eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Borderline Ovarian Cancer

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

Introduction

Borderline ovarian tumors are a subset of epithelial ovarian tumors that have a very favorable prognosis. The accepted initial treatment is surgical removal of the tumor and biopsies. However, the postoperative management protocol is far from clear. To date, no medical therapy has been shown to clearly improve outcomes.

History of the Procedure

In 1929, Taylor first described a subset of ovarian tumors that he termed semimalignant. These lesions had a more favorable outcome than other ovarian cancers, but they were not separately classified by the Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization (WHO) until the early 1970s.

Frequency

One woman in 55 (1.8%) develops some form of ovarian cancer in her lifetime. Approximately 90% of these cancers are tumors of epithelial origin. If benign lesions are included, epithelial tumors account for 60% of all ovarian tumors.

Borderline tumors comprise approximately 15% of all epithelial ovarian tumors. The mean age of occurrence is approximately 10 years younger than that of women with frankly malignant ovarian cancer. Factors reportedly linked with borderline tumors include oral contraceptive use, menarche, age at first pregnancy, age at first delivery, menstrual history, smoking, and family history of ovarian cancer, although none of these has been shown to be statistically significant.

Borderline ovarian cancer is staged according to the FIGO classification of ovarian cancer. Many clinicians group stages II-IV together for prognostic consideration. Another common component of staging is the description of the type of implants, as these have significant prognostic value. As opposed to its true malignant counterpart, epithelial ovarian carcinoma, borderline ovarian cancers are often found at early stages.

Etiology

The etiology of this disease remains unclear because of the small number of cases and the lack of randomized controlled studies. Based on molecular studies, some mucinous borderline tumors of the ovary may actually represent metastasis from the appendix.

Pathophysiology

The 2 major histologic tumor subtypes are serous and mucinous, with serous being more common. Serous tumors are presumed to originate from the germinal epithelium. Mucinous tumors do not have a clearly defined origin. Substantial information indicates that many tumors may actually originate from the appendix; thus, this organ should be removed at time of surgery.

Presentation

These tumors, as with other ovarian tumors, are difficult to detect clinically until they are advanced in size or stage. In one study, the most common presenting symptoms were abdominal pain, increasing girth or abdominal distension, and abdominal mass. Approximately 23% of patients were asymptomatic.

Indications

When a complex ovarian mass is discovered, surgery is often, if not always, indicated. Preoperatively, borderline tumors are often presumed to be either benign or malignant ovarian masses; regardless, surgery is required to determine the type of mass.

Contraindications

Contraindications to surgery include medical reasons (ie, the patient is too great a surgical risk secondary to other medical problems) or patient refusal. Otherwise, the masses should be surgically removed.

More on Borderline Ovarian Cancer

Overview: Borderline Ovarian Cancer
Workup: Borderline Ovarian Cancer
Treatment: Borderline Ovarian Cancer
Follow-up: Borderline Ovarian Cancer
References
Further Reading
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References

  1. Dietel M, Hauptmann S. Serous tumors of low malignant potential of the ovary. 1. Diagnostic pathology. Virchows Arch. May 2000;436(5):403-12. [Medline].

  2. Gershenson DM, Silva EG, Levy L, et al. Ovarian serous borderline tumors with invasive peritoneal implants. Cancer. Mar 15 1998;82(6):1096-103. [Medline].

  3. Lin PS, Gershenson DM, Bevers MW, et al. The current status of surgical staging of ovarian serous borderline tumors. Cancer. Feb 15 1999;85(4):905-11. [Medline].

  4. Chan JK, Lin YG, Loizzi V, et al. Borderline ovarian tumors in reproductive-age women. Fertility-sparing surgery and outcome. J Reprod Med. Oct 2003;48(10):756-60. [Medline].

  5. Eltabbakh GH, Natarajan N, Piver MS, Mettlin CJ. Epidemiologic differences between women with borderline ovarian tumors and women with epithelial ovarian cancer. Gynecol Oncol. Jul 1999;74(1):103-7. [Medline].

  6. Emoto M, Udo T, Obama H, et al. The blood flow characteristics in borderline ovarian tumors based on both color Doppler ultrasound and histopathological analyses. Gynecol Oncol. Sep 1998;70(3):351-7. [Medline].

  7. Harris R, Whittemore AS, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. III. Epithelial tumors of low malignant potential in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. Nov 15 1992;136(10):1204-11. [Medline].

  8. Houck K, Nikrui N, Duska L, et al. Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol. Jun 2000;95(6 Pt 1):839-43. [Medline].

  9. Menzin AW, Gal D, Lovecchio JL. Contemporary surgical management of borderline ovarian tumors: a survey of the Society of Gynecologic Oncologists. Gynecol Oncol. Jul 2000;78(1):7-9. [Medline].

  10. Menzin AW, Rubin SC, Noumoff JS, LiVolsi VA. The accuracy of a frozen section diagnosis of borderline ovarian malignancy. Gynecol Oncol. Nov 1995;59(2):183-5. [Medline].

  11. Morris RT, Gershenson DM, Silva EG, et al. Outcome and reproductive function after conservative surgery for borderline ovarian tumors. Obstet Gynecol. Apr 2000;95(4):541-7. [Medline].

  12. Nielsen JS, Jakobsen E, Holund B, et al. Prognostic significance of p53, Her-2, and EGFR overexpression in borderline and epithelial ovarian cancer. Int J Gynecol Cancer. Nov-Dec 2004;14(6):1086-96. [Medline].

  13. Sherman ME, Mink PJ, Curtis R, et al. Survival among women with borderline ovarian tumors and ovarian carcinoma: a population-based analysis. Cancer. Mar 1 2004;100(5):1045-52. [Medline].

  14. Tamakoshi K, Kikkawa F, Nakashima N, et al. Clinical behavior of borderline ovarian tumors: a study of 150 cases. J Surg Oncol. Feb 1997;64(2):147-52. [Medline].

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Further Reading

See Borderline Ovarian Cancer on Medscape.

See Treatment for Borderline Ovarian Cancer on Medscape.

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Keywords

borderline ovarian tumors, ovarian tumors of low malignant potential, epithelial ovarian tumors of low malignant potential, ovarian masses, cancer antigen 125, CA125, CA-125, mucinous tumors, serous tumors, fertility-sparing surgery, oophorectomy, salpingo-oophorectomy, cystectomy, epithelial ovarian tumors, epithelial ovarian carcinoma

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Contributor Information and Disclosures

Author

Andrew E Green, MD, BA, BS, Consulting Staff, Southeastern Gynecologic Oncology, LLC, Northeast Georgia Medical Center
Andrew E Green, MD, BA, BS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society of Clinical Oncology, and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Medical Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

 
 
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