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Preserving Fertility in Borderline Ovarian Cancer PDF Print E-mail

This retrospective study of 25 women who underwent fertility-sparing surgery for the treatment of borderline ovarian carcinoma was conducted to investigate the survival and fertility outcome of these patients.

The median age of study subjects was 29 years. Nineteen were treated with unilateral adnexectomy, 5 had unilateral adnexectomy with contralateral cystectomy, and 1 had unilateral cystectomy. The uterus and at least one portion of one ovary were preserved in each patient. Complete surgical staging was possible in 14 women of whom 10 were diagnosed with stage IA disease, 3 with stage IC, and 1 with IIIA. Histologic results for all 25 patients included 11 mucinous tumors, 11 serous, and 3 mixed tumors. None of the 25 patients were treated with chemotherapy in addition to surgery. After a median follow up of 80 months (range, 4–157 months), there were no recurrences of ovarian Cancer. One patient was diagnosed with lymphoma 5 months after she was treated for borderline ovarian cancer. After treatment with vincristine, doxorubicin, and cyclophosphamide, she was alive without evidence of disease at 34 months. Of the 15 patients whose fertility status was known, 6 had attempted pregnancy. Of these, 5 became pregnant and delivered normal healthy babies at term. One each of these women had stage IA, stage IC, or stage IIIA disease and 2 were unstaged. The sixth patient achieved pregnancy with in vitro fertilization but had a spontaneous abortion in the first trimester. Chan J, et al. J Reprod Med 2003;48:756–760



Editorial comments: (LMP or low malignant potential or borderline epithelial ovarian tumors are usually confined to one ovary or the other, not both, and rarely recur or lead to the death of the patient. The diagnosis and management of these lesions has been recently reviewed by Crispens (Curr Opin Obstet Gynecol 2003;15:39). Although it is generally recommended that women with borderline ovarian tumors be treated by removal of both ovaries and the uterus, as well as staging biopsies, most experts agree that women who desire to retain their fertility can be safely managed by removal of the affected ovary alone, or even just the cystic tumor itself, preserving most or all of both ovaries. The study noted above from the University of California at Irvine strongly supports this concept. No patient developed a recurrence during a median follow up of 80 months despite conservative surgery and no postoperative chemotherapy or radiation therapy. Similar results were reported from Italy in a series of 19 women with borderline tumors who were managed by laparoscopic oophorectomy (8) or cystectomy (11) (Seracchioli et al. Fertil Steril 2001;76:999). These women all underwent “second-look laparoscopy” at 6 months to evaluate their status and only one patient—originally treated by cystectomy for a borderline serous tumor—was found to have evidence of recurrence on follow up. She was treated by a repeat cystectomy for a 3-cm cystic borderline tumor in the same ovary. The authors advised placing the tumor in a bag (while removing it) to reduce the risk of tumor spillage if cyst rupture occurred; but at the same time, they point out that several studies have shown no adverse effect of cyst rupture at the time of surgery (Sjovall et al. Int J Gynecol Cancer 1994;4:333).
The most important argument for a careful technique to prevent spillage and for accurate staging is the uncertainty of the diagnosis at the time of surgery. Although most of these tumors appear benign to the surgeon, it is possible that the small 6-cm cyst will be a cancer on microscopic examination; and even when the 10-cm tumor is diagnosed as a borderline lesion on frozen section, it is not unusual that careful study of more sections will upgrade the diagnosis the next day to a well-differentiated serous carcinoma. In these cases, accurate staging could save the patient additional surgery or chemotherapy.


However, what should be done if staging is incomplete and the final diagnosis is borderline? Because no postoperative therapy is recommended and survival is excellent even when “metastatic” borderline ovarian lesions are diagnosed, reoperation for staging is not necessary. A careful review of the pathology is indicated and close follow up is important. In Chan’s study noted above, incomplete staging was noted in 11 patients who were managed conservatively with excellent results. Various studies have followed patients by ultrasound, computed tomography scan, and second-look laparoscopy. The less-invasive techniques are probably adequate because survival approaches 100% even when recurrent “metastatic” borderline lesions are diagnosed and removed.


