Ovarian cancer begins in the ovaries, small, oval-shaped organs in the pelvis. Cancers that begin in the fallopian tubes (the tubes that connect the ovaries to the uterus) or peritoneum (the tissue lining the abdomen) are also grouped with ovarian cancer. It’s hard to catch ovarian cancer early, when it first starts growing, because there are often few symptoms.

Cancer can quickly spread from the ovary, fallopian tube, or peritoneum to nearby tissues, and then to more distant parts of the body. When cancer cells start growing in a more distant location, doctors say that the cancer has metastasized. Ovarian cancer can metastasize to organs including the liver, lungs, intestines, and brain.

In this article, we’ll cover where ovarian cancer spreads, how doctors check for metastases, common symptoms of metastatic ovarian cancer, and its treatments.

Stage Describes How Far Ovarian Cancer Has Spread

The staging system for ovarian cancer is based on three factors: the size of the tumor, the spread to the lymphatic system, and the level of distant metastasis. (Cancer stages are sometimes noted with Roman numerals as stages I through IV.)

• Stage 1 — Ovarian cancer has only spread within or on the surface of the ovaries or fallopian tubes. It hasn’t spread to the lymph nodes or to distant organs.
• Stage 2 — Ovarian cancer has spread to pelvic organs or tissues in the pelvis, or there is primary peritoneal cancer (in the area of the abdomen between the diaphragm and pelvic floor).
• Stage 3 — Metastases have spread beyond the ovaries, fallopian tubes, or peritoneum to some lymph nodes or organs outside the pelvis, but not to distant sites.
• Stage 4 — Cancer has metastasized to distant sites. Cancer cells are growing in other areas of the body.

Collectively, stages 2, 3, and 4 ovarian cancers are called advanced ovarian cancer.

Where Does Ovarian Cancer Metastasize?

When ovarian cancer spreads, it commonly remains within the peritoneal cavity — the space inside your torso consisting of the abdomen and pelvis. Ovarian cancer cells typically first spread to other organs of the reproductive system, such as the uterus or fallopian tubes. They may also grow into nearby organs in the pelvis, like the bladder, colon, or tissues like the omentum. (The omentum is the layer of fatty tissue that covers the abdominal organs). Later, they may spread to other tissues in the abdomen and pelvis, or to more distant locations.

The most common areas of the body into which ovarian cancer cells spread include:

• Liver
• Lungs, including fluid around the lungs or the pleura (thin tissue that covers the lungs and lines the inside of the chest)
• Intestines
• Omentum
• Distant lymph nodes (small structures found throughout the body that filter out germs and cancer cells)

Less common sites of metastasis include the central nervous system (the brain and spinal cord), skin, and bones. In very rare cases, ovarian cancer can metastasize to the breasts.

If your cancer spreads to other parts of the body and you develop metastatic tumors, it’s still called ovarian cancer. For example, if cancer cells from the primary tumor in your ovary travel to your lungs and form a tumor there, the tumor is ovarian cancer, not lung cancer, and it needs ovarian cancer treatment.

Approximately 75 percent of ovarian cancer cases are diagnosed at advanced stages (most commonly stages 3 and 4). While cancer at these stages has metastasized, it can be misleading because the spread is most commonly within the peritoneal cavity. This is considered to be regional spread, as opposed to distant parts of the body.

The one exception to this commonly late detection of ovarian cancer is an ovarian stromal tumor, which is usually caught in the early stages, before the cancer has spread.

People with ovarian cancer may be more likely to experience metastasis if:

• They have advanced-stage cancer.
• They have a high-grade ovarian tumor (the tumor cells look more abnormal and grow more quickly).
• Ovarian cancer cells are found in the lymph nodes.

Metastatic Ovarian Cancer Symptoms

When ovarian cancer is in the early stages, cancer cells are only located within the pelvis. Common symptoms may include:

• Pain in their pelvis or abdomen
• Bloating
• Bladder symptoms, such as needing to urinate often

However, not everyone experiences symptoms in the early stages. Also, these symptoms can be associated with many other conditions, so may be brushed aside or misdiagnosed.

As ovarian cancer spreads to other areas, additional symptoms may appear. If cancer has metastasized to organs in the abdomen, a person may experience nausea, vomiting, constipation, back pain, and swelling in the abdomen from ascites (fluid in the belly).

Other symptoms may depend on the exact location of the cancer:

• Liver — Abdominal pain or swelling or jaundice (yellowing of the skin or the whites of the eyes)
• Lung — Shortness of breath or bloody cough
• Brain — Headache, dizziness, blurred vision, or seizures
• Bones — Pain or fractures
• Breast — Mass in breast or underarm area or breast discharge

If you have been diagnosed with ovarian cancer and are noticing health changes in another part of your body, talk to your oncologist.

