Doctors use staging of ovarian cancer to decide which treatment options are the most suitable for a patient. In stage 4, the cancer has spread beyond the ovaries to distant areas of the body.

Treatment options available for people with stage 4 ovarian cancer include surgery, chemotherapy, targeted therapies, immunotherapy, and palliative care.

This article looks at what stage 4 ovarian cancer is and whether it is terminal, as well as symptoms and treatment.

It also looks at things to consider, survival rate, and where to find support.

An image of medical equipment for a person with stage 4 ovarian cancer.Share on Pinterest
Miquel Llonch/Stocksy United

If ovarian cancer is stage 4, it means the cancer has spread to distant parts of the body, such as the lungs or liver. The main treatment for this stage is surgery and chemotherapy.

The stage of cancer describes how much the cancer has grown. A doctor may be able to diagnose and determine information about the cancer using tests and scans, but they may not be able to tell the exact stage until they perform surgery.

Doctors stage ovarian cancer on a scale from 1 to 4, which is called the FIGO system. Stage 4 is further divided into two groups:

  • Stage 4a: this means the cancer has caused fluid to build up in the lining of the lungs, called the pleura. This is called pleural effusion.
  • Stage 4b: this means the cancer has spread to other organs such as the lungs, the liver or spleen, or the lymph nodes outside the abdomen.

Ovarian cancer can be terminal. About 45% of people with any stage of ovarian cancer survive for 5 years or longer from the date a doctor diagnoses them. For stage 4 ovarian cancer, the 5-year survival rate is 30.3%.

These figures are averages, so they do not reflect what will happen in all cases.

Early-stage ovarian cancer is often asymptomatic, and symptoms that appear later are often non-specific and people can confuse them with other conditions. Because of this, more than 75% of people with ovarian cancer are diagnosed at an advanced stage.

When symptoms are present, they may include:

  • bloating or increased abdominal size
  • pain in the pelvic or abdominal region
  • a feeling of fullness or difficulty eating
  • frequently and urgently needing to urinate

Because stage 4 ovarian cancer means the cancer has spread to other sites, such as the lungs, bones, or liver, it can be very hard to cure. However, treatment is still possible. The goals of treatment for people with stage 4 ovarian cancer are to help people feel better and live longer.

Doctors can treat stage 4 ovarian cancer with surgery, which involves removing the tumor and debulking the cancer. Debulking means a doctor removes as much of the tumor as possible.

The aim of debulking surgery is make sure no visible cancer or no tumors larger than 1 centimeter (less than half an inch) in size remain. People who have had debulking have a better outlook than those who have not.

Surgery is often followed by chemotherapy. Doctors may also prescribe the targeted drug bevacizumab (Avastin). A doctor may continue this treatment alone after chemotherapy, or pair it with olaparib (Lynparza).

Sometimes, doctors may recommend chemotherapy before surgery. This is known as neoadjuvant chemotherapy. The aim of this is to shrink the cancer and reduce how extensive debulking surgery needs to be.

During neoadjuvant chemotherapy, people usually receive three cycles of chemotherapy before surgery, with at least three more after surgery.

Another option is to focus on treatments that improve a person’s comfort level. This is known as palliative care. During palliative care, people can also receive chemotherapy, but the aim is to reduce symptoms, control the disease, and improve quality of life, rather than to cure the cancer.

The survival rate refers to the proportion of people who are still alive for a length of time after receiving a particular diagnosis. For example, a 5-year survival rate of 50% means that 50%, or half, of the people are still alive 5 years after receiving the diagnosis.

It is important to remember that these figures are estimates and are based on the results of previous studies or treatments. A person can consult a healthcare professional about how their condition is going to affect them.

5-year survival rate

A relative survival rate compares people with the same stage and type of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of ovarian cancer is 80%, it means that the people with that type and stage of cancer are on average 80% as likely as people without cancer to live at least 5 years after diagnosis.

The American Cancer Society gets these percentages from the SEER (Surveillance, Epidemiology, and End Results) database, which is maintained by the National Cancer Institute (NCI).

The SEER database tracks 5-year relative survival rates for ovarian cancer in the United States. It does not group cancers into stages 1 to 4, but instead groups them into localized, regional, and distant stages:

  • Localized: This means the cancer has not spread beyond the ovaries
  • Regional: The cancer has spread beyond the ovaries to nearby structures or lymph nodes.
  • Distant: The cancer has spread to distant areas of the body, such as the lungs or liver.

Between 2010–2016, the SEER database shows the 5-year survival rates for the most common type of ovarian cancer, invasive epithelial ovarian cancer, were as follows:

  • Localized: 93%
  • Regional: 75%
  • Distant: 31%
  • All stages combined: 48%

The treatment plan a person receives will depend on various factors, including their overall health, whether they plan to have children, the stage and pathologic features of the cancer, and their personal preferences.

It is important for a person to discuss all of their treatment options, including possible side effects and the goals of treatment, with their doctors to help reach a decision that best serves them.

A person may also want to get a second opinion, which can provide them with more information and help them feel more confident in their treatment plan.

A person may choose not to opt for surgery and chemotherapy. In this case, palliative care is an option.

Research has found that patients who receive early palliative care experience significant improvement in their quality of life compared with those who receive standard care. Additionally, research shows that patients who had palliative care had a longer rate of survival than those in standard care.

A palliative care team will work with the patient and their caregivers in an empathetic, holistic way to communicate information about the disease, prognosis, and treatment choices. They will also help manage difficult symptoms and psychosocial issues.

People looking for support after receiving an ovarian cancer diagnosis can call the American Cancer Society’s cancer helpline (1-800-227 2345), chat with an ACS representative online, or find programs or services in their area.

Organizations that provide support include:

Several cancer organizations provide support specifically for people of color. These include:

Organizations based in the United Kingdom include:

In stage 4 ovarian cancer, the cancer has spread from the ovaries to distant areas of the body, such as the bones, liver, or lungs. 30.3% of people with this stage of ovarian cancer survive for at least 5 years after their diagnosis.

Ovarian cancer is often asymptomatic or has nonspecific symptoms. Symptoms can include bloating, an urge to urinate frequently, and pain in the pelvic region.

Treatment may include surgery to remove as much of the cancer as possible, followed by chemotherapy. Doctors may opt to start treatment with chemotherapy first, followed by surgery and more chemotherapy. Alternatively, people can choose not to undergo treatment, and receive palliative care instead.