Stage IV Ovarian Cancer

Medically Reviewed by Brunilda Nazario, MD on September 16, 2020

Stage IV ovarian cancer is when the cancer that started in your ovaries or fallopian tubes has spread to other areas of your body. There are two sub-stages within this category.

  • IVA: Fluid around your lungs contains cancer cells (the doctor will call this a malignant pleural effusion). But the cells haven’t spread to other areas like your intestines or lymph nodes that aren’t in your abdomen (your belly).
  • IVB: Cancer is in your spleen or liver. It may also be in lymph nodes or other organs or tissues outside your abdomen.

Treatment Options

Invasive epithelial ovarian cancer: Your doctor treats stage IV of this type of cancer by removing as much of the tumor as they can see. That means they could take out your ovaries, fallopian tubes, uterus, and some tissue from your abdomen. The doctor also checks for cancer in other organs and might remove sections of them to get rid of tumors. You’ll then get chemotherapy.

Or you start with chemotherapy to make the tumors smaller. Then you have surgery and more chemotherapy.

You can also talk to your doctor about only receiving treatments that help your symptoms. Those are “palliative” and don’t try to beat the cancer.

Germ cell tumors: If you have a dysgerminoma tumor, the most frequent kind of germ cell cancer, your doctor does surgery to remove the cancer from your pelvis and abdomen. They also take out your uterus (a procedure known as a hysterectomy), along with both ovaries and fallopian tubes (a surgery known as a bilateral salpingo-oophorectomy. You’ll get chemotherapy afterward. If you have other types of germ cell tumors, you’ll get chemotherapy before and/or after surgery.

For dysgerminoma, your doctor might only remove one ovary and the fallopian tube on the same side (this is called a unilateral salpingo-oophorectomy), then you get chemotherapy. They might suggest this if you have other types of ovarian germ cell tumors too.

They could also do another surgery, called a second-look laparotomy, after the first one to see if any cancer remains. You can also talk to your doctor about taking part in a clinical trial to help researchers try out new treatments.

Stromal tumors: For this cancer type, your doctor will remove the ovary along with the tumor. They’ll also remove other tissue if the cancer has spread. Most people get chemotherapy after surgery. But if you can’t tolerate chemo, you might get hormone therapy. Your doctor may also follow up with radiation to kill any cancer cells the surgery missed.

What Survival Rates Mean for You

Many things factor into how long you live after a cancer diagnosis. How your body handles treatment, whether it comes back, and other things play a role. Statistics can’t say what will happen to you but can help you understand the situation.

A 5-year relative survival rate tells you how likely it is that people with the same cancer type and stage as you are alive at least 5 years after diagnosis compared to people without that cancer. These numbers don’t focus on your cancer stage but instead consider how much it spreads. Stage IV cancer is categorized as distant, meaning it’s spread to areas of your body that aren’t close to where it began. The 5-year relative survival rates for standard types of ovarian cancer tumors are:

  • Invasive epithelial ovarian cancer: 30%
  • Germ cell tumors: 74%
  • Stromal tumors: 54%

Possible Prognosis

No matter what stage your cancer diagnosis is, there is always a chance that it can return. With stage IV ovarian cancer, that chance is 90% to 95%.

You can’t predict what will happen to you based on that percentage. Your doctor knows your condition and will help you make the best decisions for your situation.

Show Sources


American Cancer Society: “Ovarian Cancer Stages,” “Radiation Therapy for Ovarian Cancer,” “Surgery for Ovarian Cancer,” “Survival Rates for Ovarian Cancer,” “Treatment for Stromal Tumors of the Ovary, by Stage,”  “Treatment of Invasive Epithelial Ovarian Cancers, by Stage.”

National Cancer Institute: “Dysgerminoma,” “Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version,” “stage IV ovarian epithelial, fallopian tube, and primary peritoneal cancer.”

Ovarian Cancer Research Alliance: “Recurrence.”

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