How to Deal With Stage 4 Colon Cancer

Colorectal Cancer Survival Rate by Stage

Colorectal cancer is a cancer that starts in your colon or rectum. Depending on where the tumor begins, it may also be called colon cancer or rectal cancer. Colorectal cancer occurs when cells in the colon or rectum change and grow abnormally.

Colorectal cancer begins as a growth (polyp) on the lining of the colon or rectum. These growths can spread through different layers of the colon or rectum and into the blood vessels, eventually traveling to distant parts of your body.

Staging is used to help doctors determine the best treatment and predict survival rates. How much the cancer has spread determines the stage of the cancer.

Colorectal cancer is usually staged using the TNM staging system developed by the American Joint Committee on Cancer.

Staging is based on the following information:

Primary tumor (T). The size of the original tumor and how far it’s grown into the colon wall or spread to nearby areas.
Regional lymph nodes (N). The cancer has spread to nearby lymph nodes.
Distant metastases (M). The cancer has spread to distant lymph nodes or organs, such as the lungs or liver.

The stages of colorectal cancer range from stage 0 to stage 4. Each stage can be further sub-divided into levels of severity. These levels are indicated by the letters A, B, or C.

Given the high cost of medical care, it’s hardly a shock that patients are drowning in medical debt. Almost 20% of American households have delinquent medical bills that affect their credit report, according to NBC News. Having medical bills in collections makes it more difficult for patients to engage in other economic activities, such as purchasing a home or securing a loan to start a business.

Stage 0

The cancer is in its earliest stage and hasn’t spread beyond the mucosa, which is the inner lining of the colon or rectum. This stage is also known as carcinoma in situ.

Stage 1

The cancer has grown through the lining of the colon or rectum but hasn’t spread beyond the colon wall or rectum.

Stage 2

The cancer has grown through the wall of the colon or rectum but hasn’t spread to regional lymph nodes. Stage 2 can be divided into stages 2A, 2B, and 2C depending on how deep into the wall it has spread and whether or not it has spread to nearby organs, such as the bladder or prostate.

Stage 3

The cancer has spread to regional lymph nodes. Stage 3 can be divided into stages 3A, 3B, and 3C depending on where the cancer has grown and the number of lymph nodes involved.

Stage 4

The cancer has spread to distant sites. This is the most advanced stage. Stage 4 can be divided into stages 4A and 4B. Stage 4A indicates the cancer has spread to one distant site. Stage 4B indicates the cancer has spread to two or more distant sites.

Colorectal cancer survival rates are used as a tool to help understand your prognosis. It provides the percentage of people with the same type and stage of cancer that are still alive after a specific amount of time — usually five years after diagnosis. Many people live longer than five years, and often much longer.

Survival rates are only general estimates and can’t predict how long you will live. There are a number of individual factors that can affect survival that these numbers don’t take into account:

a person’s age and other health issues
how a person responds to treatment
specific tumor markers
type of treatment received
whether or not the cancer came back

Colorectal cancer survival rates by stage

According to the National Cancer Institute , the current estimated relative five-year survival rate for colorectal cancer is 64.5 percent. This is the estimated number of people in the United States with colorectal cancer who are still alive five years after being diagnosed. The number is based on the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program data collected from 2008 to 2014.

Based on this data, here is the breakdown by stage:

Localized. Early stage colorectal cancer that hasn’t spread outside the primary site — usually stage 0 or stage 1 — has a five-year survival rate of 89.8 percent.
Regional. The five-year survival rate for cancer that has spread to nearby lymph nodes is 71.1 percent.
Distant. The five-year survival rate for cancer that has spread to a distant site, such as the liver, brain, or lungs, is 13.8 percent.
Unknown. In some instances, cancer may not be staged. There are a number of possible reasons for this, such as a personal choice by a patient. The five-year survival rate for cancer that is not staged is 35 percent.

