What Is Stage 4 Colon Cancer?

Colon cancer comes in different stages, ranging from stage 0 to stage 4. Stage 0 is the earliest form of cancer. It’s found before the cancer cells have spread through the innermost lining of the colon. Stage 4 is when the cancer cells in the colon have spread (metastasized) to a different part of the body. Colon cancer most commonly spreads to the liver, lungs, brain, or distant lymphatic tissue. Out of all these areas, the liver is by far the most common area.

How serious is stage 4 colon cancer?

Stage 4 colon cancer is the most serious and highest stage. The 5-year survival rate for stage 4 colon cancer is just under 15%. This means that about 15% of people with a diagnosis of stage 4 colon cancer will be alive in 5 years.  

Remember that survival rates are just estimates, or educated guesses. Each person is different, and individual outcomes aren’t always predictable. Although it helps to know your cancer stage, the experience and treatment options will be different for everyone.  

What are the symptoms of colon cancer?

Symptoms typically occur based on the location of the colon cancer. Signs and symptoms of colon cancer are:

• Unexplained weight loss

• Change in stool shape

• Change in bowel habits

• Blood in stools

• Dark black stools

• Fatigue

• Anemia

• Abdominal pain

While these can be symptoms of stage 4 colon cancer, they can also occur in any stage of colon cancer. Early stages may not have symptoms, which is why early detection is so important.

Stage 4 colon cancer may also cause other symptoms. This varies based on where the cancer has spread. For example, a person may have shortness of breath if the cancer has spread to the lungs.

How do you diagnose stage 4 colon cancer?

Colon cancer screening can diagnose colon cancer. The current guidelines recommend screening for people between the ages of 45 to 75 years old. This is if you have an average risk of developing colon cancer. If you have a higher risk for colon cancer, screening may happen sooner.

There are several options for screening techniques. The most common screening methods include:  

• Fecal occult blood test: This test uses chemicals to detect blood in the stool. It’s usually done yearly.  

• Fecal immunochemical (FIT) test: A FIT test uses antibodies to detect blood in the stool. It’s usually done yearly. 

• Stool-DNA (FIT-DNA): This test detects blood in stool and abnormal DNA, such as a large polyp or cancer growth. The test is performed every 3 years. 

• Flexible sigmoidoscopy: This test uses a thin, flexible scope with a camera to look at the last part of the colon and rectum. Providers can remove polyps or early cancers they may find during this procedure. It’s performed every 5 to 10 years with a yearly stool test.

• Colonoscopy: This procedure uses a longer scope to look at the entire colon and rectum. Providers remove polyps and early cancers during the exam. This test is the gold standard for diagnosing colon cancer. A colonoscopy is performed every 10 years in a person with average risk. It may be performed more often if necessary.

Your provider will help you figure out which test is best for you. Your medical history and risk factors help to guide this decision.

How do I know what stage my cancer is? 

Once there’s a diagnosis of colon cancer, your provider will determine the stage of your cancer. Staging occurs by seeing how deep the cancer has grown within the colon wall and if it has spread outside of the colon. The first step to answering these questions is doing imaging tests and bloodwork. Tests you may need for staging include:

• Computed tomography (CT) scan: This imaging study looks for local or distant spread of cancer.

• Magnetic resonance imaging (MRI) scan: This imaging study uses radio waves and magnets to look for abnormalities.

• Positron emission tomography (PET) scan: This special imaging test looks for active cancer cells throughout the body.

• Carcinoembryonic antigen (CEA): This lab test looks for a substance in the blood that colon cancer cells make.

If any of these tests find abnormal masses, your healthcare team will often biopsy them to see if there’s cancer.

What factors increase your risk for developing stage 4 colon cancer? 

There are two types of risk factors for colon cancer. There are factors you can change to decrease your risk of colon cancer and others that you can’t change. Risk factors that you can change include:

• Obesity

• Smoking

• Diet high in red meats and processed meats

• Moderate to heavy alcohol use

Risk factors that you can’t change include:

• Age: The risk of colon cancer goes up as you get older. Although younger people can get colon cancer, it’s more common in people over the age of 50.

• Family history: You’re at a higher risk if you have a first-degree relative (parent, sibling, or child) who has had colon cancer.

• History of polyps or cancer: You’re at higher risk if you have had colon polyps or colon cancer.

• History of inflammatory bowel disease (IBD): IBD, such as ulcerative colitis or Crohn’s disease, causes the colon to be inflamed over a long period of time. This prolonged inflammation increases the risk of developing colon cancer.

There are no specific risk factors for stage 4 colon cancer or ones that make it easier for the cancer to spread. Regardless of what risk factors you may have, early detection of colon cancer is key. Removing precancerous polyps before they turn into cancer can prevent colon cancer. Early cancers are also much easier to treat and have a better survival rate. Speak to your healthcare provider about your need for colon cancer screening.

What are the treatment options for stage 4 colon cancer? 

A diagnosis of stage 4 colon cancer means there’s a distant spread of the disease. Treatment depends on where the cancer has spread. In many cases of stage 4 colon cancer, the treatment goal is to allow you to live longer. But there may not be a cure. Treatments might include: 

• Surgery: If there are few or limited amounts of cancer spread, surgery may be an option. Surgery includes removing the part of the colon with cancer as well as the sites of spread, such as a portion of the liver or lung.

• Systemic chemotherapy: Chemotherapy helps to kill the cancer cells in the body and minimize any further spread. Providers may recommend it before surgery, after surgery, or in place of surgery. This depends on the amount and location of cancer spread. You can get systemic chemotherapy via pill or intravenous (IV) infusion to the entire body.

• Guided liver chemotherapy or ablation: When colon cancer has spread only to the liver, you can get chemotherapy that goes only to the liver. This spares the rest of the body from receiving the medication, which helps to decrease the risk of side effects. Ablation is another option of destroying the cancer cells that have spread to the liver.

• Radiation: Providers usually only recommend radiation in advanced cases of colon cancer. This helps to improve symptoms such as pain or bleeding. The radiation may shrink the cancer, but it does not cure it. 

What are the goals of treatment for stage 4 colon cancer? 

This will vary from person to person. It’s very important to have a discussion with your healthcare team about your goals of treatment. This helps to make sure that you and your team are on the same page. Curing colon cancer is not always the goal. For some, it may be to give you a bit more time.

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Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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