Although pregnancy is not always attempted postoperatively in women treated conservatively, there is good evidence that these pregnancies are normal, and there is no convincing evidence that pregnancy adversely affects the risk of ovarian tumor recurrence. Although Papadimitriou et al. reported 5 recurrences after pregnancy, over 120 pregnancies have been reported in the literature with no other recurrences (Eur J Gynaecol Oncol 1999;2:94). Conservative, fertility-preserving surgery for borderline epithelial ovarian tumor is a safe and reasonable management approach.—HWJ)




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Last Updated ( Wednesday, 07 February 2007 )
 
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  • Removing ovaries to be safe - good idea???? 0:00 - 20.11.2008

    Dear AllA while ago I posted asking if US could DX ovca at early stage, and got SO MANY wonderful replies, for which I was extremely grateful.I've now gone on to have some investigative work done, and a detailed TVS has shown that I have a cyst on my right ovary which is not functional, but is almost 50:50 either benign or borderline.There doesn't seem to be any invasion of the ovary tissue from the cyst, and it is poorly vascularised, both of which I believe are optimistic signs. I read (on an Internet search) that around 7% of borderline cysts progress to becoming malignant. However, because my husband has Stage IV kidney cancer and 'staying alive' is, right now, our main concern (!!!!), I am thinking of simply having a double oophrenectomy (sp?!) (I'm 55, and my bloods show I'm now perimenopausal, so my ovaries are due for retirement anyway!), and being done with it (I hope....!)  I'm not clear whether suregery would include the fallopian tubes as well. Everything else in my pelvis is showing OK, so far as I understand. (Plus, no family history of ovca etc)Has anyone else been in a similar situation, and what was your decision, and your experience? My husband is worried at the thought of me having surgery (he had his kidney out this year, so knows abdominal surgery isn't a walk in the park!), though the TVS gynae says it could be done with keyhole.However, I also wonder whether it's best NOT to do keyhole, as is there not a risk that the ovary will rupture during removal, and then, if there IS any malignancy (or even proto-malignancy) in the cyst, that may get loose into my body and nest somewhere else!All information on this will be MOST gratefully received.I am very glad I did go ahead and get all this further checked out. I know US has its limitations, but even so, I think it's paid off this time by spotting 'something'.All the very, very best to all of you fighting ovca, and I hope, hope you win your battles.Julie.       

  • Abnormal cells after LEEP 0:00 - 19.11.2008

    I had the leep procedure done in the end of march and I recently had an abnormal pap.Before i had this procedure I was told I could have some difficulties with having children in the future. Well I went in for a pap and she told me everything looks great and now I recieved my results back and it came back abnormal. For once in for all i thought maybe i could have children without worring..but now im going back in on monday and im 24 and i almost want to be selfish and have a child now before its to late and things just get worse. Has anyone experienced a leep and abnormal paps and have had children after?I never thought i would have to think about this at my age but not having  children in the future years and waiting for it will kill me. someone please help me with a story of their own.Danny

  • Cone Biopsy 0:00 - 16.11.2008

    So the background info is that I had an abnormal pap in 2006, was diagnosed with HPV, and had a colposcopy in 2006 that showed low grade dysplasia.  They wanted me to have 6 month paps and would watch and wait I suppose.  From there, I wasn't impressed with my doctor and switched to a different clinic.  I had my records from the previous clinic sent to this one so there wouldn't be any confusion as to what was going on or why I was so persistent to have a repap right then which was 6 months after my previous one.  So, afterwards I recieved a lovely letter in the mail stating that the results were normal for my condition.  I probably should have asked what exactly that meant.  But, I was thrilled with the thought of not having another colpo.  Six months later I was back again for another pap.  Thinking the last one was "normal for my condition" I didn't freak out at all until I got the call saying I needed to schedule a colposcopy because there had been changes.  I'm not really thrilled at this point where I have a month to anxiously wait to have my colpo.  I had the colpo last week and it really wasn't as bad as the first.  Not really any pain except when she took the biopsy.  My Dr. was really good at explaining what she was doing etc. and drew me a picture of what she saw.  So I freak out for a week waiting for the results.  For some reason they didn't have my records from the previous clinic I went to and my Dr. wanted to look at them to make comparisons I suppose.  I was able to track down my records but found out she didn't really need them at this point.  I talked to the Dr. Friday night at around 6pm while I was driving in the rain and couldn't see a thing.  Not the best time to chat since I was a little preoccupied with not driving off the road.  What I got out of the conversation was that my results came back high grade and something about glands.  She wants to do a cone biopsy and I have the option of either doing it in the office with the LEEP or the operating room with the laser.  She did explain the difference between the two but I was so distracted with the rain and driving and the high grade and glands part that I can't remember the difference between the two.  I talked to her nurse today which was no help at all.  She said she was new and didn't have answers to any of my questions but would have someone call me tomorrow.  So I guess my question is...what is the difference?  What does high grade and glands mean?  Do I have cancer?  Will I ever be able to have children?  I don't do well with things that aren't in my control and at this point I'm seriously freaking out.  Any answers or suggestions?  Sorry for the lengthy detail.

