Stage IV Ovarian Cancer
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Patients diagnosed with Stage IV or metastatic ovarian cancer have disease that has spread outside the abdomen or into the liver. The following is a general overview of the diagnosis and treatment of ovarian cancer. Each person with ovarian cancer is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.
Currently, the standard treatment for Stage IV ovarian cancer consists of both surgery and chemotherapy. Unfortunately, less than 10% of patients experience long-term survival following standard treatment. This is because Stage IV ovarian cancer is difficult to completely remove with surgery and the currently available chemotherapy is unable to eradiate all of the remaining cancer. Both optimal cytoreductive surgery and platinum-based chemotherapy prolong the time to cancer recurrence and improve overall survival.
During cytoreductive surgery, physicians attempt to remove as much of the ovarian cancer as possible. Cytoreductive surgery is beneficial because it reduces the number of cancer cells that ultimately need to be destroyed by chemotherapy and therefore, decreases the likelihood of the cancer developing a resistance to chemotherapy. Initial cytoreductive surgery in ovarian cancer is currently considered the standard of care because clinical studies have shown that patients who have had optimal cytoreductive surgery live longer and have a more prolonged time to cancer recurrence than patients who have had suboptimal cytoreductive surgery.
Following cytoreductive surgery, all patients with Stage IV ovarian cancer are offered additional treatment. This is because the majority of patients will experience recurrence of their cancer even after complete surgical resection. Nearly all patients with Stage IV disease have cancer that was not removed by surgery. An effective treatment is needed to eliminate the remaining cancer in order to improve the outcome achieved with surgical removal of the cancer. Currently, this treatment is chemotherapy.
Chemotherapy for Stage IV Ovarian Cancer
Clinical trials have demonstrated that for patients with advanced ovarian cancer, treatment with combination chemotherapy regimens containing a platinum (Platinol® or Paraplatin®) compound prolongs the duration of survival and prevents more recurrences of cancer compared to treatment with surgery and non-platinum compounds. Chemotherapy typically consists of paclitaxel and a platinum compound administered every 3 weeks for 6-8 cycles.
Chemotherapy is most often given after surgery. In some cases, however, it may be given both before and after surgery. Giving chemotherapy before surgery may reduce the amount of cancer, thereby allowing for more complete surgical removal of the cancer. This approach to treatment remains controversial, but it may be considered for selected patients with advanced disease who do not appear to be candidates for initial surgery.
Unfortunately, fewer than 10% of patients treated with a platinum compound and paclitaxel survive without evidence of cancer recurrence 5 years following treatment. Because many patients still experience recurrence of their cancer following standard therapy, some patients and their doctors consider participation in clinical trials evaluating new treatment approaches as their initial option.
 Coleman, RL, Gershenson DM. Neoplastic diseases of the ovary: Screening, benign and malignant epithelial and germ cell neoplasms, sex-cord stromal tumors. In: Katz VL, ed. Comprehensive Gynecology, 5th ed. St. Louis: Mosby; 2007: 839-77.
 Bristow RE, Eisenhauer EL, Santillan A, Chi DS. Delaying the primary surgical effort for advanced ovarian cancer: a systemic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecologic Oncology. 2007;104:480-490.