Stage 4

Stage 4 bowel (colon and rectal) cancer means the cancer has spread to other parts of the body, such as the liver or lungs. It's also called advanced bowel cancer.

Stage 4 is divided into 3 stages - 4A, 4B and 4C.

Stage 4A

Stage 4A means that the cancer has spread to 1 distant site or organ, for example the liver, but it hasn’t spread to the tissue lining your tummy (peritoneum).

The cancer spreads through the lymphatic system or the bloodstream.

Diagram showing stage 4A

Stage 4B

Stage 4B means the cancer has spread to 2 or more distant organs, but it hasn’t spread to the tissue lining your tummy (peritoneum).

Diagram showing stage 4B

Stage 4C

Stage 4C means the cancer may have spread to distant organs and it has spread to the lining of your tummy (peritoneum).

Diagram showing the most common sites for bowel cancer to spread to

TNM stands for tumour, node and metastasis: 

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

In the TNM staging, stage 4A is the same as:

  • any T, any N, M1a

Stage 4B is the same as:

  • any T, any N, M1b

Stage 4C is the same as:

  • any T, any N, M1c

Treatment for stage 4 large bowel (colon) cancer

Your doctor might recommend:

  • surgery
  • chemotherapy
  • radiotherapy
  • targeted cancer drugs

Treatment for stage 4 cancer of the back passage (rectal)

Your doctor might recommend:

  • surgery
  • chemotherapy
  • radiotherapy
  • chemotherapy combined with radiotherapy (chemoradiotherapy)
  • targeted cancer drugs

Other stages

Last reviewed: 
21 Jan 2022
Next review due: 
21 Jan 2025
  • Colorectal cancer
    The National Institute for Health and Care Excellence (NICE), 2020. Updated December 2021

  • Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    E. Van Cutsem and others
    Annals of Oncology, 2014. Volume 25 (Supplement 3)

  • Rectal cancer: ESMO clinical practical guidelines for diagnosis, treatment and follow up
    R Glynne-Jones and others
    Annals of Oncology, 2017. Volume 28, Pages 422-440

  • AJCC Cancer Staging Manual (8th Edition)
    American Joint Committee on Cancer, 2017

  • Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017). 
    Colorectal disease Volume 19, issue S1,  Pages 1-97

  • Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
    G Argilés and others
    Annals of Oncology, 2020. Volume 31, Issue 10 Pages 1291-1305

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