Stage 4 ovarian cancer
The stage of a cancer tells the doctor how big it is 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 the International Federation of Gynecology and Obstetrics (FIGO) staging system to stage cancers in the:
- ovaries
- fallopian tubes
- peritoneum
There are four stages, numbered 1 to 4.
Stage 4 ovarian cancer has spread to other parts of your body organs such as the liver or lungs. The main treatments are chemotherapy and surgery.
What is stage 4 ovarian cancer?
Stage 4 ovarian cancer has spread to distant body part 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 (the pleura). This is called a malignant pleural effusion.
Stage 4b means the cancer has spread to:
- the inside of the liver or spleen
lymph nodes 
outside the tummy (abdomen)- other organs such as the lungs
Treating stage 4 ovarian cancer
Treatments for stage 4 ovarian cancer include:
- surgery
- chemotherapy
- targeted cancer drugs
- radiotherapy
Your healthcare team consider several factors when deciding what treatment you need. These include:
- where the cancer has spread to
- whether the specialist surgeon (gynaecological oncologist) thinks they can remove all the cancer
- your general health
Surgery
Your specialist surgeon (gynaecological oncologist) will remove:
- both ovaries
- fallopian tubes
- your womb (including the cervix)
They will also check where the cancer has spread to in your pelvis and if it is in your lymph nodes. Your gynaecological oncologist will aim to remove as much of the cancer as possible.
This is called cytoreductive surgery. You may also hear it called debulking surgery.
Chemotherapy
You might have:
- chemotherapy after surgery – this is called adjuvant chemotherapy with cytoreductive surgery
- chemotherapy before and after surgery – this is called neoadjuvant chemotherapy with interval cytoreductive surgery
- chemotherapy into your abdomen during surgery – this is called hyperthermic intraperitoneal chemotherapy or HIPEC
Your healthcare team will discuss the best treatment for you. When you have chemotherapy will depend on your individual case.
Targeted cancer drugs
Some people may have treatment with a targeted cancer drug. This will depend on your situation. You might have a targeted cancer drug:
- with chemotherapy
- on its own after chemotherapy
If you can't have surgery
It might not be possible to have surgery if your cancer has spread widely or you are not well enough.
You may have chemotherapy on its own to shrink the cancer as much as possible and to slow its growth.
You might have other treatments to help relieve your symptoms. This could be treatment for fluid in the abdomen (ascites) or for a blocked bowel. Or radiotherapy to relieve symptoms like pain.
