Management of Borderline Ovarian Tumors
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Published:
Jun 27, 2018
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Abstract
Borderline ovarian tumors are similar to the other adnexal masses in terms of clinical presentation. Surgery is the main treatment. Because of the young age of the patients and early stage of diseases at the time of diagnosis, fertility-sparing surgery is favorable. If the intraoperative frozen section reports a borderline tumor, surgical staging should be performed. The surgical staging includes cytologic washing or ascites fluid collection, omentectomy and peritoneal biopsies. The routine lymphadenectomy is not recommended. In terms of fertility-sparing surgery, the unilateral salpingo-oophorectomy is preferred if the other site of ovary is not affected. However, if there are bilateral ovarian involvements, unilateral salpingo-oophorectomy with ovarian cystectomy or bilateral ovarian cystectomy can be considered. The prognostic factors include the stage of disease, the presence of micropapillary in serous tumor, the presence of microinvasion, and the presence of peritoneal implants. Post-operative chemotherapy should be discussed and administrated, similar to the treatment of low grade serous epithelial ovarian cancer if the invasive implantation is detected.
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Charakorn, C. Management of Borderline Ovarian Tumors. Thai J Obstet Gynaecol 2018, 26, 70-74.
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References
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13. Schilder JM, Thompson AM, DePriest PD, Ueland FR, Cibull ML, Kryscio RJ, et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol. 2002;87:1-7.
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15. Shim SH, Kim SN, Jung PS, Dong M, Kim JE, Lee SJ. Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis. Eur J Cancer. 2016;54:84-95.
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18. Fauvet R, Boccara J, Dufournet C, David-Montefiore E, Poncelet C, Darai E. Restaging surgery for women with borderline ovarian tumors: results of a French multicenter study. Cancer. 2004;100:1145-51.
19. Gershenson DM, Silva EG. Serous ovarian tumors of low malignant potential with peritoneal implants. Cancer. 1990;65:578-85.
20. Shih KK, Zhou QC, Aghajanian C, Huh J, Soslow RA, Morgan JC, et al. Patterns of recurrence and role of adjuvant chemotherapy in stage II-IV serous ovarian borderline tumors. Gynecol Oncol. 2010;119:270-3.
21. Maneo A, Vignali M, Chiari S, Colombo A, Mangioni C, Landoni F. Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol. 2004;94:387-92.
22. Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol. 2006;101:255-60.
23. Morice P, Camatte S, El Hassan J, Pautier P, Duvillard P, Castaigne D. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001;75:92-6.
24. Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol. 2017;41:49-59.
25. Suh-Burgmann E. Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study. Gynecol Oncol. 2006;103:841-7.
26. Feigenberg T, Covens A, Ghorab Z, Ismiil N, Dube V, Saad RS, et al. Is routine appendectomy at the time of primary surgery for mucinous ovarian neoplasms beneficial? Int J Gynecol Cancer. 2013;23:1205-9.
27. Ramirez PT, Slomovitz BM, McQuinn L, Levenback C, Coleman RL. Role of appendectomy at the time of primary surgery in patients with early-stage ovarian cancer. Gynecol Oncol. 2006;103:888-90.
28. Mukhopadhyay D, Rajab R, Nobbenhuis M, Dilley J, Heath O, Wang J, et al. Outcome of Appendicectomies at Surgery for Mucinous Ovarian Neoplasms: Report From A UK Center and Review of Literature. Int J Gynecol Cancer. 2016;26:1020-6.
2. Classification and staging of malignant tumours in the female pelvis. Acta Obstet Gynecol Scand. 1971;50:1-7.
3. Sutton G. Ovarian tumors of low malignant potential. In: Rubin S, Sutton G, editors. Ovarian cancer. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 399-417.
4. Skirnisdottir I, Garmo H, Wilander E, Holmberg L. Borderline ovarian tumors in Sweden 1960-2005: trends in incidence and age at diagnosis compared to ovarian cancer. Int J Cancer. 2008;123:1897-901.
