Introduction -
Borderline ovarian tumors (BOTs) are low-malignant tumors with better outcomes than ovarian cancer. Its ten-year survival rate is as high as 95 %. Although, there is a small group of patients who is prone to relapse and death. The prognosis of BOTs is based on age, pathological diagnosis, pre-operative carbohydrate antigen 125 level, micropapillary patterns, and invasive implants. The main treatment for borderline ovarian tumors is surgery. The treatment is effective in most women and has no further problems. A small percentage of tumors return, and rarely do these cells change into cancer cells.
What Is Borderline Ovarian Cancer?
Borderline ovarian tumors are abnormal cells forming in the tissue covering the ovary. They are also known as tumors of low malignant potential or atypical proliferative tumors. These tumors are not cancer and can be cured with surgery. Around 15 % of ovarian tumors are borderline tumors. They are different from ovarian cancer as they do not grow in the stroma (supportive tissue of the ovary). They grow more slowly and in a controlled way than cancer cells.
These tumors affect women between 20 and 40 years. They can be diagnosed early when the abnormal cells are still seen within the ovary. In rare cases, some abnormal cells break out from the tumor and settle in another location in the body, commonly in the abdomen.
What Are the Causes of Borderline Ovarian Cancer?
According to the research, around 15 % of ovarian tumors are borderline ovarian tumors. It commonly affects women who are 20 to 40 years old. In rare situations, stage 1 borderline ovarian tumors may become malignant and outspread to other parts of the body. The borderline ovarian tumor transforms into cancer based on several factors. Even though the exact cause of this tumor is unknown.
The American cancer society says that the following factors be a key factors in whether a person develops ovarian tumors or cancer:
- Genetic factors.
- Levels of hormones known as androgens.
- An increased number of ovulations.
What Are the Symptoms of Borderline Ovarian Cancer?
If the borderline tumors are small, it does not usually cause symptoms. These tumors are often found when doctors recommend other tests. And if the borderline tumors are larger or more advanced, they might cause the following symptoms, that include:
- Pain or pressure in the tummy (pelvis or abdomen).
- A swollen abdomen.
- Pain, heaviness, or pressure in the pelvis or abdomen.
- Pain during or after intercourse.
- Vaginal bleeding is not related to the menstrual period.
What Are the Stages of Borderline Ovarian Cancer?
The staging of cancer helps to detect the size of the tumor and how long it has spread. The doctor uses the same cancer staging to check for borderline tumors. They are classified into four stages, from 1 to 4. Most women have stage 1 of BOTs.
- Stage 1 is the initial stage, where the borderline tumor stays within the ovary.
- Stage 2 - In this stage, the abnormal cells will spread within the pelvis, like the fallopian tubes, uterus, bladder, or rectum.
- Stage 3 - The cells will spread outside the pelvis and reach the abdominal cavity.
- Stage 4 - This is the most advanced, in which the cells will spread to another part of the body, for example, the lungs.
What Are the Types of Borderline Ovarian Tumors?
Different types of borderline ovarian tumors are differentiated according to the cells affected. Serous and mucinous are the most common types. Around 50 % of all borderline cancers are due to mucus, while around 45 % are caused due to mucus.
Other less common types include:
- Seromucinous.
- Borderline Brenner.
- Endometrioid.
- Clear cell.
What Are the Diagnostic Methods for Borderline Ovarian Tumors?
The initial step of borderline ovarian tumor involves a general physical examination and taking a person's medical history to check for symptoms and unusual signs.
Then followed by a pelvic examination by the doctor to examine the following areas:
- Vagina.
- Cervix.
- Uterus.
- Ovaries.
- Fallopian tubes.
- Rectum.
The doctor may perform a pap smear (a test that helps check the cervix's health). To confirm the diagnosis of a BOT, a doctor will mostly order several diagnostic tests. These may include the following:
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Transvaginal Ultrasound - This device uses the sound wave to create images of the pelvic region and the reproductive organs.
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CT Scan - This test provides detailed three-dimensional images of the pelvic organs and details of the bones, fat, muscles, and organs that may not appear on a normal X-ray.
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Biopsy - A tiny piece of tissue is collected from the affected area and sent to a laboratory for further analysis. This test can check for abnormalities in the cells.
- CA-125 Assay - A blood test is done to check for cancer markers and other conditions.
What Is the Treatment for Borderline Ovarian Cancer?
The treatment for borderline ovarian cancer varies depending on the tumor's stage and the person's fertility preferences.
1) Stage 1 and 2 - In this stage, the doctors will recommend surgery to remove a BOT, and the surgery will vary depending on a person's fertility preferences. For people who are willing to have children in the future, the doctor may choose a unilateral salpingo-oophorectomy. This surgery involves removing only the affected ovary and fallopian tube. In some cases, a partial oophorectomy may be performed, which involves removing part of an ovary.
A bilateral salpingo-oophorectomy is recommended for people who are not willing to have children in the future. In this procedure, a surgeon removes both ovaries and fallopian tubes. Hysterectomy (removal of the uterus) may also be recommended in people who do not opt for children in the future.
2) Stage 3 and 4 - A person with stage 3 or 4 of borderline ovarian cancer will need the same surgical treatment, which includes the following:
- Hysterectomy.
- Bilateral salpingo-oophorectomy.
- Omentectomy is a surgical procedure to remove the omentum, the fatty tissue in the abdomen.
- If this stage reoccurs, a doctor may recommend chemotherapy and a combination of surgery.
Conclusion -
Borderline ovarian tumors are abnormal growths or cells that develop in the tissue around an ovary. These growths have a low incidence of spreading to other parts and are slow-growing, typically considered non-cancerous. However, in some rare cases, they have the potential to become cancerous. Treatment depends on the stage at diagnosis. Usually, surgery is recommended. In severe cases, chemotherapy, along with surgery, is done.
