What is Stage 4 Ovarian Cancer?

Stage three ovarian cancer is considered an advanced stage where cancer has spread far away to other organs or organ systems of the body like the lungs, intestines, or liver. If you’re diagnosed at this stage, the doctor cannot confirm if it is stage 3 or stage 4 ovarian cancer until they have performed the surgery. The extent of cancer cell migration or metastasis can be evaluated during surgery.

What are the subtypes of stage 4 Ovarian Cancer?

The type of ovarian cancer depends on the type of cell the tumor originates from. There are over thirty types of Ovarian Cancer. However, 85 to 90 percent of Ovarian cancer cases originate from the cells making the outer layer of the ovaries, the epithelial cells, and it’s called epithelial ovarian carcinoma.

Other than epithelial cells, stromal cells, and germ cells can also produce cancerous tumors, however, much less often.

There are three common subtypes of epithelial ovarian carcinoma, with a few other rarer types occurring: [¹], [²]

Serous Carcinoma (occurrence~52% of all epithelial ovarian carcinomas) -further divided into low or high-grade serous carcinoma
Endometrioid carcinomas (occurrence~8-15% of all ovarian carcinomas)
Mucinous carcinomas (occurrence~6% of ovarian cancer cases)

When it comes to stage 4 ovarian cancers, there are two types.

Stage 4a: This causes the buildup of fluid in the lungs or pleural effusion.
Stage 4b: This is when the cancer spreads to the liver, spleen, lymph nodes around the abdomen, or other organs such as the lungs.

Stage 4 Ovarian Cancer staging and diagnosis

Ovarian Cancer Staging

In general, the TNM system is used to describe and classify cancers, including Ovarian Cancer, where:

T (tumor) describes the size and location of the tumor
N (nodes) indicates whether or not it has spread to nearby lymph nodes
M (metastasis) describes if and how far the cancer has spread from its origin

How common is stage 4 Ovarian Cancer?

There were 313,000 new cases of ovarian cancer in 2020. Ovarian cancer is the eighth most common cancer in women and the eighteenth most common cancer overall. 75% percent of patients are diagnosed after the disease has progressed to an advanced stage. That is because early-stage symptoms are not distinct.

How is stage 4 Ovarian Cancer diagnosed?

Most ovarian cancer cases are diagnosed at advanced phases close to stage 4. However, it can be caught early. If your doctor notices something concerning during a pelvic exam or suspects ovarian cancer after hearing your symptoms or medical history, they will recommend the following tests or screenings, especially if you are tall, older, never bore children, or breastfed, overweight, have taken hormone therapy after menopause, have irregular periods, have a family history of the disease, or other risk factors: [⁶] [⁷]

Imaging Tests: Different imaging tests take pictures of the body’s insides and can single out abnormalities, like a tumor, but cannot confirm whether it’s cancer or not. These include x-rays, CT or PET scans, ultrasounds, etc.
Sample Tests: These tests take a sample of the tumor or the blood to confirm whether the growth or tumor is indeed cancer.
Internal Investigation: These tests physically take a camera inside the body to view the tumor.

Stage 4 Ovarian Cancer Symptoms

Here are the early symptoms of ovarian cancer, which can be caused by other cancers as well: [⁵]

Bloating or gas
Pelvic or lower belly pain
Loss of appetite or feeling full quickly
Urinary symptoms such as urgency

The following are the other symptoms of ovarian cancer. [⁵]

Fatigue (extreme tiredness)
Upset stomach
Back pain
Pain during sex
Constipation
Changes in a woman's period, such as heavier bleeding than normal or irregular bleeding
Abdominal (belly) swelling with weight loss stage 4 Ovarian Cancer treatment

Stage 4 Ovarian Cancer first-line treatment

The first line of treatment against stage 4 Ovarian Cancer is surgery with combination therapy. A skilled specialist in treating ovarian tumors, such as a gynecologist or a gynecologic oncologist. The following surgeries are performed to treat stage 4 ovarian cancer.

Hysterectomy: A hysterectomy is the removal of the uterus from the body and any subsequent tumors originating from it.
Salpingo-oophorectomy: A salpingo-oophorectomy is the removal of one or both ovaries and attached fallopian tubes.
Additional Surgeries: In addition to removing reproductive organs and tissues, like the ovaries, uterus, and fallopian tubes, the surgeon would remove any tissues where cancer is confirmed. That could be in the liver, peritoneal cavity, or spleen. The goal is to de-bulk as much of the tumor as possible. Before chemotherapy.

In most cases, all three surgeries are performed. In the case of stage 4 ovarian cancer, the surgeon checks nearby tissues to analyze the degree of metastasis. Surgery is followed by another systemic treatment, such as chemotherapy, to kill and remove the remaining cancer cells. Chemotherapy works to shrink and kill the remaining cancer cells in the body.

Chemotherapy is not optional as the cancer has spread to different areas of the body, and surgery alone is not enough to cure it. If you cannot have surgery on certain body parts, any combination of radiation therapy, targeted drug therapy, and chemotherapy can be used to shrink the tumor in those regions.