5. Song T, Lee YY, Choi CH, Kim TJ, Lee JW, Bae DS, et al. Histologic distribution of borderline ovarian tumors worldwide: a systematic review. J Gynecol Oncol. 2013;24:44-51.
6. Park JY, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, et al. Micropapillary pattern in serous borderline ovarian tumors: does it matter? Gynecol Oncol. 2011;123:511-6.
7. Seong SJ, Kim DH, Kim MK, Song T. Controversies in borderline ovarian tumors. J Gynecol Oncol. 2015;26:343-9.
8. Song T, Choi CH, Kim HJ, Kim MK, Kim TJ, Lee JW, et al. Accuracy of frozen section diagnosis of borderline ovarian tumors. Gynecol Oncol. 2011;122:127-31.
9. Winter WE, 3rd, Kucera PR, Rodgers W, McBroom JW, Olsen C, Maxwell GL. Surgical staging in patients with ovarian tumors of low malignant potential. Obstet Gynecol. 2002;100:671-6.
10. Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016;3:Cd010360.
11. Morice P, Denschlag D, Rodolakis A, Reed N, Schneider A, Kesic V, et al. Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer. 2011;21:951-63.
12. Fader AN, Rose PG. Role of surgery in ovarian carcinoma. J Clin Oncol. 2007;25:2873-83.
13. Schilder JM, Thompson AM, DePriest PD, Ueland FR, Cibull ML, Kryscio RJ, et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol. 2002;87:1-7.
14. Shazly SA, Laughlin-Tommaso SK, Dowdy SC, Famuyide AO. Staging for low malignant potential ovarian tumors: a global perspective. Am J Obstet Gynecol. 2016;215:153-68.e2.
15. Shim SH, Kim SN, Jung PS, Dong M, Kim JE, Lee SJ. Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis. Eur J Cancer. 2016;54:84-95.
16. Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol. 2004;104:261-6.
17. Lesieur B, Kane A, Duvillard P, Gouy S, Pautier P, Lhomme C, et al. Prognostic value of lymph node involvement in ovarian serous borderline tumors. Am J Obstet Gynecol. 2011;204:438 e1-7.
18. Fauvet R, Boccara J, Dufournet C, David-Montefiore E, Poncelet C, Darai E. Restaging surgery for women with borderline ovarian tumors: results of a French multicenter study. Cancer. 2004;100:1145-51.
19. Gershenson DM, Silva EG. Serous ovarian tumors of low malignant potential with peritoneal implants. Cancer. 1990;65:578-85.
20. Shih KK, Zhou QC, Aghajanian C, Huh J, Soslow RA, Morgan JC, et al. Patterns of recurrence and role of adjuvant chemotherapy in stage II-IV serous ovarian borderline tumors. Gynecol Oncol. 2010;119:270-3.
21. Maneo A, Vignali M, Chiari S, Colombo A, Mangioni C, Landoni F. Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol. 2004;94:387-92.
22. Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol. 2006;101:255-60.
23. Morice P, Camatte S, El Hassan J, Pautier P, Duvillard P, Castaigne D. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001;75:92-6.
24. Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol. 2017;41:49-59.
25. Suh-Burgmann E. Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study. Gynecol Oncol. 2006;103:841-7.
26. Feigenberg T, Covens A, Ghorab Z, Ismiil N, Dube V, Saad RS, et al. Is routine appendectomy at the time of primary surgery for mucinous ovarian neoplasms beneficial? Int J Gynecol Cancer. 2013;23:1205-9.
27. Ramirez PT, Slomovitz BM, McQuinn L, Levenback C, Coleman RL. Role of appendectomy at the time of primary surgery in patients with early-stage ovarian cancer. Gynecol Oncol. 2006;103:888-90.
28. Mukhopadhyay D, Rajab R, Nobbenhuis M, Dilley J, Heath O, Wang J, et al. Outcome of Appendicectomies at Surgery for Mucinous Ovarian Neoplasms: Report From A UK Center and Review of Literature. Int J Gynecol Cancer. 2016;26:1020-6.