Doctors may use the term “stage 4 eye cancer” to refer to the last stage of the disease, where the cancer has spread beyond the eye to other parts of the body.

While treatment is often successful in the early stages, once it progresses to stage 4, the last stage, it can be difficult to manage, and the prognosis is typically unfavorable.

This article covers the outlook, spread, symptoms, and treatment options for the last stage of eye cancer, or uveal melanoma. It will also explain the staging systems for uveal melanoma and intraocular lymphoma.

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The outlook and survival rates for stage 4 eye cancer depend on several factors, including the type of eye cancer, its location, and how much it has spread. The treatment plan and response to treatment also influence the outlook.

According to the American Cancer Society, the 5-year survival rate for the last stage of eye melanoma is 16%. However, a person needs to consider that survival rates derive from statistics and can vary greatly depending on individual circumstances and treatment improvements.

Factors that can affect the outlook for stage 4 eye cancer include:

  • the location of the cancer
  • whether it has spread outside the eye
  • tumor size
  • cell type
  • mitotic count — how fast the cancer cells are dividing and growing
  • chromosome changes
  • genetic changes
  • the tumor tissue classification
  • age

A note about survival rates

The survival rate refers to the proportion of people who are still alive for a length of time after receiving a particular diagnosis. For example, a 5-year survival rate of 50% means that 50%, or half, of the people are still alive 5 years after receiving the diagnosis.

It is important to remember that these figures are estimates and are based on the results of previous studies or treatments. A person can consult a healthcare professional about how their condition is going to affect them.

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The speed at which stage 4 eye cancer can spread depends on various factors, including the location, cancer type, and a person’s immune system function.

Stage 4 eye cancer cells can spread to nearby and distant tissues and organs rapidly and aggressively. The spread of the disease to other parts of the body is known as metastasis. Stage 4 uveal melanoma nearly always involves liver metastasis.

In the last stage, the cancer has spread beyond the eye to regional lymph nodes and distant areas, including the bone, liver, and lungs. The spread of cancer to distant areas is distant metastasis, and doctors consider the cancer metastatic at this point.

Sometimes, doctors can determine a person’s risk of eye cancer spreading by performing genetic testing.

Stage 4 eye cancer can cause various symptoms affecting vision and overall health.

Symptoms of this disease include:

  • eye pain
  • visible lump or mass in the eye
  • redness or swelling of the eye
  • blurred or distorted vision
  • loss of vision
  • eye fluid and discharge
  • light sensitivity
  • changes in the size or shape of the pupil
  • pressure in the eye or face
  • bulging of the eye
  • headaches
  • weakness
  • fatigue
  • weight loss

Learn more common symptoms of eye tumors.

Treatment options for stage 4 eye cancer can manage symptoms but do not offer a cure. Meeting with a healthcare professional is essential to discuss the options, risks and benefits, and preferences for treatments.

Treatment methods for stage 4 uveal melanoma include:

  • Radiation therapy: Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. Doctors may use it alone or in combination with surgery.
  • Chemotherapy: This involves using drugs to kill cancer cells.
  • Surgery: If the growth of the primary intraocular tumor has resulted in a blind, painful eye, surgical removal of the affected eye, called enucleation, may help provide comfort.
  • Immunotherapy: Immunotherapy is a treatment that helps the body’s immune system fight cancer cells.
  • Targeted therapy: This treatment uses drugs or other substances to target specific cancer cells or their growth processes.
  • Palliative care: Palliative care focuses on relieving symptoms and improving quality of life. It may include pain management, psychological support, and other services.

Learn about palliative care vs. hospice care.

The basic staging system for most types of eye cancer, including uveal melanoma, uses the TNM system, which stands for tumor, node, and metastasis.

This system describes:

  • the size and extent of the primary tumor (T)
  • whether the cancer has spread to nearby lymph nodes (N)
  • whether the cancer has metastasized to distant parts of the body (M)

This standardized system helps doctors describe how far the cancer has grown and spread, determine appropriate treatment options, and predict an individual’s prognosis. The categories can signify the tumor size, location, and whether the disease has spread to other areas.

The process of stage grouping involves combining the T, N, and M categories to determine the overall stage of the cancer.

For stage 4 uveal melanoma, the cancer is either:

any Tthe primary tumor can be any size
N1cancer has spread to nearby lymph nodes
M0there is no spread (metastasis) to distant areas


any Tthe cancer may or may not have spread to nearby lymph nodes
M1there is metastasis to distant areas

Symptoms of the last stage of eye cancer may include vision changes, eye pain, and redness. Stage 4 indicates cancer has already spread to other areas, such as the liver or lungs.

Although a cure is not likely, treatment approaches, such as surgery, chemotherapy, and radiation therapy, may help manage symptoms and improve quality of life. Palliative care is also a choice to alleviate pain and additional symptoms. A healthcare professional can offer personalized recommendations and determine the best plan.