What is Stage 4 Cancer?

Todd W Franzen

May 25, 2019

photo of late sunset with text "What is stage 4 cancer?"
What is Stage 4 Cancer?

Cancer is a scary word that strikes fear into the hearts of many. It’s even scarier to find out that your diagnosis has been changed to stage 4. Everything seems so much more hopeless than before. Luckily, for those who are diagnosed with lymphoma, there is hope!

The first thing that you really need to know is that stage four cancer has spread from its origin into other parts of the body.

What that means is that cancer has metastasized. This is the term that doctors and oncologists use to describe what has happened.

Cancer has spread or it has moved from the point of origin. Now in my case as a stage 4 cancer survivor, my lymphoma started in a lymph node just above my heart.

Over time the cells separated and grew, then worked their way through my lymphatic system in my body. It ended up making its way into different lymph nodes.

I had all sorts of lymph nodes in my chest and my armpit, down in my groin and it eventually metastasized into an organ, my liver.

Click here if your on the go!

That’s when it really became serious.

I’ve learned Stage 4 means two things.

One

cancer metastasizes so it can break apart and then get into your bloodstream or into your lymphatic system and it can spread into other parts of your body.

Two

Cancer must be above and below your diaphragm. When it spreads like this is when it really becomes a very serious issue.

So there are two groupings that I know of as a stage 4 cancer patient. There’s actually three, but there are two that I learned of.

There is grouping A and grouping B. Grouping A means you are asymptomatic. Meaning you don’t show any symptoms. I was in the most serious group because I had more symptoms. The third one is stage C, which means that you go into clinical trials.

There are multiple groupings that go on with Stage 4.

Understanding the differences in how cancer behaves and current staging will help tremendously.

Understanding what is happening to your body from the perspective of a doctor can be difficult, but understanding it more fully with this information could save both time and money for healthcare providers as well as patients. This also helps determine what your treatment will consist of.

My Staging


For me, I got to be at stage 4B reoccurring, which means I had a reoccurrence. This automatically put me into the next realm of treatment, which was an autologous stem cell transplant. This led to the rest of the treatment I experienced. And which has actually put me in remission.

At this point, I have been in remission for eight and a half years with that classification. There’s one system that explains how staging works. It’s called the TNM system. The American Joint Committee on Cancer and the International Union for Cancer Control maintains the classification system. Developments in the classification system show that its update cycle is every six to eight years.

To a greater extent, the TNM system needs to be updated more frequently. Considering how treatments have advanced and the new outlook on this illness.

This is The Norm


But as of 2019, that’s how staging works. How cancers are staged allows doctors to assess a person’s cancer in greater detail.

We all know that cancer is a disease, but what does it look like in the stages? Stage 4 Cancer means different things for each type of cancers. I hope this gives you and idea as to how serious stage four can be.

So just as a quick recap, your cancer has spread from its origin. It moved above and below the diaphragm and metastasized or spread into different organs in your body. And that’s it.

That’s really the simple jist of what Stage 4 Cancer is. For more info click HERE.

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Todd W Franzen


I am a two-time Hodgkin's lymphoma survivor with 17 years of documented cancer survivorship experience that spans multiple treatment eras. My journey began in November 2009 with a Stage 4B diagnosis at age 33, and continued through recurrence and treatment in 2019-2021. This rare longitudinal perspective—living through two complete treatment cycles a decade apart—gives me comparative insight into cancer care evolution that no single medical professional can replicate.

MY TREATMENT EXPERIENCE

First Treatment Cycle (2009-2010)
• 12 infusions of ABVD Chemotherapy over 6 months
• 2 infusions of ICE Chemotherapy (4-day infusions)
• 1 infusion of BEAM Chemotherapy
• 1 Autologous Stem-Cell Transplant
• 8 PET Scans
• 6 CT Scans

Second Treatment Cycle (2019-2021)
• 2 infusions of Brentuximab and Bendamustine
(Severe allergic reaction to Brentuximab — hives)
• 25 rounds of Radiation to Mediastinum (46RAD combined)
• 4 infusions of Keytruda Immunotherapy
• 2 infusions of IGEV Chemotherapy (5-day infusions)
• 1 Total Body Radiation (2RAD)
• 1 Sibling Allogeneic Stem-Cell Transplant
• 6 PET Scans
• 6 CT Scans

COMPARATIVE EXPERTISE

Surviving two stem-cell transplants—one autologous, one sibling allogeneic—across different decades of cancer treatment has given me firsthand experience with nearly every major modality in lymphoma care: combination chemotherapy, salvage chemotherapy, immunotherapy, radiation protocols, and both types of stem-cell transplantation. I've experienced treatment side effects from the "standard" ABVD era through the modern immunotherapy period.

This comparative expertise matters for survivors. Treatment protocols in 2009 looked very different from 2019, and the long-term survivorship implications are still emerging. Doctors treat; survivors live with the aftermath. I've done both—twice.

CREDENTIALS & PROJECTS

• Founder: Strap In For Life 501(c)(3) nonprofit
• Author: Internal Architect: A Cancer Survivor's Memoir
• Licensed Insurance Agent (practical healthcare system navigation)
• 17-year cancer survivor documenting the journey since 2008

WHAT I WRITE ABOUT

Cancer survivorship doesn't end when treatment stops—it's when the real reconstruction begins. My blog covers:
• Practical survivorship (relationships, careers, identity)
• Treatment experience insights (what they don't tell you)
• Long-term effects and secondary health considerations
• Mental health and emotional reconstruction
• Healthcare system navigation

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