Stage IV Ovarian Cancer

Medically Reviewed by Jabeen Begum, MD on August 07, 2023
Written by Alexandra McCray, Lisa Guthrie
12 min read

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 has cancer cells in it. (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 are in your abdomen (your belly area).
  • IVb: Cancer is in your spleen or liver. It may also be in lymph nodes or other organs or tissues outside your abdomen.

Ovarian cancer often isn't diagnosed until later stages because in the early stages, symptoms may not be noticeable. When symptoms do happen, you might not pay much attention to them, because they also can be caused by other common conditions. One way to tell the symptoms might be tied to ovarian cancer is that they keep on for a long time or get worse over time. The symptoms can include: 

  • Feeling full, even though you haven't eaten a lot
  • Weight loss for no obvious reason
  • Digestive problems, like constipation (not being able to poop) or diarrhea
  • Belly pain and bloating (the belly area gets bigger)
  • Vomiting
  • Feeling like you have to pee a lot
  • Tiredness
  • Lower back pain

Learn more about managing advanced ovarian cancer symptoms.

The goal of treating stage IV ovarian cancer is to control it as long as possible. That can help you live longer and feel better. Chemotherapy and surgery are the two main options. Your doctor will suggest your treatment plan based on: 

  • Your overall health
  • Where the cancer has spread

Surgery and chemotherapy together

The combination and order of chemo and surgery to shrink and take out certain tumors depend on the type of tumors you have:

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.

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 (which is  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 is still there. 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.

Chemotherapy alone

If surgery isn't an option for you – because your cancer is very advanced or you're quite sick – your doctor may suggest chemotherapy by itself to shrink the cancer or slow down its growth.

Targeted drugs

Bevacizumab (Avastin) is a drug that targets cancer by stopping the creation of blood vessels that bring oxygen and nutrients to tumors. This may slow down the growth of tumors and keep them from spreading.

You might take niraparib (Zejula) or olaparib (Lynparza) if chemotherapy doesn't work for you. You might get one of them in combination with bevacizumab. They block DNA repair in cells, which may cause cancer cells to die.

Clinical trials for stage IV ovarian cancer

You can ask your doctor about taking part in a clinical trial. That's when researchers – in a strictly controlled way – study how effective and safe new treatments are. You can ask about this at any point after your diagnosis. It doesn't have to be right at the beginning or when all other options have not worked. Everyone who is in a clinical trial gets treatment, either the standard (regular) treatment or the new treatment being tested. It's important to know that no one gets a placebo or "fake" treatment. 

To find a trial, you can search on ClinicalTrials.gov or on the Ovarian Cancer Research Alliance website.

Learn more about ovarian cancer clinical trials.

Supportive (palliative) care

Palliative care is for people who have serious conditions, including ovarian cancer. A special team of doctors, nurses, and other professionals works with you and your family to give medical, emotional, and other support.  The palliative care team's goal is to improve your quality of life and generally make things easier for you as you go through your treatment. In fact, palliative care can start as soon as you're diagnosed. 

The palliative care team can help you deal with your symptoms and side effects of treatment (including nausea, pain, anemia, etc.).  Another big benefit of palliative care is your team can help you understand your treatment options so you can make smart decisions. 

You can get palliative care at hospitals, skilled nursing centers, clinics, or at home. Insurance, Medicare, and Medicaid may cover it. When palliative care is used with your other treatment, it can make you feel better and even live longer. If your doctor doesn't suggest it, ask about it.

Some people confuse palliative care with hospice care. Palliative care happens along with treatment for your condition. Hospice gives comfort to you and your family, but it happens after you choose to stop treatment.

Treatment side effects

Chemotherapy drugs can cause side effects. Some common ones are: 

  • Hair loss
  • Nausea
  • Vomiting
  • No appetite
  • Sores in your mouth
  • Rashes on your hands and feet
  • Lower numbers of cells in your bone marrow that form blood, which can cause:
    • Possibility of more infections
    • Fatigue
    • Bruising and bleeding more easily

Radiation can be used to treat ovarian cancer. It comes with side effects, including: 

  • Fatigue
  • Skin around the treated area may look and feel sunburned
  • Diarrhea
  • Nausea
  • Vomiting

Surgery that removes both ovaries can mean you won't be able to get pregnant. If you don't have your uterus removed, you can still get pregnant using frozen embryos or with your own frozen eggs or eggs from a donor. If you have your uterus and ovaries removed, a side effect of that is menopause, no matter how old you are. This may cause: 

  • Hot flashes
  • Sleep problems
  • Night sweats
  • Fatigue
  • Brain fog

If you're having symptoms with your stage IV ovarian cancer, or your treatment is causing some side effects, you may feel like you can't live life the way you're used to. You can find ways to make yourself feel better and stay healthier.

Exercising with ovarian cancer

You'll need to make sure your doctor says it's OK for you to make any changes in your activity level , but once they sign off on it, exercise is an important part of life after your diagnosis. Exercise can help lessen pain and increase strength, and could help with fatigue and mental health issues, too. In studies, exercise has even been shown to boost the immune system's response to tumors. 

If you're able, try to follow the CDC's exercise guidelines for people who have chronic (long-term) conditions: 

  • Get at least 150 minutes of moderate exercise every week. You can break it up into 30-minute blocks of exercise over 5 days.
  • Do exercises to make your muscles stronger at least 2 days a week. Make sure you include all the major muscle groups – arms, legs, chest, back, and your trunk.

Examples of exercise include walking, biking, or swimming. You can strengthen your muscles with handheld weights, exercise bands, or weight machines in a gym. Stretching is also good. 

You might not be able to do a full 150 minutes a week at first, especially if you hadn't exercised much before your diagnosis. But you can work your way up to it.

