Borderline ovarian tumors represent a small subset of epithelial ovarian tumors. Because it's an uncommon and unfamiliar diagnosis, it's often misunderstood.
Joining the show to discuss the prognosis for a low malignant potential ovarian tumor, and treatment options available, is Peter Frederick, MD. He is a Gynecologic Oncologist with Roswell Park Comprehensive Cancer Center.
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What is the Prognosis for a Low Malignant Potential Ovarian Tumor?
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Learn more about Peter Frederick, MD
Peter Frederick, MD
Peter Frederick, MD has been on the faculty at Roswell Park Comprehensive Cancer Center in the Department of Gynecologic Oncology since 2010. Originally from Buffalo, NY, I did my medical school and residency training in Obstetrics/Gynecology at the University at Buffalo School of Medicine and Biomedical Sciences.Learn more about Peter Frederick, MD
Transcription:
What is the Prognosis for a Low Malignant Potential Ovarian Tumor?
Bill Klaproth (Host): Borderline tumors of the ovary, also called low malignant potential ovarian tumors, are uncommon and an unfamiliar diagnosis. Here to talk with us about the prognosis for borderline ovarian tumors, is Dr. Peter Frederick, Associate Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Frederick, thank you so much, for your time today. Let’s start at the beginning. What is a borderline ovarian tumor?
Dr. Peter Frederick (Guest): Okay, so borderline tumors of the ovary are a group of tumors that are intermediate between a benign cyst of the ovary and actual ovarian cancer. There are some features that are identified under the microscope that show abnormal or atypical proliferation of the cells, but there’s not an invasion of the cells that would meet the strict definition of a carcinoma. A lot of times, these tumors will present in women as pelvic masses.
Bill: And how are these tumors found?
Dr. Frederick: Sometimes, they can be identified as the time of a regular exam if a healthcare practitioner identifies a pelvic mass on an exam. Sometimes, they can cause symptoms, and the patient will bring that to her healthcare provider’s attention.
Bill: Would a typical symptom be a pain in the abdomen?
Dr. Frederick: Yeah, that’s a common presenting symptom. Sometimes they can cause pelvic pain. Sometimes it can cause abdominal bloating or GI issues. Sometimes it can be urinary complaints, either pressure or urinary frequency. Sometimes patients will note changes in appetite or discomfort with intercourse. A lot of these symptoms are pretty nonspecific. Which one of us hasn’t had indigestion at some point or the other? But if these symptoms are severe or if they are persistent over a number of weeks, then that’s something we would encourage our patients to communicate to their providers.
Bill: Dr. Frederick, who is at risk for borderline ovarian tumors? Does heredity play any role in this?
Dr. Frederick: That’s a very good question, and we’re still learning about some of the risk factors for this. As you noted, this is a pretty rare tumor, and unlike ovarian cancer where we have the BRCA genetic mutation which has clearly been identified as a genetic predisposition.
The genetics of borderline tumors are a little bit less well understood. We know probably that age is one risk factor, we would rarely see these tumors in young women in their teens and early twenties, but we do see it at a younger age, generally, than women with ovarian cancer. There are some epidemiological studies or evidence that tie borderline tumors to the use of hormone therapy and infertility treatments, but this data is far from definitive. Some studies have shown a link while other studies have not shown that link, so the jury is still out on that one.
Bill: And how are these tumors diagnosed if they’re found?
Dr. Frederick: When there is a suspicion for a pelvic mass, a lot of times, imaging tests will be the first step to define the mass clearly. Pelvic ultrasound or sonogram will give us good information – how big is the mass, and what does the mass look like? And if the ultrasound is concerning for a large mass or has features concerning for a neoplasm, then surgery gives us the definitive diagnosis. Depending on the size of the mass, a surgeon might elect to start with a minimally invasive surgery – usually laparoscopy or robotic surgery. If it’s a larger mass, sometimes a bigger incision is required, and then at the time of surgery, the mass is removed, it’s sent to the pathologist to look at under the microscope, and the pathologist will give us the definitive diagnosis – is it a borderline tumor, is it a cancer, is it a benign cyst, or is it something else altogether?
Bill: So, is surgery and complete removal the only option for treatment?
Dr. Frederick: Surgery is definitely the mainstay, and because about one-third of these are diagnosed in women under the age of 40, there are often fertility concerns and concerns about premature menopause that can stem from surgery. You did say complete removal – sometimes we can do what’s called an ovarian cystectomy where we remove a portion of the ovary – the abnormal appearing portion – and maintain that ovarian function by leaving the normal part of the ovary behind. Because these borderline tumors have such an excellent prognosis, that is something we’re more able to do with borderline tumors than we are with an actual ovarian cancer where complete removal is recommended.
Bill: And then, do you ever consider removing the ovary or the uterus as well?
