Ovarian Epithelial Cancer Stage IV

Stage IV ovarian epithelial cancer is the most advanced form of this disease, where cancer has spread beyond the ovaries to distant parts of the body such as the liver or lungs. While this diagnosis is serious, treatment combining surgery and chemotherapy can help control the disease and improve quality of life.

Table of contents

• What is Stage IV Ovarian Epithelial Cancer?
• Signs and Symptoms
• Treatment Approaches
• When Surgery Is Not Possible

What is Stage IV Ovarian Epithelial Cancer?

Stage IV ovarian epithelial cancer means the cancer has spread from the ovaries to distant parts of your body^[1]. Epithelial ovarian cancer is the most common type of ovarian cancer, accounting for more than 95% of all ovarian cancers^[4]. This type of cancer develops in the thin tissue that covers the outside of the ovaries, but can also start in the fallopian tubes (tubes that connect the ovaries to the womb) or the peritoneum (tissue lining the inside of the abdomen)^[7].

Stage IV is divided into two groups based on where the cancer has spread^[1]:

• Stage IVa means the cancer has caused a build up of fluid in the lining of the lungs, called the pleura. This fluid buildup is known as a malignant pleural effusion, and it contains cancer cells^[1].
• Stage IVb means the cancer has spread to the inside of the liver or spleen, to lymph nodes outside the abdomen, or to other organs such as the lungs^[1].

About 20% of people with ovarian cancer have stage IV disease at the time they are diagnosed^[15]. Many ovarian cancers are diagnosed at advanced stages because early-stage cancer often does not cause noticeable symptoms^[4].

Signs and Symptoms

Ovarian epithelial cancer rarely causes symptoms in its early stages. Symptoms become more noticeable as the disease progresses and spreads^[7]. As cancer spreads into the peritoneum, fluid can accumulate in your abdomen.

Common symptoms of stage IV ovarian cancer include^[7]:

• Abdominal pain and bloating
• Pelvic pain
• Difficulty eating or feeling full quickly
• Nausea and vomiting

Less common symptoms may include^[7]:

• Changes in bowel habits, such as constipation or diarrhea
• Strong urge to urinate or urinating more frequently
• Vaginal bleeding
• Lower back pain
• Tiredness
• Weight loss

Treatment Approaches

The main treatments for stage IV ovarian epithelial cancer are chemotherapy and surgery^[1]. The goal of treatment is to control the cancer as long as possible, which can help you live longer and feel better^[6].

Your healthcare team considers several factors when deciding what treatment you need. These include where the cancer has spread to, whether the specialist surgeon believes they can remove all the cancer, and your general health^[1].

Surgery

A specialist surgeon called a gynaecological oncologist will typically remove both ovaries, fallopian tubes, and your womb (including the cervix)^[1]. They will also check where the cancer has spread to in your pelvis and whether it is in your lymph nodes.

The surgeon will aim to remove as much of the cancer as possible. This is called cytoreductive surgery, and you may also hear it called debulking surgery^[1]. The amount of cancer remaining after surgery is one of the most important factors affecting survival^[8]. Complete removal of all visible cancer provides the best outcomes^[15].

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. For stage IV ovarian cancer, you might have chemotherapy at different times^[1]:

• Chemotherapy after surgery, called adjuvant chemotherapy with cytoreductive surgery
• Chemotherapy before and after surgery, called neoadjuvant chemotherapy with interval cytoreductive surgery
• Chemotherapy into your abdomen during surgery, called hyperthermic intraperitoneal chemotherapy or HIPEC

Your healthcare team will discuss the best treatment approach for your individual case. When you have chemotherapy depends on your specific situation^[1].

The most common chemotherapy combination used is carboplatin and paclitaxel^[12]. This combination of drugs has been shown to be an important factor in improving survival^[8].

Targeted Cancer Drugs

Some people may have treatment with a targeted cancer drug. These are medications that target specific characteristics of cancer cells. Whether you receive this treatment depends on your situation^[1].

You might have a targeted cancer drug^[1]:

• With chemotherapy
• On its own
• After chemotherapy

When Surgery Is Not Possible

It might not be possible to have surgery if your cancer has spread widely or you are not well enough to tolerate the operation^[1]. In these cases, you may have chemotherapy on its own to shrink the cancer as much as possible and to slow its growth.

You might have other treatments to help relieve your symptoms. This could include treatment for fluid buildup in the abdomen (called ascites) or for a blocked bowel. You might also receive radiotherapy to relieve symptoms like pain^[1].

These treatments that focus on relieving symptoms and improving quality of life are called palliative care^[6].