survival after negative-margin resection of liver metastases 25% to 40%, mostly in non-randomised studies [6] |
| HER2-positive metastatic breast cancer (CLEOPATRA) | 808 patients without previous treatment for metastatic disease, ECOG 0 or 1 | Pertuzumab plus trastuzumab and docetaxel: median OS 57.1 vs 40.8 months (HR 0.69); 8-year OS 37% vs 23% [7] |
| EGFR-mutant NSCLC (FLAURA) | 556 previously untreated patients, exon 19 deletion or L858R | Median OS 38.6 months with osimertinib vs 31.8 months with gefitinib or erlotinib (HR 0.80) [8] |
| Advanced melanoma (CheckMate 067) | Previously untreated patients; minimum follow-up 10 years | Median OS: nivolumab plus ipilimumab 71.9, nivolumab 36.9 and ipilimumab 19.9 months; 10-year melanoma-specific survival in patients alive and progression-free at 3 years: 96%, 97% and 88% [9] |
| Early palliative care (Temel) | 151 patients with newly diagnosed metastatic NSCLC | FACT-L 98.0 vs 91.5; depressive symptoms 16% vs 38%; aggressive end-of-life care 33% vs 54%; median survival 11.6 vs 8.9 months [10] |
5-year relative survival for distant-stage disease in SEER (diagnosed 2015 to 2021): all cancers 35% (17% in 1995 to 1997); prostate 38%, melanoma 35%, breast 33%, ovary 32%, rectum 18%, colorectal 15%, lung 10% (2% in 1995 to 1997), stomach 8% and liver 3% [3].
Scientific evidence
Scientific evidence
7 itemsPredicting Outcomes in Men With Metastatic Nonseminomatous Germ Cell Tumors (NSGCT): Results From the IGCCCG Update Consortium
Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC
Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial
Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial
Early palliative care for patients with metastatic non-small-cell lung cancer
Final, 10-Year Outcomes with Nivolumab plus Ipilimumab in Advanced Melanoma
Pertuzumab plus Trastuzumab plus Docetaxel for Metastatic Breast Cancer
Related cancer types
Related questions
References
14 referencesShow all references, 7 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 12Infection and Neutropenia during Cancer Treatment
- 13Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial
- 14Pain and Cancer Treatment
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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