Dr. Frederick: Yeah, and again, that really goes back to the age of the patient at diagnosis. If you have a postmenopausal woman, where fertility and hormonal production is not as much of a concern, we would generally remove both ovaries, and fallopian tubes, as well as the uterus. Sometimes a frozen section diagnosis at the time of surgery, especially with a larger mass, can have a small degree of inaccuracy, and by removing all of that tissue all at once, you might spare the patient the need for a second surgery down the road if in the unlikely event that cancer is identified. If you have a younger woman – younger than the age of 40, for example – we would often leave that other ovary and the uterus behind.
Bill: Right, so if it is determined to be cancer, does treatment then include chemo and radiation after the surgery to remove the pelvic mass?
Dr. Frederick: Yeah, radiation is less commonly used for ovarian cancers, but chemotherapy is often a mainstay for treatment. The need for chemotherapy is often related to the stage of the cancer, or in other words, how much has the cancer spread? If we have ovarian cancer that is confined to the ovary and has not spread anywhere else in the pelvis or abdomen, in some cases, observation without chemotherapy can be done safely. If there is evidence that the cancer has spread outside of the ovary, then the risk of the cancer progressing or coming back in the future is higher and chemotherapy is often recommended to reduce the risk of recurrence.
Bill: And Dr. Frederick, what about the prognosis for someone diagnosed with borderline tumors?
Dr. Frederick: The prognosis for the vast majority of borderline tumors is excellent. We measure prognosis in terms of 5-year survival – how many patients are alive 5 years after they are diagnosed with this – and 10-year survival. With a Stage I borderline ovarian tumor, the 5- and 10-year survival is around 99%. The majority of borderline tumors – about 70% of them – are Stage I, meaning they are confined to the ovary and have not spread anywhere else. Even if you go up to Stage III and Stage IV borderline ovarian tumors, the survival is still in the range of 60-80%, so it’s an excellent prognosis.
Some of these can come back in the future and will recur as borderline tumors again, and in very rare instances, we will see a recurrence come back as cancer. That is something that – that’s why the survival statistics aren’t 100%. And there are some subtle differences between borderline ovarian tumors. Some of them have more aggressive features that might merit additional treatment.
Bill: But overall, those numbers are encouraging. Dr. Frederick, is there anything else that we should talk about today or know about borderline tumors?
Dr. Frederick: I think if I were to tell a patient one thing, one message, it’s that those symptoms that we talked about before – the bloating, the pelvic pain, the pressure – these are things that tragically, some of my patients have described these symptoms and have had them for a long time. Sometimes, ovarian cancer has been called the silent killer, but sometimes these symptoms are there. Don’t ignore those symptoms if you have them, and don’t be afraid to bring them to your healthcare provider’s attention.
Bill: Well, that’s great advice. Dr. Frederick, thank you again, for your time today. For more information, you can go to RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
What is the Prognosis for a Low Malignant Potential Ovarian Tumor?
Bill Klaproth (Host): Borderline tumors of the ovary, also called low malignant potential ovarian tumors, are uncommon and an unfamiliar diagnosis. Here to talk with us about the prognosis for borderline ovarian tumors, is Dr. Peter Frederick, Associate Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Frederick, thank you so much, for your time today. Let’s start at the beginning. What is a borderline ovarian tumor?
Dr. Peter Frederick (Guest): Okay, so borderline tumors of the ovary are a group of tumors that are intermediate between a benign cyst of the ovary and actual ovarian cancer. There are some features that are identified under the microscope that show abnormal or atypical proliferation of the cells, but there’s not an invasion of the cells that would meet the strict definition of a carcinoma. A lot of times, these tumors will present in women as pelvic masses.
Bill: And how are these tumors found?
Dr. Frederick: Sometimes, they can be identified as the time of a regular exam if a healthcare practitioner identifies a pelvic mass on an exam. Sometimes, they can cause symptoms, and the patient will bring that to her healthcare provider’s attention.
Bill: Would a typical symptom be a pain in the abdomen?
Dr. Frederick: Yeah, that’s a common presenting symptom. Sometimes they can cause pelvic pain. Sometimes it can cause abdominal bloating or GI issues. Sometimes it can be urinary complaints, either pressure or urinary frequency. Sometimes patients will note changes in appetite or discomfort with intercourse. A lot of these symptoms are pretty nonspecific. Which one of us hasn’t had indigestion at some point or the other? But if these symptoms are severe or if they are persistent over a number of weeks, then that’s something we would encourage our patients to communicate to their providers.
Bill: Dr. Frederick, who is at risk for borderline ovarian tumors? Does heredity play any role in this?
Dr. Frederick: That’s a very good question, and we’re still learning about some of the risk factors for this. As you noted, this is a pretty rare tumor, and unlike ovarian cancer where we have the BRCA genetic mutation which has clearly been identified as a genetic predisposition.
