Is Stage 4 Metastatic Melanoma Curable

What Is Stage 4 Melanoma

Melanoma is a type of skin cancer that develops in the pigment cells of skin. It often starts out as a dark spot or mole.

In stage 4 melanoma, the cancer has spread from skin to other organs, such as the liver, lungs, brain, or gastrointestinal tract. It may also mean that the cancer has spread from the spot where it started to distant parts of your skin.

Stage 4 melanoma is harder to treat than less advanced stages of the cancer. However, treatment may still help improve your quality of life, your chances of survival, or both.

Treatment options for melanoma include:

• immunotherapy
• radiation
• chemotherapy

Your doctors recommended treatment plan will depend on several factors, such as your overall health and where the cancer has spread in your body.

Immunotherapy involves the use of medications to stimulate your immune system. This may help it attack cancer cells.

Several types of immunotherapy are used to treat stage 4 melanoma, including:

Your doctor might prescribe one type of immunotherapy or a combination of immunotherapy drugs. For example, they might prescribe Yervoy and Opdivo together.

Immunotherapy has helped improve survival rates for people with stage 4 melanoma. However, this treatment can cause potentially serious side effects.

If you think you might be experiencing side effects, contact your doctor right away.

Is Stage 4 Metastatic Pancreatic Cancer Curable

Few cancers strike greater fear into patients than pancreatic cancer. With over 60,000 new cases per year and 48,000 deaths, this disease is among the most lethal of all human malignancies.

Unfortunately, pancreas cancer does not have any early signs or symptoms. Most often, people complain of weight loss. Some patients develop jaundice and others low back pain. But by the time most patients are diagnosed, the disease is no longer curable.

Over the years, oncologists have developed a number of chemotherapy combinations, the most widely of which used is FOLFIRINOX and Abraxane plus gemcitabine. They carry response rates of 31% and 23% respectively with median survivals of less than one year.

Recently, investigators have extended the concept of kitchen-sink therapy by giving everyone-everything-all the time. This group combined gemcitabine, Abraxane, and platinum with all 3 of these drugs administered at full dose for consecutive weeks

As one of the people who developed cisplatin plus gemcitabine, I am extremely familiar with this drug doublet, both from a standpoint of activity and more importantly toxicity. I have also studied the Taxanes and have examined the interaction between all of these drugs in almost every imaginable way.

When physicians decide to put drugs together because they can, instead of because they work better together, patients receive too much of the wrong drug and not enough of the right drug, all at the cost of extraordinary toxicity.

Treating Stage Iv Melanoma

Stage IV melanomas have already spread to distant lymph nodes or other areas of the body. Skin tumors or enlarged lymph nodes causing symptoms can often be removed by surgery or treated with radiation therapy.

Metastases in internal organs are sometimes removed, depending on how many there are, where they are, and how likely they are to cause symptoms. Metastases that cause symptoms but cannot be removed may be treated with radiation, immunotherapy, targeted therapy, or chemotherapy.

The treatment of widespread melanomas has changed in recent years as newer forms of immunotherapy and targeted drugs have been shown to be more effective than chemotherapy.

Immunotherapy drugs called checkpoint inhibitors such as pembrolizumab or nivolumab are typically the first drugs tried, especially in people whose cancer cells do not have BRAF gene changes. These drugs can shrink tumors for long periods of time in some people. Ipilimumab , a different type of checkpoint inhibitor, is not typically used by itself as the first treatment, although it might be combined with nivolumab or pembrolizumab. This slightly increase the chances that the tumor will shrink, although itâs also more likely to result in serious side effects, which needs to be considered carefully. People who get any of these drugs need to be watched closely for serious side effects..

Itâs important to carefully consider the possible benefits and side effects of any recommended treatment before starting it.

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Treatment Of Stage Ii Melanoma

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage II melanoma may include the following:

• Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
• A clinical trial of new types of treatment to be used after surgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

What Goes Into A Prognosis

When figuring out your prognosis, your doctor will consider all the things that could affect the cancer and its treatment. Your doctor will look at risk estimates about the exact type and stage of the cancer you have. These estimates are based on what results researchers have seen over many years in thousands of people with the same type and stage of cancer.

If your cancer is likely to respond well to treatment, your doctor will say you have a favorable prognosis. This means youre expected to live many years and may even be cured. If your cancer is likely to be hard to control, your prognosis may be less favorable. The cancer may shorten your life. Its important to keep in mind that a prognosis states whats likely or probable. It is not a prediction of what will definitely happen. No doctor can be fully certain about an outcome.

