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Stage 4

Find out what stage 4 stomach cancer means and about treatment options.

The stage of a cancer tells you how big it is and how far it’s spread. It helps your doctor decide which treatment you need.

There are 2 staging systems. Doctors can use a numbers system or the TNM system to stage your cancer.

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

Stage 4 means that your cancer is advanced and has spread to body organs further away from the stomach, such as the lungs, brain or bones. This is the same as any T, any N, M1.

stage 4 stomach cancer.png


The stage of your cancer helps your doctor to decide what treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is in your stomach
  • other health conditions

You might have one or more of the following treatments:

  • chemotherapy
  • surgery for symptom control, for example an operation to remove a blockage in your stomach
  • trastuzumab (Herceptin) biological therapy with chemotherapy -  you only have this if you have adenocarcinoma and your cancer has HER2 protein on the cells

Radiotherapy is not a common treatment for stomach cancer, but you may have it on its own to relieve symptoms. Rarely, you may have radiotherapy in combination with chemotherapy to shrink your cancer.

About other stages

Last reviewed: 
20 Jul 2016
  • AJCC Cancer Staging Manual (8th Edition)
    M Amin and S Edge.
    Springer, 2017.

  • Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    Waddell t. (and others)
    Annals of Oncology 24. 2013. (Supplement 6) vi57-vI63

  • Gastric cancer
    Custem EV. (and others)
    The Lancet, 2016. 5th May S0140-6736(16)30354-3

  • Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy
    Izuishi and Mori
    J Gastrointestin Liver Disease. 2016. March  Volume 25, Number 1/Article 13 [PMID: 27014758]

  • Trastuzumab for the treatment of HER2-positive metastatic gastric cancer
    NICE technology appraisal guidance [TA208]
    Published date: 24 November 2010

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