Other types of treatment for stage 4 Ovarian Cancer

Other treatments for stage 4 ovarian cancer include localized treatments like radiation or systemic treatments like chemotherapy or intraperitoneal chemotherapy, hormone therapy, and targeted drug therapy. [⁸]

Radiation Therapy: high-energy x-rays to kill cancer cells.
Chemotherapy: drugs that kill cancer cells taken via IV injections or through a catheter in the peritoneal cavity.
Hormone Therapy: Hormones and hormone-blocking drugs to defeat cancer.
Targeted Drug Therapy: Drugs that kill the parts of cancer cells that separate them from normal cells.

While treating stage 4, Ovarian cancer Surgery is often combined with one or more of these other types of treatment. Since the cancer cells have migrated to other parts of the body, such as the lymph nodes or peritoneum, the surgical removal of reproductive organs is not enough to treat the disease.

Doctors may suggest the best option from among these; however, intraperitoneal chemotherapy is the most often paired treatment.

Can stage 4 Ovarian Cancer be cured?

Even stage 4 ovarian cancer, which has advanced, can be treated with both chemotherapy and surgery. More than half of instances of cancer are detected at advanced stages. Despite the fact that once it reaches stage 4, surgery is no longer enough to cure it, the survivability rate of patients is increasing while the number of cases also increases.

The disease becomes very difficult to cure, so the focus shifts towards treatment which improves the patient’s quality of life and extends their lifespan. The objective is to eradicate cancer cells and keep the body free of cancer for as long as possible if the malignancy is incurable. [⁹]

Prognosis: Stage 4 Ovarian Cancer Survival Rate

Stage 4 Ovarian Cancer survival rate

The survival percentage for stage three ovarian cancer after five years is 20%, whereas the average survival rate for all instances with distant spread ovarian cancer is 31%, according to the American joint council on cancer. [¹⁰] The prognosis for ovarian cancer is better than for lung, liver, brain, or pancreatic cancer.

Nonetheless, it has the lowest chance of survival among malignancies that only affect women. [¹¹] Stage 4 ovarian cancer has a five-year survival rate of 20%, while the average five-year survival rate for all cancers, regardless of stage, is 67%. [¹²]

Stage 4 Ovarian Cancer recurrence rate

When ovarian cancer returns after a patient has been cancer free for a certain period, it’s called a recurrence. On average, 70% of all ovarian cancer patients will experience a recurrence post-cancer remission or no proof of symptoms. The risk of recurrence is directly related to the stage at which the cancer was diagnosed. The stage of ovarian cancer tells us how far the cancer has spread.

Once the cancer has spread beyond the pelvic region to the lymph nodes around other organs or into other organs and reaches stage 4, there is a chance it will not be completely wiped out through treatment.

Any remaining cancer cells can localize somewhere else in the body or in the same region, and new cancerous growth can occur.

Patients who were diagnosed at stage 4 have a 90% chance of experiencing a recurrence. The approach to treating cancer once it’s recurred depends on several factors, including

Previously attempted treatments
Side effects of previous treatments
Progression of recurred cancer
Number of recurrences
Time since last treatment, or progression-free interval [¹³]

More aggressive or less harsh treatments can be investigated depending on these variables. In order to weigh therapy, side effects, quality of life, and the patient's expectations, constant dialogue with the doctor is required.

In some instances, a less aggressive treatment that has little to no effect on the quality of life and prevents cancer may be preferred to a more aggressive, intense treatment that has severe side effects but may be curative.

Stage 4 Ovarian Cancer growth rate

The more that ovarian cancer spreads, the faster it grows. In a nutshell, stage 1 ovarian cancer grows at a significantly slower pace than stage 4 ovarian cancer. The anticipated time it takes for ovarian cancer to spread from the fallopian tubes to one or both ovaries is 6.5 years. As cancer cells start to spread to different tissues, the growth rate considerably accelerates once it has done so.

The type of cells from which ovarian cancer develops also affects how quickly it grows. There are two types of epithelial ovarian cancer: low-grade and high-grade. Malignancies with low-grade cells grow more slowly than those with high-grade cells.

[¹⁴]

Lifestyle changes for preventing and managing Ovarian Cancer

There is no foolproof way to prevent ovarian cancer. There are some known risk factors that you can work on to reduce the chances of getting ovarian cancer. However, that would only reduce the risk and not eliminate it entirely. The following will reduce your risk of developing ovarian cancer:

Taking hormonal birth control for over five months continuously
Bearing and giving birth to a child
breastfeeding, especially for over a year or more
Tubal ligation, hysterectomy, or any part of the reproductive system removed

Ultimately, the best method of combating ovarian cancer the early discovery of the illness. If you have any known risk factors like a family history of ovarian or breast cancer, test positive for certain genes, have irregular periods, or are overweight, you should get regular pelvic exams and imaging to check for any suspicious cell growth.

Conclusion

Takeaway

stage 4 ovarian cancer is when the tumor has spread from beyond the ovaries and fallopian tubes to distant organs in the trunk of the body like the liver, spleen, lungs, etc. Many patients reach this stage because early symptoms are not distinct.

For stage 4 ovarian cancer, surgery combined with chemotherapy is the most chosen route of treatment, sometimes intraperitoneal chemotherapy. Radiology, hormone therapy, and targeted drug therapy are also considered.

People diagnosed with stage 4 face a 90% chance of recurrence, and their 5-year survival rate is 20% compared to the average of 67% across all cancers. Childbearing, breastfeeding, taking birth control, and avoiding hormonal therapy post-menopause reduce your risk of developing ovarian cancer.