The genetics of borderline tumors are a little bit less well understood. We know probably that age is one risk factor, we would rarely see these tumors in young women in their teens and early twenties, but we do see it at a younger age, generally, than women with ovarian cancer. There are some epidemiological studies or evidence that tie borderline tumors to the use of hormone therapy and infertility treatments, but this data is far from definitive. Some studies have shown a link while other studies have not shown that link, so the jury is still out on that one.
Bill: And how are these tumors diagnosed if they’re found?
Dr. Frederick: When there is a suspicion for a pelvic mass, a lot of times, imaging tests will be the first step to define the mass clearly. Pelvic ultrasound or sonogram will give us good information – how big is the mass, and what does the mass look like? And if the ultrasound is concerning for a large mass or has features concerning for a neoplasm, then surgery gives us the definitive diagnosis. Depending on the size of the mass, a surgeon might elect to start with a minimally invasive surgery – usually laparoscopy or robotic surgery. If it’s a larger mass, sometimes a bigger incision is required, and then at the time of surgery, the mass is removed, it’s sent to the pathologist to look at under the microscope, and the pathologist will give us the definitive diagnosis – is it a borderline tumor, is it a cancer, is it a benign cyst, or is it something else altogether?
Bill: So, is surgery and complete removal the only option for treatment?
Dr. Frederick: Surgery is definitely the mainstay, and because about one-third of these are diagnosed in women under the age of 40, there are often fertility concerns and concerns about premature menopause that can stem from surgery. You did say complete removal – sometimes we can do what’s called an ovarian cystectomy where we remove a portion of the ovary – the abnormal appearing portion – and maintain that ovarian function by leaving the normal part of the ovary behind. Because these borderline tumors have such an excellent prognosis, that is something we’re more able to do with borderline tumors than we are with an actual ovarian cancer where complete removal is recommended.
Bill: And then, do you ever consider removing the ovary or the uterus as well?
Dr. Frederick: Yeah, and again, that really goes back to the age of the patient at diagnosis. If you have a postmenopausal woman, where fertility and hormonal production is not as much of a concern, we would generally remove both ovaries, and fallopian tubes, as well as the uterus. Sometimes a frozen section diagnosis at the time of surgery, especially with a larger mass, can have a small degree of inaccuracy, and by removing all of that tissue all at once, you might spare the patient the need for a second surgery down the road if in the unlikely event that cancer is identified. If you have a younger woman – younger than the age of 40, for example – we would often leave that other ovary and the uterus behind.
Bill: Right, so if it is determined to be cancer, does treatment then include chemo and radiation after the surgery to remove the pelvic mass?
Dr. Frederick: Yeah, radiation is less commonly used for ovarian cancers, but chemotherapy is often a mainstay for treatment. The need for chemotherapy is often related to the stage of the cancer, or in other words, how much has the cancer spread? If we have ovarian cancer that is confined to the ovary and has not spread anywhere else in the pelvis or abdomen, in some cases, observation without chemotherapy can be done safely. If there is evidence that the cancer has spread outside of the ovary, then the risk of the cancer progressing or coming back in the future is higher and chemotherapy is often recommended to reduce the risk of recurrence.
Bill: And Dr. Frederick, what about the prognosis for someone diagnosed with borderline tumors?
Dr. Frederick: The prognosis for the vast majority of borderline tumors is excellent. We measure prognosis in terms of 5-year survival – how many patients are alive 5 years after they are diagnosed with this – and 10-year survival. With a Stage I borderline ovarian tumor, the 5- and 10-year survival is around 99%. The majority of borderline tumors – about 70% of them – are Stage I, meaning they are confined to the ovary and have not spread anywhere else. Even if you go up to Stage III and Stage IV borderline ovarian tumors, the survival is still in the range of 60-80%, so it’s an excellent prognosis.
Some of these can come back in the future and will recur as borderline tumors again, and in very rare instances, we will see a recurrence come back as cancer. That is something that – that’s why the survival statistics aren’t 100%. And there are some subtle differences between borderline ovarian tumors. Some of them have more aggressive features that might merit additional treatment.
Bill: But overall, those numbers are encouraging. Dr. Frederick, is there anything else that we should talk about today or know about borderline tumors?
Dr. Frederick: I think if I were to tell a patient one thing, one message, it’s that those symptoms that we talked about before – the bloating, the pelvic pain, the pressure – these are things that tragically, some of my patients have described these symptoms and have had them for a long time. Sometimes, ovarian cancer has been called the silent killer, but sometimes these symptoms are there. Don’t ignore those symptoms if you have them, and don’t be afraid to bring them to your healthcare provider’s attention.
Bill: Well, that’s great advice. Dr. Frederick, thank you again, for your time today. For more information, you can go to RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.