Ovarian cancer often begins in the ovaries — small, oval-shaped organs in the pelvis. Cancers that begin in the fallopian tubes (the tubes that connect the ovaries to the uterus) or peritoneum (the tissue lining the abdomen) are also grouped with ovarian cancer.

It is hard to catch ovarian cancer early, when it first starts growing. Cancer quickly spreads from the ovary, fallopian tube, or peritoneum to nearby tissues, and then to other parts of the body. When cancer cells start growing in a more distant location, doctors say that the cancer has metastasized. Ovarian cancer can metastasize to places like the liver, lungs, intestines, and brain.

Doctors assign ovarian cancer stages to describe how far a person’s cancer cells have spread.

• Stage 1 ovarian cancer is only located within the ovaries or fallopian tubes. Doctors assign a higher stage if the cancer has spread farther.
• Stage 2 ovarian cancer has spread to nearby tissues in the pelvis.
• Stage 3 ovarian cancer has spread outside the pelvis and into the abdomen.
• Stage 4 cancer is metastatic — cancer cells are growing in more distant areas of the body.

Together, stage 2, 3, and 4 ovarian cancers are called advanced ovarian cancer. (Notably, cancer stages are sometimes noted with Roman numerals, as stages I through IV.)

Where Does Ovarian Cancer Metastasize?

When ovarian cancer spreads, it most often remains within the peritoneal cavity — the space inside your torso consisting of the abdomen and pelvis. Ovarian cancer cells typically first spread to other organs of the reproductive system, such as the uterus or fallopian tubes. They may also grow into nearby organs in the pelvis, like the bladder, colon, or tissues like the omentum. (The omentum is the layer of fatty tissue that covers the abdominal organs). Later, they may spread to other tissues in the abdomen and pelvis, or to more distant locations.

The most common areas of the body into which ovarian cancer cells spread include:

• Liver
• Lungs, including fluid around the lungs or the pleura (thin tissue that covers the lungs and lines the inside of the chest)
• Intestines
• Omentum (folds of the abdomen’s lining, or peritoneum)
• Distant lymph nodes (small structures found throughout the body that filter out germs and cancer cells)

Less common sites of metastasis include the central nervous system (the brain and spinal cord), skin, spleen, and bones. In very rare cases, ovarian cancer can metastasize to the breast.

If you develop metastatic tumors, they are still called ovarian cancer. For example, if ovarian cancer cells travel to your lungs and form a tumor there, the tumor is ovarian cancer, not lung cancer, and it needs ovarian cancer treatments.

About 7 out of 10 cases of ovarian cancer have metastasized by the time they are diagnosed. Any type of ovarian cancer can spread to other locations, although ovarian stromal tumors are usually caught in the early stages, before they have spread.

People with ovarian cancer may be more likely to experience metastasis if:

• They have advanced-stage cancer.
• They have a high-grade ovarian tumor (the tumor cells look more abnormal and grow more quickly).
• Ovarian cancer cells are found in the lymph nodes.

Metastatic Ovarian Cancer Symptoms

When ovarian cancer is in the early stages, cancer cells are only located within the pelvis. A person’s symptoms may include pain in their pelvis or abdomen, bloating, and bladder symptoms such as needing to urinate often.

As ovarian cancer spreads to other areas, additional symptoms may appear. If cancer has metastasized to organs in the abdomen, a person may experience nausea, vomiting, constipation, back pain, and swelling in the abdomen from ascites (fluid in the belly).

Other symptoms may depend on the exact location of the cancer:

• Liver — Abdominal swelling or jaundice (yellowing of the skin or the whites of the eyes)
• Lung — Shortness of breath
• Brain — Headache, dizziness, or seizures
• Bones — Pain or fractures
• Breast — Mass in breast or underarm area

If you have been diagnosed with ovarian cancer and are noticing health changes in another part of your body, talk to your oncologist.

How Do Doctors Know if Ovarian Cancer Has Spread?

In some cases, ovarian cancer has spread before it is diagnosed, and doctors can detect metastases right away. One of the main ways doctors determine how far cancer has spread is during surgery. For most people with ovarian cancer, surgery is both a treatment (doctors use surgery to remove tumors) and a part of tumor staging (doctors remove and test different tissues to see if they contain cancer).

For other people, ovarian cancer metastases are discovered through imaging tests. These tests may occur during the process of diagnosis, or they may be recommended during follow-up visits during or after treatment.

Imaging tests to look for metastatic disease may include:

• Computed tomography (CT scan) — An X-ray test that can be used to identify tumors in other organs
• CT-guided needle biopsy — A test that uses CT scans to help doctors direct a needle towards a mass and remove a small sample to be further studied under a microscope
• Chest X-ray — An imaging test that can help doctors see tumors in the lungs, pleura, or surrounding fluid
• Magnetic resonance imaging (MRI) — A test that uses magnets to look for signs of cancer in other parts of the body, such as the central nervous system
• Positron emission tomography (PET scan) — A test that shows whether tumors or abnormal areas contain rapidly growing cells, which may be cancer cells
• Colonoscopy or barium enema X-ray —Tests that can help look for ovarian cancer that has spread to the intestines

Treatments for Metastatic Ovarian Cancer

Doctors may use a variety of treatments to help treat ovarian cancer that has spread to other parts of a person’s body. Which treatments are needed depends on your overall health and where in your body the cancer has metastasized to.

During debulking surgery, a surgeon will remove as much cancer as possible from the pelvis and abdomen areas. Doctors may remove all or part of organs like the spleen or liver if cancer has spread there. If ovarian cancer has spread to the bladder, a piece of this organ may be removed, and a catheter (a thin tube) will be inserted to help remove urine until the bladder heals.

When ovarian cancer metastasizes to the intestines, part of the intestine may be taken out. In many cases, a piece of intestine is removed, and the two nearby ends are sewn together. Other times, the end of the intestine may be connected to a stoma (the opening a surgeon makes in a person’s skin to allow digested food to leave the body). This is usually temporary.

Most people with ovarian cancer receive systemic therapy. This treatment includes medication like chemotherapy and targeted therapy. These drugs travel throughout the bloodstream and kill cancer cells located in most parts of the body.

Doctors may also recommend other types of treatment for different metastatic sites. For example, radiation therapy is sometimes used to treat ovarian cancer in the central nervous system or other distant tissues.

Talk With Others Who Understand

On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, more than 3,400 members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Have you been diagnosed with metastatic ovarian cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.