Information & support Information booklets Stage 4 ovarian cancer . Download booklet Order printed booklet . Ovacome is a national charity providing support to anyone affected by ovarian cancer. We give information about symptoms, diagnosis, treatments, research and screening. Ovacome also runs a telephone support line and works to raise awareness and give a voice to all those affected by ovarian cancer. This booklet is part of a series giving clinical information about ovarian cancer. It is for those who have been diagnosed with stage 4 ovarian cancer and want more information about their cancer and how it is treated. . Cancer staging At stage 4 the cancer has spread beyond the abdomen and pelvis. The cancer may be staged by doctors during surgery, when they will aim to remove as much of it as possible. They will take samples of tissue and the fluid used to wash out the abdomen. These samples are then examined under a microscope to show how far the cancer has spread. Some people may have biopsies taken from various parts of the body to find out the stage of the cancer. This means taking tissue samples through the skin using a fine needle. Sometimes a CT scan, which builds up a picture of the body using layers of x-rays, is used to find out the stage. The system of staging also applies to fallopian tube and peritoneal cancers. . 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. 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). 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. . If you would like more information on the sources and references for this booklet, please call us on our support line 0800 008 7054. If you would like to discuss anything about ovarian cancer, please phone our support line on 0800 008 7054, Monday to Friday between 10am and 5pm. You can also visit our website at www.ovacome.org.uk. Written by Professor Sean Kehoe, Lawson Tait Professor of Gynaecological Cancer, University of Birmingham. Disclaimer Ovacome booklets provide information and support. We make every effort to ensure the accuracy and reliability of the information at the time of printing. The information we give is not a substitute for professional medical care. If you suspect you have cancer you should consult your doctor as quickly as possible. Ovacome cannot accept liability for any inaccuracy in linked sources. v.2.1 Date last updated February 2020 Date for review February 2022 . Did you find this booklet helpful? We welcome your feedback. If you have any comments or suggestions, please email [email protected] or call 0207 299 6653.