Your prognosis depends on:

• The type and location of the cancer

• The stage of the cancer

• Your overall health

• How well your cancer responds to treatment

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Is Metastatic Cancer The Same As Stage 4

Metastatic cancer is not the same as stage 4 cancer, according to the National Cancer Institute. Metastasis means that the cancer has spread from its original site to other sites, according to the American Cancer Society. What precisely the stage designation means depends on the type of cancer.

Stage 4 means that the cancer is metastatic and has spread to sites distant from the original tumor, notes the American Cancer Society. However, stages 1, 2 and 3 also sometimes mean that the cancer has spread to other organs and lymph nodes. These structures are not as distant as the organs affected in stage 4 cancer.

Cancers such acute myeloid leukemia do not follow standard staging because they are blood cancers and thus are not localized, according to Cleveland Clinic. Brain cancer is dangerous but does not metastasize or does so rarely, notes the National Cancer Institute.

Taking Care Of Yourself

Hearing that your cancer has spread is scary, but a lot of research is underway to find new treatments. And there are treatments available to try to stop the disease from spreading, so you can live longer.

It’s important to have support and to talk about your fears and feelings, too. Your doctor can help you find a cancer support group.

These tips may help you feel better during melanoma treatment:

• If you lose your appetite, eat small amounts of food every 2 to 3 hours instead of bigger meals. A dietitian can give you other tips on nutrition and eating during your cancer treatment. Ask your doctor for a referral.
• Exercise can help you feel better overall and fight fatigue. But listen to your body, and balance rest and activity.
• Get the kind of emotional support that’s right for you. It could be from family, friends, your cancer support group, or a religious group.

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It Usually Starts With Suspicious Spot

Maybe you noticed a mole that stood out from the rest . Its edges were irregular, maybe it was asymmetrical in shape, unevenly pigmented, noticeably large , or rapidly changing . These are the spots that concern dermatologists. If you had one, your doc did a biopsy on your own ugly duckling. During this in-office procedure, your doctor either shaved off a layer of your mole, punched it out with a hole-punch-like tool, or removed it with surgical excision, along with a margin of healthy skin to check for wandering cancer cells.

Risk Factors For Metastatic Melanomas

You cannot get metastatic melanoma without first having melanoma, though the primary melanoma may be so small its undetectable. Major risk factors for melanomas include:

• Light skin, light-colored hair or light-colored eyes
• Skin prone to burning easily
• Multiple blistering sunburns as a child
• Family history of melanoma
• Frequent exposure to sun or ultraviolet radiation
• Certain genetic mutations
• Exposure to environmental factors, such as radiation or vinyl chloride

Other factors have been connected with increased metastasis. In a 2018 study in the Anais Brasileiros de Dermatologia and a 2019 study in the Journal of the National Cancer Institute, the following factors were associated with higher levels of metastasis:

• Male gender
• Primary tumor thickness of more than 4 mm
• Nodular melanoma, which is a specific subtype that a care team would identify
• Ulceration of the primary tumor

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Treatment Of Stage Iii Melanoma That Cannot Be Removed By Surgery Stage Iv Melanoma And Recurrent Melanoma

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrentmelanoma may include the following:

• Radiation therapy to the brain, spinal cord, or bone.

Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following:

• Immunotherapy alone or in combination with other therapies such as targeted therapy.
• For melanoma that has spread to the brain, immunotherapy with nivolumab plus ipilimumab.
• Targeted therapy, such as signal transduction inhibitors, angiogenesis inhibitors, oncolytic virus therapy, or drugs that target certain genemutations. These may be given alone or in combination.
• Surgery to remove all known cancer.
• Systemic chemotherapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

How Do You Treat Stage 4 Melanoma

The good news is that even stage 4 melanoma can be treated. The sooner the cancer is found, the sooner it can be removed and the higher your chances are for recovery. Stage 4 melanoma also has the most treatment options, but these options depend on:

• where the cancer is
• how advanced the cancer has become
• your age and overall health

How you respond to treatment also affects your treatment options. The five standard treatments for melanoma are:

• surgery: to remove the primary tumor and affected lymph nodes
• chemotherapy: a drug treatment to stop growth of cancer cells
• radiation therapy: the application of high-energy X-rays to inhibit growth and cancer cells
• immunotherapy: treatment to boost your immune system
• targeted therapy: the use of drugs or other substances to attack cancer drugs

Other treatments may also depend on where the cancer has spread to. Your doctor will discuss your options with you to help map out a treatment plan.

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There Are Three Ways That Cancer Spreads In The Body

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

It May Not Be Your First Run

Many people with stage 4 melanoma have a history of primary melanoma, says Philip Friedlander, M.D., a medical oncologist specializing in melanoma at Mount Sinai Hospital in New York City. Earlier-stage melanoma that was considered high risk may return at some point as stage 4, he says. In fact, 13.4% of those with a high-risk melanoma had a recurrence, research in JAMA Dermatology showed. Seventy percent of those recurred in a local area, while 29% had a recurrence somewhere else on their body.

