Understanding Stage IV Stomach Cancer: What It Is, Symptoms, Diagnosis, and Treatment

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All you need to know about stage IV stomach cancer

Stomach cancer is one of the most prevalent cancers¹ globally despite a significant decline in numbers over the past two decades. Stomach cancer starts to form in the stomach's inner lining, and it usually grows slowly for several years before true cancer develops. Before it becomes true cancer, the precancerous stages typically happen in the stomach's mucosa without causing any symptoms. For that reason, it may go undetected. But once stomach cancer advances to stage IV, it will have spread or metastasized to other body parts.

This article gives a comprehensive explanation of stage IV stomach cancer.

What is stage IV stomach cancer?

During stage 0,  abnormal cells are present in the stomach walls. These abnormal cells are found in the innermost layer (mucosa). They continue to spread to the layer of tissue adjacent to the mucosa (sub-mucosa), then to the layer of connective tissue next to the sub-mucosa (sub-serosa). 

Before stomach cancer advances to stage IV, it affects the outermost layer of the stomach and will reach nearby organs such as the liver, colon, pancreas, and kidney. In stage IV, stomach cancer also spreads to other organs such as the lungs and distant lymph nodes.

Stage IV Stomach Cancer Symptoms

The symptoms associated with the final stages of stomach cancer can include:

  • Blood in the stool (often black in color)

  • Vomiting

  • Stomach pain

  • Unexplained weight loss

  • Jaundice

  • Ascites (fluid accumulation in the abdomen)

  • Difficulties swallowing

Stomach cancer diagnosis

The doctor performs a physical examination, imaging, and blood and stool tests during a gastroenterology appointment. The tests provide the doctor with information and direction for clinical decisions moving forward.

Imaging tests include:

  • CT or CAT (computed axial tomography) scans

  • PET (positron emission tomography) scans

  • MRI (magnetic resonance imaging)

  • Upper gastrointestinal endoscopy (also known as an EGD)

The doctor can also perform the following:

Endoscopy with biopsy

Endoscopy is an accurate and reliable test for gastrointestinal issues, particularly in the inner stomach lining and small intestines. It assists the doctor in examining the esophagus, stomach, throat, mouth, and small intestines by viewing them on a screen. This test requires a patient to receive anesthesia so they can relax or sleep during the procedure. The doctor can then take a small tissue sample of any abnormal findings for further testing in the laboratory.

Endoscopic ultrasound

This test uses both endoscopy and ultrasound to provide detailed information and images about the digestive tract. The imaging probe generates a sound wave and helps the doctor see the spread and depth of the tumor.

Treatment options for stage IV stomach cancer

The aim of treating stage IV stomach cancer is to relieve symptoms and curb cancer growth. The doctor often recommends a combination of therapies, and the treatment plan can change depending on how well it is working.

Some of the treatments for stage IV stomach cancer include:

Laser therapy or stent

Laser therapy can help destroy tumors, remove a blockage in the stomach, or stop bleeding. The doctor places a long flexible tube, called an endoscope, through the throat to the stomach. This tube can emit a laser beam for tumor ablation. Stents are hollow tubes that a doctor places between the stomach and small intestine or esophagus so that food can pass through without hindrances.

Radiation therapy

Radiation therapy helps shrink tumors, relieve pain, and stop bleeding. As a targeted treatment, it means the doctor can focus on specific tumors.


Chemotherapy medication can help relieve symptoms, shrink tumors, and extend life. As a systemic treatment, it can treat tumors throughout the body.


Surgery will involve removing the section of your stomach that has tumors via the subtotal gastrectomy procedure. Gastric bypass surgery can be an option when tumors in the lower parts of the stomach prevent food from passing.

This procedure involves attaching a section of the small intestine to the upper section of the stomach, bypassing tumors, and allowing food to pass out of the stomach. Since stomach cancer may cause eating problems, the doctor may insert a feeding tube via the skin to the stomach to ensure you get the required nutrients (called a percutaneous endoscopic gastrostomy or PEG tube).

Targeted drug therapy or immunotherapy

Targeted drug therapy helps treat stage IV stomach cancer by attacking particular characteristics of cancer. Below are some of the drugs and cancers they target:

  • Imatinib (Gleevec) - stromal tumors

  • Regorafenib (Stivarga) - stromal tumors

  • Sunitinib (Sutent) - stromal tumors

  • Trastuzumab (Herceptin) - HER2-positive tumors

  • Ramucirumab (Cyramza) – stage IV stomach cancer when other treatments fail

Immunotherapy drugs boost the body's immune system to help fight cancer. For example, Pembrolizumab (Keytruda) treats recurring stomach cancer or when a patient has not responded to two or more types of chemotherapy.

Is stage IV cancer curable or just manageable?

Stage IV stomach cancer is more challenging to treat than the previous stages due to cancer already spreading to distant organs. We can say it is treatable but not curable.

Stage IV stomach cancer statistics


About four out of five stomach cancer diagnoses in the US occur after cancer has spread to other areas of the body.

Average life expectancy

There are numerous aspects taken into account before contemplating the average life expectancy for patients with stomach cancer. Factors that affect prognosis include a person's overall health, preferred treatments, and age. In addition, individuals may respond differently to various treatments.

The five-year survival rate for stomach cancer is 31.5%² (with this type of data, the cause of death is not specified). However, the survival rate is higher in the early stages than in the advanced stages.

Patients diagnosed with stage IV stomach cancer have a five-year relative survival rate of 4%³ (this means that compared to the general population, 4% of patients with stage IV stomach cancer are likely to be alive in five years).

The lowdown

Stomach cancer is easier to treat when detected in its early stages. Once it reaches stage IV, treatment is crucial to slow cancer growth and ease symptoms. Keeping in touch with medical professionals is essential for patients with advanced stomach cancer to improve possible outcomes. Fortunately, new innovative treatments are now available to help patients with stage IV stomach cancer live a longer, better quality of life.

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