Gender appears to impact survival in people with colorectal cancer. More men are diagnosed with colorectal cancer than women, according to the most recent statistics. Multiple studies have found that women also have better survival rates.

A 2017 meta‐analysis that studied the influence of gender on overall survival and cancer-specific survival in people with colorectal cancer found that gender was the most significant predictor of relative advantage for survival.

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

The American Cancer Society medical and editorial content team. (2018). Colorectal cancer stages.
cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/staged.html
The American Cancer Society medical and editorial content team. (2018). Survival rates for colorectal cancer, by stage.
cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
Cancer stat facts: Colorectal cancer. (n.d.).
seer.cancer.gov/statfacts/html/colorect.html
Colorectal cancer. (2018).
my.clevelandclinic.org/health/diseases/14501-colorectal-cancer
Colorectal cancer statistics. (2018).
cdc.gov/cancer/colorectal/statistics/index.htm
Find support programs and services in your area. (n.d.).
cancer.org/treatment/support-programs-and-services.html
Hendifar A, et al. (2009). Gender disparities in metastatic colorectal cancer survival. DOI:
10.1158/1078-0432.CCR-09-0877
Majek O, et al. (2013). Sex differences in colorectal cancer survival: Population-Based Analysis of 164,996 Colorectal Cancer Patients in Germany. DOI:
10.1371/journal.pone.0068077
Rate of new cancers colon and rectum, United States, 2015. (2018).
gis.cdc.gov/Cancer/USCS/DataViz.html
Yang Y, et al. (2017). Gender differences in colorectal cancer survival: A meta&dash;analysis. DOI:
10.1002/ijc.30827

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

How to Deal With Stage 4 Colon Cancer

Suzanne Dixon, MPH, MS, RDN, is an award-winning registered dietitian and epidemiologist, as well as an expert in cancer prevention and management.

Updated on April 11, 2022

Oliver Eng, MD, is a double board-certified surgeon and surgical oncologist and an Assistant Professor of Surgery at the University of Chicago.

Table of Contents
Table of Contents

How can you best cope when you learn you have stage 4 colon cancer? What decisions will you need to make and what do you need to know to make the best choices for yourself personally?

Let’s look at what having stage 4 colon cancer means, how long people usually live with this stage of the disease, and what you need to know to make the best decisions possible.

What Is Stage 4 Colon Cancer?

Stage 4 colon cancer is the most advanced stage of the disease and may also be referred to as metastatic colon cancer.

By definition, stage 4 colon cancers are those which have traveled beyond the colon (metastasized). There are several different regions to which this occurs. Not all stage 4 colon cancers are alike. so sometimes statistics regarding survival can be misleading.

Deciding on Treatment

For most people, stage 4 colon cancer is not considered curable. However, it can almost always be treated. People can live many months and even years with stage 4 colon cancer.

How long a person lives after the diagnosis depends on many things, including where the cancer has spread and how the individual responds to available treatments.

The most common site to which colon cancer spreads is the liver (liver metastases) but it may also spread to the lungs, the brain, and the peritoneum (the membranes which surround the abdominal cavity) as well as other areas.

While making decisions, it’s important to note that there has been a new approach to treating colon cancer in recent years. In the past, stage 4 colon cancers were all treated the same, no matter where the cancer had spread. This has changed.

Now, when a person has only a few or small areas of metastases, treatment of the metastases may be considered. A single or only a few metastases are referred to as “oligometastatic” with the term “oligo” meaning few.

For those who have metastatic colon cancer with only a few metastases to the liver or lungs, removing the metastases can sometimes increase the chance of long-term survival.

Learning About Your Prognosis

Among the first things you will discuss with your healthcare team is how much information you want about your prognosis. Prognosis refers to the possible course of the disease and how much time you have.

Some people want very specific information regarding how long they might live with stage 4 colon cancer. Other people prefer not to know these details. Even if you want as much information as possible, keep in mind that predicting how long someone will live with stage 4 colon cancer is not exact. Some people live much longer than expected. Others live for a shorter time.