Stage IV ovarian cancer and nutrition

There's no special diet for people who have ovarian cancer. But you can choose certain foods that may boost your immune system, give your body the nutrition it needs during your treatment, and even help with some side effects. 

Foods that can help your immune system and have good nutrition include: 

  • Fruits, such as citrus fruit and berries
  • Nuts and seeds
  • Veggies, like spinach and mushrooms
  • Garlic
  • Herbs and spices
  • Proteins, such as fish, eggs, tofu, and beans
  • Grains, including oats, brown rice, quinoa, and whole wheat

If you're having side effects, some foods may be able to help: 

  • For nausea, watermelon, strawberries, apples, foods that have ginger in them, saltine crackers, dry toast, or cold or frozen foods like smoothies
  • For diarrhea, well-cooked vegetables (not raw), fresh or canned fruit, oatmeal, applesauce, and plain rice
  • For constipation, foods with fiber like bran and quinoa; vegetables such as artichokes, carrots, and broccoli; lentils and chickpeas; fruits like apples, berries, and pears; and prunes or dried apricots

Dietitians often suggest cutting back on some foods if you're having cancer treatment. Those include: 

  • Red meat and processed meats like bacon, hot dogs, deli meat, and pepperoni
  • Alcohol
  • Added sugar

Foods may taste different to you when you're having treatment. You might get a metallic flavor, or food might taste stronger than usual. Sometimes you might not be able to taste much at all. You can change it up with herbs, spices, and sauces to try to help find a flavor that's good for you.

One side effect of cancer treatment can be that you don't feel like you want anything to eat. Still, you need to keep your strength and energy up, and that takes fuel. Try these tips to make the most of a smaller appetite:

  • Try eating more smaller meals instead of two or three big meals.
  • Eat full-fat foods for more energy and flavor, like butter, olive oil, peanut butter, or cream.
  • Choose foods that pack a lot of nutrition, such as eggs, fish, nuts, or yogurt.
  • Make sure you have some nutritious snacks around, like cheese and crackers or yogurt and granola.

It's completely normal to have all kinds of different emotions after your diagnosis. You might feel: 

  • Shocked
  • Afraid
  • Angry
  • Uncertain about what happens next

You might not know what you feel. That's normal, too. 

One reason for feelings of anxiety or depression is that – because of the nature of ovarian cancer – many people are diagnosed at later stages. That means they have to face major surgery and other treatments right away. That can make the news of your cancer even harder and more upsetting.

Talking about your stage IV ovarian cancer

You may want to keep as much information as possible private as long as you can. Or you may feel you need to talk to someone, whether it's a trusted friend, relative, a professional counselor, or other mental health professional. Keep in mind that your diagnosis might be hard to talk about for some people close to you. They may be afraid of saying the wrong thing or not being able to handle their emotions or any emotions you may have. 

Your health care team may be able to put you in touch with local ovarian cancer support groups. Facebook groups and other online communities can be helpful, too. It can help you to connect with people who are going through similar situations. CancerCare.org is one resource for support groups. 

Practical tips for helping yourself

People may offer to help you, and it's OK to accept help. It might not be easy, especially at first. But your friends and loved ones wouldn't offer if they didn't really want to help. Write down things you want to ask your doctor, and take someone with you to your appointments to remind you to get answers. Ask them to take notes to help you remember information.

You can also: 

  • Keep a calendar with all your appointments, and arrange rides. If you decide to take someone with you, make sure they know the dates, too.
  • Make lists to keep yourself organized. With so much on your mind, it can be hard to keep everything straight.
  • Think about goals you have for your care and write them down.
  • If you see weeks on your calendar that look like they might be challenging, plan something fun or relaxing around them. Keeping on top of your care can take so much of your energy. Recharging is good for your mind and body.

Financial resources

Various groups offer help with copayments, treatment costs, transportation, and other expenses related to your treatment. Your care team can point you to local resources. CancerCare.org has an online "Helping Hand Online Financial Resource Database." The American Cancer Society lets you search for programs and services in your area, too.

Many things factor into how long you live after a cancer diagnosis. How your body handles treatment, whether the cancer comes back, and other things play a role. 

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%

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.

Stage IV ovarian cancer is a disease that started in the ovaries or fallopian tubes and has spread to other areas of the body. 

  • Talk to your doctor about what you know about this cancer, what kind of tumors you have, and what kind of treatment might be most effective for that type.
  • Ask about palliative care that happens along with the treatment for your ovarian cancer. It is aimed at helping you feel better and deal with symptoms and side effects of treatment.
  • Make a plan with your care team for exercise and good nutrition that can help you be as strong and healthy as you can while you're going through treatment. 

Has anyone survived stage IV ovarian cancer?

Some major hospital systems and cancer research groups tell the stories of people who have survived stage IV ovarian cancer. Some people had been given a prognosis of a few months or a couple of years. Instead, they've survived, gone into remission (when the cancer stops actively growing or spreading), and lived for years longer.

These stories have similar themes: 

  • Fear, at first
  • A positive attitude
  • Not giving up
  • Hope
  • Gratitude

One stage IV ovarian cancer survivor – who has lived with the disease 10 years – says now, she and her health care team treat her cancer like any other long-term disease: When a new issue pops up, they face it. Another says encouragement from her health care team left her feeling "empowered." 

This highlights the importance of having a care team you can trust and feel comfortable with. 

How serious is stage IV ovarian cancer?

In about 75% of people who are diagnosed with ovarian cancer, it is already in advanced stages (III or IV). That makes it a serious condition that needs attention right away. With treatment, it can be controlled in many people, sometimes for a number of years. If the cancer comes back, most times it can't be cured. Palliative (supportive) care can help extend your life and make your quality of life better.