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Stage 4

Find out what stage 4 ovarian cancer means and about treatment options.

Staging ovarian cancer

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. This information will help your specialist tailor your treatment to the stage of your cancer.

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.

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 - 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 - the cancer has spread to the inside of the liver or spleen, to the lymph nodes in the groin or outside the abdomen and/or to other organs such as the lungs
Diagram showing stage 4 ovarian cancer


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

Treating stage 4 ovarian cancer

Stage 4 ovarian cancers are classed as advanced (metastatic) cancer. The aim of treatment is to control the cancer to help you feel better and live longer.


You may have surgery as the first treatment for your cancer. The surgeon removes as much of the cancer as possible. This is called debulking. Whether you have surgery will depend on a number of factors, including:

  • where the cancer has spread to
  • your general health
  • how quickly the cancer is growing


You may start chemotherapy once you have recovered from your operation. The aim of chemotherapy is to shrink the cancer that has been left behind. Some women may then have further surgery.

Or you may have chemotherapy before surgery, to shrink the cancer and make it easier for the surgeon to remove as much cancer as possible. Chemotherapy before surgery is called neo adjuvant (pronounced nee-oh-ad-joo-vent) or primary chemotherapy.

Scans during chemotherapy

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

Biological therapy

For some advanced cancers, you may have a type of biological therapy called bevacizumab with chemotherapy. Women with gene changes called BRCA1 or BRCA2 may have a drug called olaparib if chemotherapy is no longer controlling their cancer.

If surgery isn't possible

If you have a very advanced cancer or you are not well enough, it may not be possible to have surgery.

You can have chemotherapy on its own to shrink the cancer as much as possible and to slow it down. You may 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.

Last reviewed: 
30 Nov 2016
  • Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    Annals of oncology 2013. 24 (suppl 6): Vi24 - vi 32

  • Cancer and its management (7th edition)
    Tobias J. and Hochhauser D.
    Wiley-Blackwell, 2015

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