How Do Doctors Know if Ovarian Cancer Has Spread?

In some cases, ovarian cancer has spread before it is diagnosed, and doctors can detect metastases right away. One of the main ways doctors determine how far cancer has spread is during surgery. In most cases, surgery is both a treatment and a part of tumor staging for ovarian cancer, since doctors remove tissue and test for cancer spread.

For others, ovarian cancer metastases are discovered through imaging tests. These tests may occur during the process of diagnosis, or they may be recommended during follow-up visits during or after treatment. The modern standard for diagnostic imaging to assess metastatic disease is a cross-sectional imaging test, using MRI or a CT scan to produce 3D-like pictures of sections of your body and identify where cancer has spread.

Further imaging tests may include:

• CT scan — Uses multiple X-ray beams rotating around the body that can be used to identify tumors in other organs
• CT-guided needle biopsy — Uses CT scans to help doctors direct a needle toward a mass and remove a small sample to be further studied under a microscope
• Chest X-ray — Helps doctors see tumors in the lungs, pleura, or surrounding fluid
• MRI — Uses magnets to look for signs of cancer in other parts of the body, such as the central nervous system (brain and spinal cord)
• Positron emission tomography (PET scan) — Involves measuring radioactivity that shows whether tumors or abnormal areas such as the lymph nodes contain rapidly growing cells, which may be cancer cells
• Colonoscopy — Involves inserting a small camera through the rectum and moving it through the colon to check for tumors or polyps (clusters of abnormal cells), used if symptoms indicate cancer may have spread to the large intestine

Treatments for Metastatic Ovarian Cancer

Doctors may use a variety of treatments to help treat ovarian cancer that has spread to other areas of the body. Treatment options depend on your overall health and the location of the metastasis. Cancer research has evolved significantly in recent years and now involves many targeted medications and therapies based on the stage and details about cancer cell mutations.

Debulking Surgery

During debulking surgery, a surgeon will remove as much cancer as possible from the pelvis and abdomen areas. Doctors may remove all or part of organs like the spleen or liver if cancer has spread there. If ovarian cancer has spread to the bladder, a piece of this organ may be removed, and a catheter (a thin tube) will be inserted to help remove urine until the bladder heals.

When ovarian cancer metastasizes to the intestines, part of the intestine may be taken out. In many cases, a piece of intestine is removed, and the two nearby ends are sewn together. Other times, the end of the intestine may be connected to a stoma (the opening a surgeon makes in a person’s skin to allow digested food to leave the body). This is usually temporary.

Systemic Therapy

Most people with ovarian cancer receive systemic therapy — drugs that travel throughout the bloodstream and kill cancer cells located in most parts of the body. Types of systemic therapy medications include chemotherapy, immunotherapy, and targeted therapy.

Standard first-line postsurgical treatment often includes platinum-taxane chemotherapy, sometimes along with bevacizumab (Avastin). Your oncology team may also recommend maintenance therapy depending on which proteins and genetic mutations (variants) are found in your cancer cells.

Poly-ADP ribose polymerase (PARP) inhibitors are a class of drugs that block enzymes and cause specific cancer cells to die. PARP inhibitors are prescribed as targeted therapies for people with BRCA mutations. However, some PARP inhibitor therapies have been phased out in recent years and are no longer standard treatments.

The U.S. Food and Drug Administration (FDA) approved mirvetuximab soravtansine-gynx (Elahere) in 2024 as a targeted treatment for platinum-resistant metastatic cancer, which is advanced ovarian cancer that recurs after being treated initially with chemotherapy. The treatment is approved for people whose tumors produce an excessive amount of a certain common protein.

Other newer systemic treatment options are also emerging for platinum-resistant ovarian cancer. In March 2026, the FDA approved relacorilant (Lifyorli) in combination with nab-paclitaxel for adults with platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer. Relacorilant may be an option after trying one to three prior systemic treatment regimens, at least one of which must have included bevacizumab.

Doctors may also recommend other types of treatment for different metastatic sites. For example, radiation therapy is sometimes used to treat metastatic ovarian cancer in the central nervous system or other distant tissues. You may also consider joining a clinical trial testing new treatments.

Join the Conversation

On MyOvarianCancerTeam, people come together to share their experiences with ovarian cancer, get advice, and find support from others who understand.

Have you experienced any symptoms of metastatic ovarian cancer spreading? Let others know in the comments below.