Your healthcare provider may give you a range of time that they expect you will live. This is their best guess, which is based on your particular case.

The most important thing to know is that you can learn as much or as little as you want about your prognosis. It is up to you. Be sure to make what you want to know (or don’t) clear to your healthcare team.

What Does Your Family Want to Know?

When making your decision about details, of course, it can be important to think about those who love you and may help care for you.

Many family members want complete information about how long a loved one may live after being diagnosed with stage 4 colon cancer. Other family members may find this information very upsetting. They may not want to hear it.

Make sure your healthcare provider knows who in your family wants (or needs) complete information and who does not.

Your healthcare provider can make a note in your chart describing your goals for information sharing about your cancer treatment. This way, everyone on the healthcare team will be on the same page during appointments.

Being diagnosed with stage 4 colon cancer can make you feel out of control. Knowing your options regarding information sharing about your cancer, your treatment decisions, and end of life care decisions will help you move forward at a difficult time.

Survival With Stage 4 Colon Cancer

Predictions about survival with stage 4 colon cancer are based on statistics, and people are not numbers. In addition, survival statistics are, by definition, always a few years old.

The 5-year survival rate for a disease will give you an estimate of how long someone may have lived who was diagnosed five years ago. How someone does today with colon cancer may be very different than how someone may have done even just five years ago.

With recent advances in cancer treatment, and many new cancer drugs, such as targeted therapies and immunotherapy being studied in clinical trials, these numbers are expected to change.

It’s important to understand this changing course of cancer medicine when you make your decisions. If you talk to someone, perhaps a neighbor or another family member, who dealt with colon cancer in the past, the approach to treatment may be very different now.

The current 5-year survival rate for stage 4 colon cancer, according to the American Cancer Society, is 14%. However, a 2017 study found survival rates for those with stage 4 colon cancer that metastasized to the liver and were candidates for removal of the liver metastases at the same time as colon surgery improved to up to 70% .

There are more people living longer, even disease-free, with stage 4 colon cancer than ever before. If you have colon cancer with liver metastases that are treatable, there are many people who are living evidence that sometimes stages 4 colon cancer is survivable.

MD Anderson Cancer Center has a colon cancer survival calculator which takes into account cancer stage, cancer grade, age, ethnicity, and sex,

Of course, even with these variables, survival can vary considerably based on other medical conditions you may have, the specific treatments you receive, and the molecular profile of your tumor.

When to Stop Treatment

While we have better treatments than in the past, and sometimes can even treat metastases, we know that many people with stage 4 colon cancer will reach a time at which the risks and side effects of treatment outweigh the benefits.

The advent of new treatments is a double-edged sword. These newer treatments can extend life and provide options not available just a few short years ago.

In the past, we often simply ran out of treatments to offer, but today we have reached a point in which the choice to discontinue treatments often needs to be an active decision. If you are at this point in your journey, make sure to ask a lot of questions, and carefully contemplate the answers.

In addition to having to make decisions about when to stop treatment, people have to learn about and consider taking part in clinical trials—some of which have been changing the outlook for stage 4 colon cancer considerably. It’s important to learn all you can about your cancer.

Palliative Care

If you’ve decided to stop active treatment for your cancer, what is the next step? Just because active treatment of your colon cancer ends, it does not mean that you will not have any treatments.

Palliative care for colon cancer addresses comfort rather than cure, but may, at times, include radiation therapy, chemotherapy, or even surgery.

Hospice Care

It can be difficult to bring up a discussion about hospice care. Cancer patients and their families may hope to protect each other by ignoring this discussion. Even healthcare providers are reluctant to bring up the issue.

What is important to know, however, is that choosing hospice care does not mean that you are giving up. With hospice care, people are still treated.

Instead of focusing on treatments to attack cancer, hospice care focuses on treatments to control the symptoms of cancer, and hopefully improve your quality of life.

