Stage 4 ovarian cancer presents significant treatment challenges due to its advanced nature and widespread metastasis. The mainstay of treatment includes a combination of surgery, chemotherapy, and, increasingly, targeted therapies, which together aim to control the disease, alleviate symptoms, and improve survival. Surgery remains a cornerstone, primarily involving cytoreductive or debulking surgery designed to remove as much of the tumor burden as possible. Evidence suggests that optimal cytoreduction, leaving no visible tumor, is associated with improved overall survival. However, complete debulking is challenging in stage 4 due to the cancer's extensive spread. Chemotherapy typically follows surgery, with platinum-based compounds combined with taxanes being the standard regimen. Intravenous administration of these drugs aims to target residual microscopic disease. In some cases, neoadjuvant chemotherapy is used before surgery to shrink tumors and facilitate less extensive surgery. Targeted therapies have revolutionized the treatment landscape. PARP inhibitors, such as olaparib, have shown efficacy, particularly in patients with BRCA1 or BRCA2 mutations, by exploiting the DNA repair weaknesses in cancer cells. These agents have significantly extended progression-free survival in maintenance settings post-chemotherapy. Bevacizumab, an anti-angiogenesis drug, inhibits blood vessel growth within tumors, thereby limiting their nutrient supply and growth, and is often combined with chemotherapy, showing benefit in overall survival. Immunotherapy is an emerging field with promising potential. Agents like immune checkpoint inhibitors (pembrolizumab) are under investigation for their ability to unleash the body's immune system against cancer cells. Hormonal therapy and radiation therapy are less frequently used but may have roles in managing hormone receptor-positive cancers or localized disease, respectively. Multidisciplinary care, integrating oncologists, surgeons, radiologists, and genetic counselors, is critical in personalizing treatment approaches to patient-specific tumor biology and clinical status. Furthermore, participation in clinical trials is encouraged, as ongoing research continuously seeks more effective treatment combinations and novel therapies to improve outcomes for stage 4 ovarian cancer patients.