Ovarian cancer can be hard to detect. The ovaries lie deep in the abdomen, making it virtually impossible to find tumors in early stages. There are also no reliable screening tests. Unfortunately, this means most ovarian cancers are in advanced stages at diagnosis. In fact, 60% of ovarian cancers are diagnosed in stage III. Ovarian cancer spreads or metastasizes in three ways. Cancer can spread in three ways: Into nearby tissues and areas including the lymph nodes. Lymph nodes are part of your body’s lymphatic system, which collects fluid from your tissues and returns it to your blood. Through the lymph system to distant lymph nodes or other parts of the body Through the bloodstream to other parts of the body The location where the cancer starts—or primary site—tends to determine where it spreads. In stage III ovarian cancer, doctors can find cancer in one or both ovaries or fallopian tubes. Cancer has also spread beyond the pelvis to the abdominal wall or to lymph nodes at the back of the abdomen. However, it has not spread to distant lymph nodes or body sites. As ovarian cancer becomes more advanced, it most often spreads to the following areas: Bones Distant lymph nodes Liver or spleen Lungs Outer lining of the lungs Rarely, ovarian cancer can spread to the brain or skin. Once cancer appears at any of these distant sites, it is stage IV—the most advanced stage. Advanced ovarian cancer needs a combination of treatments. Doctors treat metastatic cancer based on the primary site, not the site where it spreads. They call it the same as the primary site as well—it is still ovarian cancer even if it shows up in the lungs. For stage III, doctors will remove as much of the cancer as possible in the process of debulking. This may involve removing parts of organs, such as the liver and intestines. Combination chemotherapy is necessary after surgery. For some women, intra-abdominal chemotherapy in addition to IV chemotherapy is an option. It involves injecting chemotherapy inside the abdomen. This puts a concentrated dose of chemotherapy directly at the cancer site. Current treatments cannot cure stage IV ovarian cancer. Instead, treatment is palliative, aiming to relieve symptoms and help prolong your life. Treatment can involve a combination of surgery, chemotherapy, and targeted therapies. Targeted therapy uses specific markers to identify and attack cancer cells without damaging normal cells. These drugs can help shrink ovarian tumors and stop them from growing. This can help relieve symptoms. Discuss your cancer stage and treatment options with your doctor. Talk about the possibility of a clinical trial to see if you are a good candidate. Clinical trials may allow you to gain access to a cancer treatment that is not otherwise available to you. Your doctor can help you develop a treatment plan that best suits your needs.