Stage 4 ovarian cancer

Cancer staging

The ovarian cancer stage means how far your cancer has spread at the time it is discovered. This may be assessed following your diagnostic tests but usually confirmed after surgery.

During your operation to remove the cancer the surgeon may take samples from the cancer and from fluid which are then examined under a microscope. This usually shows the stage of your cancer.

The system of staging also applies to fallopian tube and primary peritoneal cancers

This information is for anyone who has been dagnosed with stage 4 ovarian cancer and for anyone who wants to know more about this stage and its treatment.

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What is stage 4 ovarian cancer?

At this stage the cancer has spread away from the ovaries to more distant organs.

Stage 4a is when ovarian cancer has spread to the sheets of tissue (called pleura) which line the lungs. This is usually diagnosed when the cancer cells cause fluid to build up between the two sheets of tissue. This is a pleural effusion.

Stage 4b is when the cancer has spread to organs or lymph nodes outside the abdomen. This can include the liver or spleen.

Grading stage 4 ovarian cancer

Ovarian cancer is graded as well as staged, to show how active it is and how quickly or slowly it grows. Stage 4 cancer may be graded if it is treated with surgery.

Grade 1 (sometimes also called well differentiated cancer) means that when seen under a microscope, the cells look similar to normal cells which means they are likely to grow normally.

Grade 2 (moderately differentiated) cells look more abnormal and are expected to grow slightly faster.

Grade 3 (poorly differentiated) cells look very different from normal cells and are expected to grow more quickly.

How is stage 4 ovarian cancer treated?

Treatment for this stage includes relieving symptoms caused by the cancer.

If you have stage 4a you are likely to have a pleural effusion. If this is making you breathless and uncomfortable your consultant will arrange for the fluid to be drained off in a simple procedure. This is called pleural drainage and involves numbing the area with an injection of local anaesthetic and inserting a drain to remove the excess fluid.

You may be offered a pleurodesis. This is when the fluid is drained and the space between the pleural membranes is blocked by inserting medical talc. This stops fluid collecting there and can prevent further pleural effusions. Less commonly you may be offered a pleurectomy. This is an operation under general anaesthetic to remove pleural tissue and seal the space where fluid has been collecting.

Some people can be treated for stage 4 ovarian cancer with abdominal surgery that aims to remove as much of the cancer as possible, followed by chemotherapy. Sometimes you will be recommended to have chemotherapy to shrink the cancer before surgery, followed by another course after the operation. Sometimes surgery is not possible and chemotherapy alone is used to reduce the tumours and control the cancer’s spread. You can read more about surgery here.

Chemotherapy is given as a course of six treatments every three weeks. It is likely that your consultant will recommend using two chemotherapy drugs called carboplatin and paclitaxel (Taxol). You can read more about chemotherapy here.

They may also recommend using a third drug called Avastin which is a targeted therapy (monoclonal antibody) and works by reducing the cancer’s blood supply.

Did you find this page helpful?

We welcome your feedback. If you have any comments or suggestions, please email r.grigg@ovacome.org.uk or call 0207 299 6653.

Get support

Ovacome is the UK 's national ovarian cancer support charity. We've been providing emotional support and personalised, expert information since 1996. Contact our support line by phone, email or text if you have questions about a diagnosis, or if you just want to talk things through.

We support anyone affected by ovarian cancer, including family members, carers, those with an inherited risk, and health professionals working in the field.

Ovacome has 50 information booklets on a variety of topics about ovarian cancer.

View all 50 booklets here.

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