What are the signs of borderline ovarian tumors?
Like ovarian cysts, borderline ovarian tumors can cause pain or pressure in the lower abdomen. Many times, however, they are asymptomatic and are discovered by chance in the gynecological examination or a screening test performed for different reasons (e.g., genital ultrasound). Very rarely do borderline tumors cause the symptoms of advanced ovarian cancer (see ovarian cancer).
What tests help diagnose borderline ovarian tumors?
If, after a gynecological examination or genital ultrasound, the doctor finds a tumor in the ovarian area, the doctor will probably ask you to have an MRI of the lower abdomen with intravenous contrast agent. The clinical value of measuring tumor markers in the blood, such as CA-125, is more limited in borderline ovarian tumors. On suspicion of localization of the disease in other parts of the abdomen (except the ovaries), useful information is given by further screening with computed tomography (CT) with intravenous and oral contrast agent. In any case, the final diagnosis of the disease is made only after the excision and histological examination (biopsy) of the tumor. Intraoperative biopsy (rapid biopsy) is useful in determining the plan of surgery, but it does not have the same accuracy in borderline ovarian tumors, especially if they are large and mucinous.
What should I do if it is suspected I have a borderline ovarian tumor?
If the examinations show an increased chance of borderline ovarian tumor, the next step for the patient is to visit a Gynecologic Oncologist, i.e. a Gynecologist with official individualization in treating gynecological types of cancer. This is even more important given that the imaging characteristics of borderline ovarian tumors and cancer are similar. The Gynecologic Oncologist disposes of all the necessary knowledge and technical skills to evaluate the patient, to provide the appropriate surgical treatment and to coordinate the rest of the treatment and the subsequent follow-up of the patient.
What is the classic treatment for borderline ovarian tumors?
The classic treatment for borderline ovarian tumors is surgery and includes:
- Collection of the free peritoneal fluid for cytological examination. Otherwise, the above test is performed in the peritoneal cavity.
- Removal of the tumor (individually or together with the rest of the ovary +/- the corresponding fallopian tube), making every effort not to rupture the capsule. This preparation is sent for a rapid biopsy, during which the Pathologist will respond in a short time whether it is cancer, a borderline tumor or a benign tumor. On borderline ovarian tumors, surgery is continued based on the following.
- Removal of the uterus and the cervix (total hysterectomy) and the lateral appendage (fallopian tube and ovary)
- Omentectomy
- Careful examination of the peritoneal surfaces for any metastatic foci of the disease. In case nodules or adhesions are found that could indicate metastases, excision is necessary. Otherwise, random biopsies are obtained from the pelvis, the paracolic gutters, and the diaphragmatic peritoneal surfaces.
- Appendectomy, if the histological type is mucinous
Borderline ovarian tumors do not require the removal of the pelvic and paraaortic lymph nodes as part of the disease staging.
What is the treatment for younger women who want to maintain their reproductive potential or avoid menopause?
Quite often, borderline ovarian tumors are diagnosed in women younger than 40 years old who want to have children or avoid the effects of premature menopause. In these cases, the preservation of the uterus and the unilateral fallopian tube and ovary, as long as they are not diseased, is acceptable. The excision of the tumor from the affected side can be done individually or together with the corresponding fallopian tube and ovary. In the latter case, the probability of future recurrence is lower. The rest steps of the surgery (e.g., omentectomy, biopsy) follow the classic treatment of borderline ovarian tumors, as above. Depending on the results of the histological examination, assisted reproduction techniques (e.g., in vitro fertilization, cryopreservation of eggs/ embryos) are acceptable postoperatively and should always be applied by doctors with individualized specialization in female reproduction.
Can borderline ovarian tumors be treated with minimally invasive surgery techniques (laparoscopy, robotic surgery)?
Laparoscopy and robotic surgery of borderline ovarian tumors do not increase the likelihood of recurrence of the disease, as long as they are performed by experienced Gynecologic Oncologists in women patients who take all the relevant precautions. In this context, the advantages of laparoscopic and robotic surgery include:
- Much less blood loss
- Lower chance of infection of the surgical wound or postoperative hernia
- Minimization of postoperative pain
- Faster recovery
- Better aesthetic result in the area of the incisions
Do I need chemotherapy after surgery?
Chemotherapy in cases of borderline ovarian tumors has not been shown to improve oncological outcomes. Therefore, with the existing data, it is not recommended by the large scientific companies abroad. Exception is the finding of infiltrating peritoneal implants.
Is there a risk of relapse in the future?
The possibility of disease recurrence is mainly determined by the type of the initial surgery, the stage of the disease and its individual histological features. In interventions to maintain fertility and as long as the disease is at an early stage, the risk of recurrence is between 7% and 30%. In the majority of relapses, the disease manifests itself again as a borderline tumor, while the development of ovarian cancer is rare. In this context, long-term monitoring of the patient at regular intervals with clinical examination, screening tests and measurement of tumor markers is important.
