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Stage 4

Stage 4 ovarian cancer has spread to other body organs such as the liver or lungs. The main treatments are chemotherapy and surgery. 

The stage of a cancer tells the doctor how far it has grown and if it has spread. The tests and scans you have to diagnose your cancer will give some information about the stage.  But your doctor might not be able to tell you the exact stage until you have surgery.

Doctors use a simple 1 to 4 staging system for ovarian cancer. It is called the FIGO system after its authors - the International Federation of Gynaecological Oncologists.

What is stage 4?

Stage 4 ovarian cancer means the cancer has spread to other body organs some distance away from the ovaries, such as the liver or lungs. 

It is divided into 2 groups:

Stage 4a means the cancer has caused a build up of fluid in the lining of the lungs (called the pleura). This is called a pleural effusion.

Stage 4b means the cancer has spread to:

  • the inside of the liver or spleen
  • lymph nodes outside the abdomen
  • other organs such as the lungs
Diagram showing stage 4 ovarian cancer

Treating stage 4 ovarian cancer

Stage 4 ovarian cancer is classed as advanced (metastatic) cancer. This means the cancer has spread away from the ovary to other body organs such as the liver or lungs.

The aim of treatment is to control the cancer for as long as possible and to help you feel better and live longer.

The main treatments are surgery and chemotherapy. Some women have targeted cancer drug treatment or radiotherapy.

Treatment decisions 

The specialist doctors consider several factors when deciding whether you can have surgery and if so, when you should have the operation. These factors include:

  • where the cancer has spread to
  • your general health

You might have;

  • chemotherapy before and after surgery – doctors sometimes call this interval debulking surgery (IDS)
  • chemotherapy after surgery – this is called debulking surgery
  • chemotherapy without surgery

Chemotherapy before surgery

You might have chemotherapy as your first treatment. This is called neoadjuvant chemotherapy or primary chemotherapy. The chemotherapy aims to shrink the cancer and make it easier to remove.

You have a scan halfway through the chemotherapy course. You then have surgery if the scan shows your cancer is shrinking. You may hear your surgeon call this interval debulking surgery, or IDS. After the surgery, you have the rest of the course of chemotherapy.

Chemotherapy after surgery

You might have debulking surgery as your first treatment if you are well enough. The surgeon removes as much of the cancer as possible.

After you recover from surgery, you have chemotherapy. This is called adjuvant chemotherapy.

Adjuvant chemotherapy aims to shrink the cancer that has been left behind. Some women may then have further surgery.

If you can't have surgery

It might not be possible to have surgery If you have very advanced cancer or you are not well enough.

You can have chemotherapy on its own to shrink the cancer as much as possible and to slow it down. You might have radiotherapy to relieve symptoms, depending on where in the body the cancer has spread.

Instead of cancer treatments, you might have other treatments to help relieve your symptoms. For example, treatment for fluid in the abdomen (ascites) or for a blocked bowel.

Targeted cancer drugs

For some advanced cancers, you may have a type of targeted drug called bevacizumab with chemotherapy.

You might have a targeted cancer drug called olaparib or niraparib if your cancer comes back after treatment.

Last reviewed: 
23 Jan 2019
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