My husband's oncologist said that stage 4 means the cancer has metastisized to multiple sites, and thus is systemic. Surgery would not do enough to stop the tumor growth, and would be very hard on the body due to multiple tumor sites.
My husband did chemo, then radiation, and now chemo again. We've asked about surgery, but each time been told that it's not an option. You have to be stage 3A or below for surgery.