Many people admit that after choosing hospice care, they wish they had done so earlier. In order to receive hospice care, you will need a note from your healthcare provider estimating that you have six months or less to live.

If you live beyond the six months period, that’s wonderful! You are never “penalized” for choosing hospice care too soon, and at that time you could choose to renew your hospice care for another six months, if you need it.

Hospice care does not mean you are giving up hope. It means that you are choosing to hope for the best quality of life possible in the days you have left.

Finding Support

Take some time to learn about how to research your cancer online. Becoming involved in a colon cancer support community—ideally, one in which you can communicate with other people coping with stage 4 cancer—offers a source of support and can be invaluable in learning about the latest research on the disease.

Your healthcare team may include a surgeon and a radiation oncologist, along with your medical oncologist.

Palliative care specialists are often called upon to help people cope with symptoms of the disease.

Of course, the most important member of your cancer care team is you.

If you have chosen to stop treatment, expect people to respect your decision. This has to be your decision alone, and unfortunately, many people are begged by loved ones to continue treatment even when the side effects far outweigh any benefits.

That said, reach out to your friends and family for support. Not everyone is comfortable being around a person with advanced cancer, and your relationships may change; some close friends moving farther away, and new friends becoming closer.

A Word From Verywell

Stage 4 colon cancer is frightening, and until very recently had a very poor prognosis. We have many more treatments available at this time, with even more available in clinical trials. This is wonderful in many ways, and you need to be a very active part of your own cancer care team as you make the most of the treatments that are available for you.

Most importantly, learn how to be your own advocate in your cancer care. This will reduce your anxiety and help you to feel empowered in making your decisions, and it sometimes can make a difference in outcomes.

Frequently Asked Questions

What are the symptoms of stage 4 colon cancer?

Colon cancer can have symptoms such as fatigue, weight loss, blood in the stool, constipation, or thin, pencil-shaped stools. This is more likely with later-stage cancers, such as stage 4. Stage 4 can have additional symptoms, depending on where the cancer has spread, such as the liver, lung, brain, or bones. For example, if the disease has spread to the liver, potential symptoms can include jaundice and swelling of the belly. If colon cancer has spread to the lung, it can cause shortness of breath.

Can you survive colon cancer?

Yes, and the odds are best the earlier the cancer is found. Colon cancer often doesn’t have noticeable symptoms until it’s advanced. That’s why getting regular recommended screenings—usually a colonoscopy—is so important.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Cancer Institute. Colon cancer treatment (PDQ) – Health Professional Version. Stage IV and recurrent colon cancer treatment.
Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016;6:29765. doi:10.1038/srep29765
Massaut E, Bohlok A, Lucidi V, Hendlisz A, Klastersky JA, Donckier V. The concept of oligometastases in colorectal cancer: from the clinical evidences to new therapeutic strategies. Curr Opin Oncol. 2018;30(4):262-268. doi:10.1097/CCO.0000000000000453
American Cancer Society. Survival rates for colorectal cancer.
Inoue Y, Imai Y, Osumi W, et al. What is the optimal timing for liver surgery of resectable synchronous liver metastases from colorectal cancer?. Annals of Surgery. 2017. 83(1):45-53.
Nosher, J., Ahmed, I., Patel, A. et al. Non-operative therapies for colorectal liver metastases. Journal of Gastrointestinal Oncology. 2015;6(2):224-40. doi:10.3978/j.issn.2078-6891.2014.065
National Cancer Institute. Metastatic cancer: When cancer spreads.
Cleveland Clinic. Colorectal (colon) cancer.

Additional Reading

Inoue Y, Imai Y, Osumi W, et al. What is the optimal timing for liver surgery of resectable synchronous liver metastases from colorectal cancer?. Annals of Surgery. 2017. 83(1):45-53.

By Suzanne Dixon, MPH, RD
Suzanne Dixon, MPH, MS, RDN, is an award-winning registered dietitian and epidemiologist, as well as an expert in cancer prevention and management.

How to Deal With Stage 4 Colon Cancer