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Whats The Outlook For Stage 4 Melanoma

Once the cancer spreads, locating and treating the cancerous cells becomes more and more difficult. You and your doctor can develop a plan that balances your needs. The treatment should make you comfortable, but it should also seek to remove or slow cancer growth. The expected rate for deaths related to melanoma is 10,130 people per year. The outlook for stage 4 melanoma depends on how the cancer has spread. Its usually better if the cancer has only spread to distant parts of the skin and lymph nodes instead of other organs.

How Dangerous Is Melanoma Its All A Matter Of Timing

Skin cancer holds the unfortunate distinction of being the worlds most common cancer. Though its prevalence around the globe is disturbing, there is some good news: When caught early, skin cancers are almost always curable.

You might already know that catching a cancer early means a more favorable prognosis. But it can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Melanoma should never be underestimated, but treating a tumor early rather than after it is allowed to progress could be lifesaving.

Leland Fay, 46, understands better than most the seriousness of this distinction. When the Monument, Colorado native was diagnosed with melanoma in 2012, he was given a bleak prognosis due to the advanced stage of the tumor it had already reached stage IV.

Leland hadnt thought much of the little black mole on his head a few months earlier, when a dermatologist froze it off during a routine exam. But the mole resurfaced, bigger than it had been originally. After a biopsy and imaging tests, doctors told Leland it was melanoma, and that it had already spread. He could have as few as six weeks to live.

To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumor site.

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What Are The Prognosis And Survival Rates For Metastatic Melanoma

The prognosis for thin melanomas completely removed by surgery remains quite good although patients require long-term monitoring to watch for both new melanomas as well as evidence of late recurrence and previously undiagnosed metastasis of the original one. Survival rates for melanoma, especially for metastatic melanoma, vary widely according to many factors, including the patient’s age, overall health, location of the tumor, particular findings on the examination of the biopsy, and the depth and stage. Survival statistics are generally based on five-year survival. Much of the success reported for the targeted therapies focus on “disease free” time because, in many cases, the actual five-year survival is not affected. It is hoped that combination therapy with two or more agents targeting different stages of the melanoma cell cycle will change that.

• For stage 1 , five-year survival is near 100%.
• For stage 2 , five-year survival is 80%-90%.
• For stage 3 , five-year survival is around 50%.
• For stage 4 , five-year survival is 10%-25% depending upon sex and other demographic factors.

Your May Experience Side Effects

The vast majority of patients who receive immunotherapy will have little to no side effects, says Dr. Betof Warner. Its a huge change from the days when patients were on chemotherapy and were profoundly nauseous, vomiting, and had suppressed immune systems. Still, side effects can occur, including flu-like fever, aches, fatigue, and nausea. The risk of side effects with targeted therapy is a bit higher, but Dr. Betof Warner says they tend to disappear faster. These can include rashes, headaches, joint pain. And more seriously, kidney failure, bleeding, and heart and liver problems.

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Signs Of Melanoma Include A Change In The Way A Mole Or Pigmented Area Looks

These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:

• A mole that:
• changes in size, shape, or color.
• has irregular edges or borders.
• is more than one color.
• is asymmetrical .
• itches.
• oozes, bleeds, or is ulcerated .

For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.

Advanced Skin Cancer Was Once A Death Sentence Immunotherapy Is Changing That

Most cancer patients are haunted by the same two questions:

“Why me?”

“Why now?”

Walton, 34, actually feels lucky advanced melanoma struck when it did.

If I had been diagnosed five years prior, who knows if I would be here,” she says.

Stage 4 melanoma used to be a death sentence. The disease doesnt respond to radiation or chemotherapy, and patients survived, on average, less than a year.

But over the last decade, doctors are successfully using a new approach, one significantly different than the treatment options available for the last 150 years.

Instead of burning or poisoning cancer cells, new medicines unleash the body’s natural defenses to fight them.

This treatment is called immunotherapy.

Beating the Odds

When Walton was 26, she found a mole on the back of her hip.

“It started morphing into this ugly, dark, bleeding thing,” she says, grimacing. “I just knew something was wrong.”

Doctors surgically removed her tumor. But a couple of years later, she discovered a tiny lump in her abdomen. It felt like a popcorn kernel, and within a few weeks grew to the size of a walnut.

A biopsy revealed she had stage 4 melanoma.

Walton searched online for information about the disease. She recalls the moment she discovered the average survival rate: six to nine months.

“I remember sort of losing my hearing, almost losing my vision to where I felt like I was in a tunnel,” she says.

But when she consulted with her oncologist, Dr. Adil Daud of UC San Francisco, he had consoling news.

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