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Stage 4 Ovarian Cancer Explained

Posted on October 19, 2021
Medically reviewed by
Howard Goodman, M.D.
Article written by
Kristopher Bunting, M.D.

Stage 4 (or stage IV) is the most advanced stage of cancer. Ovarian cancer is cancer of the ovaries, fallopian tubes, or abdominal lining (peritoneum). It is currently the 12th most common type of cancer in women and the fifth most common cause of death from cancer in women. Ovarian cancer has several different types and subtypes based on what kind of tissue the cancer cells come from. When ovarian cancer is diagnosed, it is assigned a stage and grade based on factors such as the size, location, and spread of the tumor.

What Is Stage 4 Ovarian Cancer?

Stage 4 ovarian cancer is advanced, or late-stage, ovarian cancer that has spread (metastasized) beyond the pelvis and abdominal cavity to other parts of the body. There are two staging systems used for ovarian cancer: the FIGO (International Federation of Gynecology and Obstetrics) staging system and the TNM (tumor, node, metastases) staging system.

The FIGO system has four stages (1 to 4). The TNM system describes the cancer stage using three measures:

  • The size of the primary tumor (described as T1 to T4)
  • The involvement of regional lymph nodes (described as N0 to N3)
  • The presence of distant metastases (described as M0 or M1)

Both systems have subtypes to describe additional details. Stage 4 ovarian cancer has two distinct subtypes:

  • Stage 4A (stage IVA) — Ovarian cancer with spread to the fluid surrounding the lungs (malignant pleural effusion)
  • Stage 4B (stage IVB) — Ovarian cancer with spread to the inside of the spleen or liver, distant lymph nodes (including lymph nodes in the groin), or other distant organs

Using the TNM staging system, stage 4 ovarian cancer is described as any T, any N, and M1 (stage 4A is M1a, and stage 4B is M1b).

Stage 4 Ovarian Cancer Treatment

Treatment for stage 4 ovarian cancer consists primarily of surgery and chemotherapy, but treatment may also include targeted therapy using PARP inhibitors or other drugs. Treatments can vary based on the type of ovarian cancer, the main types of which include epithelial ovarian cancer, germ cell tumors, stromal cell ovarian cancer, and fallopian tube cancer.

Surgery

Surgery for stage 4 ovarian cancer involves the removal of as much tumor as possible (debulking) to allow chemotherapy to work better. In an oophorectomy, removal of the ovaries may be unilateral or bilateral (one ovary or both ovaries). A salpingectomy also removes the fallopian tubes. Sometimes, the uterus is also removed in a procedure called a hysterectomy. Other tissue, including lymph nodes and portions of the bowel or bladder, may be removed as needed based on exactly where tumors are found before and during surgery. Infertility is a common side effect of surgery when the uterus is removed or when both ovaries (and fallopian tubes) are removed.

If portions of the intestines must be removed, an intestinal resection, an ileostomy, or colostomy (which diverts digestive waste) may be needed (usually temporarily).

Chemotherapy

Chemotherapy for stage 4 ovarian cancer may be given before surgery (called neoadjuvant chemotherapy) to decrease tumor size and limit spread. This treatment may allow for surgery to be performed. Chemotherapy may also be given after surgery (called adjuvant chemotherapy) to kill the remaining cancer cells. Many different chemotherapy drugs can be used to treat ovarian cancer. Specific chemotherapy regimens used to treat stage 4 ovarian cancer can vary based on the type of ovarian cancer, but treatments normally include a combination of intravenous Platinol (cisplatin) or Paraplatin (carboplatin) with Taxol (paclitaxel). This is frequently combined with Avastin (bevacizumab).

Side effects from chemotherapy can include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Skin rashes
  • Mouth sores
  • Anemia and fatigue
  • Bruising or bleeding
  • Increased risk of infection

Certain chemotherapy drugs also have other short-term or permanent side effects, including kidney damage, hearing loss, neuropathy, and bone marrow damage leading to different types of cancer.

Targeted Therapy

Various targeted therapy drugs are used to treat ovarian cancer, including:

  • Angiogenesis inhibitors such as Avastin (bevacizumab)
  • PARP inhibitors, including Lynparza (olaparib) and Rubraca (rucaparib)
  • TRK (tropomyosin receptor kinase) inhibitors, including Rozlytrek (entrectinib) and Vitrakvi (larotrectinib), which target cancer cells with certain abnormal genes

Palliative Care and Hospice Care

Stage 4 ovarian cancer is a very serious disease with many severe symptoms and side effects from treatment. Palliative care focuses on treating symptoms and improving quality of life as well as easing the burden on family and caregivers. Palliative care is important for any type of serious medical diagnosis, but it is especially important for those with advanced cancer who have severe symptoms such as stage 4 ovarian cancer.

When an illness reaches the point that treatment is not effective or when a person chooses not to undergo treatment, hospice care, like palliative care, focuses on easing symptoms and keeping people comfortable as they approach the end of life.

Stage 4 Ovarian Cancer Outlook

The outlook after a diagnosis of stage 4 ovarian cancer varies based on the type and grade of ovarian cancer, as well as other factors such as a person’s age and overall health. Statistics for survival rates of different stages of ovarian cancer can sometimes be confusing because of how they are reported. The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program does not group data for ovarian cancer based on FIGO or TNM stages but rather uses three SEER stages: localized, regional, or distant.

The five-year relative survival rate for all types and stages of ovarian cancer combined is 49.1 percent. According to SEER, 57 percent of ovarian cancers are distant (late-stage) at the time of diagnosis and have a combined five-year relative survival rate of 30.3 percent. Individual types of ovarian cancer have varying five-year relative survival rates for distant stages:

  • Epithelial ovarian cancer — 31 percent
  • Stromal cell ovarian cancer — 60 percent
  • Germ cell ovarian cancer — 73 percent
  • Fallopian tube cancer — 45 percent

These data reflect the average survival statistics for groups of people with ovarian cancer and do not necessarily predict a person’s outlook for stage 4 ovarian cancer. If you have questions about your outlook and prognosis, talk to your doctor.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer. On MyOvarianCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Are you or someone you care for living with stage 4 ovarian cancer? Share your experience in the comments below, or start a conversation by posting on MyOvarianCancerTeam.

All updates must be accompanied by text or a picture.
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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