Diagnosis, Treatment, and Follow-Up of Borderline Ovarian Tumors

Abstract

After completing this course, the reader will be able to:1. Compare the epidemiologic and reproductive risk factors in BOTs with those in ovarian cancers and describe the molecular background of development of BOTs.2. Use the pathological terminology with either original grouping of borderline category or new subclassification of BOTs and assess the major predictor of recurrence and survival.3. Determine an appropriate diagnostic algorithm for patients with symptoms suggesting malignant ovarian tumors that will identify borderline ovarian tumors when present.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBorderline ovarian tumors represent a heterogeneous group of noninvasive tumors of uncertain malignant potential with characteristic histology. They occur in younger women, are present at an early stage, and have a favorable prognosis, but symptomatic recurrence and death may be found as long as 20 years after therapy in some patients. The molecular changes in borderline ovarian tumors indicate linkage of this disease to type I ovarian tumors (lowgrade ovarian carcinomas). The pathological stage of disease and subclassification of extraovarian disease into invasive and noninvasive implants, together with the presence of postoperative macroscopic residual disease, appear to be the major predictor of recurrence and survival. However, it should be emphasized that the most important negative prognostic factor for recurrence is just the use of conservative surgery, but without any impact on patient survival because most recurrent diseases are of the borderline type-easily curable and with an excellent prognosis. Borderline tumors are difficult masses to correctly preoperatively diagnose using imaging methods because their macroscopic features may overlap with invasive and benign ovarian tumors. Over the past several decades, surgical therapy has shifted from a radical approach to more conservative treatment; however, oncologic safety must always be balanced. Follow-up is essential using routine ultrasound imaging, with special attention paid to the remaining ovary in conservatively treated patients. Current literature on this topic leads to a number of controversies that will be discussed thoroughly in this article, with the aim to provide recommendations for the clinical management of these patients. The Oncologist

Fertility Preservation Is Safe for Serous Borderline Ovarian Tumors

“…1,2 In contrast to invasive ovarian cancer, they are characterized by the absence of stromal invasion. Serous BOTs are divided into typical (papillary) serous BOT (90%) and borderline tumor with micropapillary pattern (5%Y10%).…”

“…Serous BOTs are divided into typical (papillary) serous BOT (90%) and borderline tumor with micropapillary pattern (5%Y10%). 2 A subgroup of BOTs presents microinvasion (10%). 3 One third of the patients diagnosed with BOTs are younger than 40 years with an average age of 42 years for serous BOT.…”

Management of a borderline ovarian tumor in a pregnant woman in a rural hospital: a case report

“…Cystectomy is associated with a higher recurrence rate (up to 31%) [23] . It should be performed only for patients with bilateral tumors and/or only one ovary; it was associated with a higher rate of intraoperative cyst rupture [24] , and with the knowledge that is not safe in patients with mucinous borderline tumors because is associated with an increased risk of recurrence in the form of invasive carcinoma [25] , but is an acceptable option for women who plan further pregnancies [26] . If borderline tumor is revealed by the histology of a surgical specimen, it seems reasonable to defer surgical treatment until after delivery and the surgical staging should be completed 3-6 weeks after delivery [16] .…”

“…The available data suggest that the rate of recurrence is higher after conservative surgery (10% to 20% vs. approximately 5% for radical surgery) [22] . Nevertheless, the psychological impact of waiting for relapse is considerable and there is still a risk for development of invasive ovarian tumors, for this reason its recommend definitive surgery after family planning is completed [24] . There is no clear evidence that chemotherapy can decrease relapse rates or improve survival in any subset of patients with this diagnostic [24] .…”

“…In the case of relapse on the remaining ovary after conservative surgery, cystectomy may be proposed to preserve fertility, or salpingoophorectomy with or without hysterectomy is performed. When extraovarian recurrence or invasive disease occurs, extensive cytoreductive surgery, in line with the surgical management of primary ovarian cancer, is the treatment option of choice [24] . The overall recurrence rate for patients previously treated is estimated to be up to 11%.…”