eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Borderline Ovarian Cancer: Follow-up

Author: Andrew E Green, MD, BA, BS, Consulting Staff, Southeastern Gynecologic Oncology, LLC, Northeast Georgia Medical Center
Contributor Information and Disclosures

Updated: Jan 15, 2008

Outcome and Prognosis

Patients with stage I disease confirmed by comprehensive staging have an approximate 15% recurrence rate. The 5-year survival rate for such patients approaches 100%. However, the 10-year survival rate is 90-95% depending on histologic findings.

In patients with stage II-IV disease, the prognosis is different. In women with serous tumors with noninvasive peritoneal implants, a mean 20% recurrence rate and a mean 7% death rate were found in reported series. In patients with recurrence, a median time to diagnosis of 3.1 years was reported if the recurrence was of the borderline type. In patients whose recurrence was invasive carcinoma, the median time to diagnosis was 8.3 years. It is believed that the former was a recurrence but that the latter was probably a new primary tumor. The CA-125 level was normal in 65% of the recurring cases. Death was noted only when invasive carcinoma was noted in the recurrence.

In patients with serous borderline tumors with invasive implants, the relapse rate was 31-45%. The median time from diagnosis to recurrence was 24 months, although the time to progression of disease was significantly longer in patients who had no macroscopic disease remaining at time of initial operation. Additionally, patients who received postoperative platinum-based chemotherapy had a significantly worse progression-free survival rate. However, the authors of this study believed that this finding might have been due to selection bias. Gershenson and colleagues' research indicated that age, stage, type of surgery, postoperative treatment, coexistence with noninvasive implants, and number of invasive implants had no effect on progression-free survival.²

No statistically significant differences are found in survival between mucinous and serous tumors. Mucinous tumors are most often stage I at time of diagnosis, and it is quite unusual to find extraovarian disease in tumors of mucinous origin.

Given the excellent prognosis of patients with stage I disease and its occurrence in women of reproductive age, fertility-sparing surgery is of great interest. In patients diagnosed with stage I disease who were treated with fertility-sparing surgery of any type, a higher recurrence was found in patients who had a cystectomy (with or without contralateral oophorectomy) as opposed to patients treated with oophorectomy (58% and 23%, respectively). However, only half of these patients underwent complete staging. When comprehensive staging was performed, no statistical difference was found in recurrence in confirmed cases of stage I disease. Thus, fertility-sparing surgery is an acceptable option in confirmed stage I disease. This again emphasizes the need for comprehensive staging in all cases.

Of patients who attempted pregnancy after fertility-sparing operations, a 50% conception rate was achieved among 24 patients who were studied. At the endpoint of the study, 16 live births, 4 spontaneous abortions, 3 ectopic pregnancies, and 2 ongoing pregnancies were found. No fetal anomalies were reported. All authors, nevertheless, indicate that this is an area that needs further research because, in the literature, only 48 patients were found to have conceived after having conservative surgery for borderline tumors. Another study looked at 25 women who underwent fertility-sparing surgery. No recurrences took place in the study period, although the range of follow-up varied widely (4-157 months). Of the 6 patients who attempted to become pregnant, 5 were successful, resulting in 5 live births and one patient had a miscarriage who underwent assisted reproductive techniques.

Patient Education:

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Ovarian Cancer.

Future and Controversies

Patients with borderline tumors have an excellent overall prognosis. Patients have a 60% chance of having stage I disease when diagnosed. Postoperative treatment for any stage is controversial; therefore, recommending reoperation for surgical staging alone is difficult. This being said, adequate staging is essential for determining the prognosis.

One study found that only 12% of patients were adequately staged at initial operation. Of these patients, 78% were operated on by general obstetrician/gynecologists, 10% by gynecologic oncologists, and 6% by general surgeons. When gynecologic oncologists were asked about surgical staging for borderline tumors, 97% recommend some type of staging procedure, although opinions varied significantly about which samples should be taken.³

Currently, an important area of research is postoperative chemotherapy. Little advantage has been reported after postoperative chemotherapy, but the number of patients studied is small and the chemotherapeutic regimens used were varied. The general consensus is that borderline tumors with noninvasive implants do not require any further therapy and should be observed. However, the benefit of treating tumors with invasive implants has been discussed. To date, no randomized data show a benefit.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Laszlo Sogor to the development and writing of this article. 

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