  • mouth sores from Doxil 0:00 - 15.11.2008

    I was just wondering if anyone has any cures that have worked for mouth sores from Doxil.  My mom has them very bad.  Her oncologist has given her varies treatments but nothing seems to work, not even the "magic mouthwash"  My mom is a fighter, but this is really kicking her but.  She started getting them with her 3rd treatment, were they were so bad that they even ran down her throat.  Now on her 4th treatment she has them again, luckly not down her throat, but has them really bad, that she can barely even speak.  Please help, she will pretty much try anything just to get rid of them.Sandra  

  • need advice 0:00 - 14.11.2008

    I am recovering from a cone biopsy and scraping of cervix. I am 1 week post op. My wonderful MD called me on thursday 11-13-08 to let me know that my results from the biopsy came back and did show severe displasia of the cervix, which i knew, that was why we did the procedure. He also told me that the scraping that was done further inside my cervix also came back with displasia.  So i am left with not many options. Eaither go for another cone, or have a hysterectomy. I think this has put me in a depression. I feel down, tired, and dont want to talk to anyone. I have one child and probably would not have had anymore, but it is tearing me up to have this taken away from me. I know i have to have it done. I feel like i am not worth anything anymore.                thanks  dancie

  • Radiation or not 0:00 - 13.11.2008

    I am post-op, a month ago I had a hysterectomy  for cervical cancer 1a2, for my two week fallow up my doctor said that the tumor that was removed was bigger than what they thought and I might need radiation if it was bigger than 1/5 of an inch.  My tumor was 3mm by 3.2mm before the surgery. I can not Imagine being much more. Does anyone know what is the cut off mesurement for not reciving anymore treatment after a hysterectomy?

  • after chemo radiation 0:00 - 12.11.2008

    hi! I had treatment of chemo radiation in July. Some side effects i am experiencing still are swelling of the abdomen/ lower back ache/ some spotting - i also started HRT but wonder if anyone else experienced these things ? i am due back to cancer agency next week for check up.

  • Signet Ring Adenocarcinoma 0:00 - 12.11.2008

    Hi, Any information on Signet Ring Abenocarcinoma ?  

  • scared 0:00 - 11.11.2008

    Hi, I am a 23 year old female. Over the past month or so I've developed some symptoms that are concerning me...For the past 2 years or so, I've had very painful intercourse upon deep penetration - I get a shooting pain throughout my pelvis....then about 1 month go, I started to experience burning upon urination & increased frequency...I made an appointment to go see my family doctor (to rule out infection, etc) & get a pap, in between the time of scheduling my appointment & going to see my doctor, I developed a dull aching in my pelvis, mostly in the lower right quadrant. I tell him this informtion, he does a urine test, pregnancy test - all negative. during my pelvic examination, he presses down on my lower right quadrant, & it just about sends me off the bed, I had pushed down on my pelvis on my own standing up & didn't really have much discomfort. Over the next few days I've been experiencing lower back pain & shooting pain into my right groin area. The doctor's next suggestion is to go for a pelvic ultrasound....however, I have to wait until January for an appointment- in the meantime I am beside myself worrying I have cancer! I will note that my periods have remained normal, & I have had no abnormal bleeding

  • Signet Ring Adenocarcinoma/Ovarian Cancer 0:00 - 11.11.2008

    My BFF is 39 and was just diagnosed with Signet Ring Adenocarcinoma/Ovarian Cancer. Her first Chemo treatment is today.Does anyone have any experience with this type of Cancer or any suggestions that can help us better understand it?Any information would be really appreciated!Thanks,Juli