Borderline malignant Ovarain Tumours-What we as Gynecologist should know?/

How many of us have come across “Borderline Ovarian Cancer per year?? Any guess??  Borderline Tumor-What we need to know??

Ans:-These are a subset of epithelial ovarian tumors that are  termed semimalignant. These lesions have a more favorable outcome than do other ovarian cancers, but they were not separately classified by the International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization(WHO) until the early 1970s.

The 2 major histologic tumor subtypes are serous and mucinous, with serous being more common. Serous tumors are presumed to originate from the germinal epithelium. Mucinous tumors do not have a clearly defined origin.

Should we remove the appendix while operating such borderline ovarian atumours ??  Ans:-Possibly yes. Substantial information indicates that many tumors may actually originate from the appendix; thus, this organ should be removed at the time of surgery.

What are the presenting symptoms of borderline ovarian tumors??

Borderline tumors, as with other ovarian tumors, are difficult to detect clinically until they are advanced in size or stage. In one study, the most common presenting symptoms were abdominal pain, increasing girth or abdominal distention, and abdominal mass. Approximately 23% of patients were asymptomatic.

What is the etiology of such border line tumors??

Ans:-The etiology of this disease remains unclear Based on molecular studies, some mucinous borderline tumors of the ovary may actually represent metastasis from the appendix.

Some presumed factors reportedly linked with borderline tumors include the following:

·        Oral contraceptive use

·        Early Menarche

·        Age at first pregnancy

·        Age at first delivery

·        Smoking history

·        Family history of ovarian cancer

What is the prevalence? Ans:-Incidence of borderline ovarian tumors

One woman in 55 (1.8%) develops some form of ovarian cancer in her lifetime. Approximately 90% of these cancers are tumors of epithelial origin. If benign lesions are included, epithelial tumors account for 60% of all ovarian tumors.

borderline tumors make up approximately 15% of all epithelial ovarian tumors. The mean age of occurrence is approximately 10 years younger than that of women with frankly malignant ovarian cancer.

Q .How to perform Tumor Staging??/

Comprehensive staging of borderline ovarian tumors is of significant prognostic value and is performed surgically. As opposed to its true malignant counterpart, epithelial ovarian carcinoma, borderline ovarian cancer is often found at an early stage.

Without comprehensive surgical staging, the prognosis for an individual patient is difficult to predict.

Borderline ovarian tumors are staged according to the FIGO classification of ovarian cancer. Many clinicians group stages II-IV together for prognostic consideration.Another common component of staging is the description of the type of implants, as these have significant prognostic value.

Preoperatively, borderline tumors are often presumed to be either benign or malignant ovarian masses; however, as with other ovarian masses, staging is performed surgically.

 Many sources recommend complete staging if a borderline tumor is found. Q. How to stage an possible Ovarian Ca ?? Biopsy from where??  Ans;-Current guidelines include biopsy specimens of the pelvic peritoneum (cul-de-sac, pelvic wall, and bladder peritoneum), abdominal peritoneum (paracolic gutters and diaphragmatic surfaces), omentum, intestinal serosa and mesentery, and retroperitoneal lymph nodes (pelvic and para-aortic).

Ans:- The diagnosis of borderline ovarian cancer is based on surgical staging. Pathologic diagnosis is difficult to confirm by frozen section. Borderline tumors are correctly diagnosed 60 -86% of the time by frozen section, depending on the experience of the pathologist and the site of the operation .

However, in one study at a tertiary referral center, benign disease was excluded in 94% of cases subsequently diagnosed as borderline tumor.

Q. 12: How  will be prognosis Borderline Ovarian Cancer ?? Ans;-Prognosis in

Women with borderline tumors have an excellent overall prognosis. These women have a 60% chance of having stage I disease when diagnosed. Postoperative treatment for any stage is controversial; therefore, recommending reoperation for surgical staging alone is difficult.  

Q.12: What is the prevalence of  diploid deoxyribonucleic acid (DNA)?? Ans:-. Approximately 95% of borderline ovarian tumors have diploid deoxyribonucleic acid (DNA -- Biomarkers and DNA Cytometry)---). This finding is almost always associated with an excellent prognosis. But if the tumor is aneuploid, the recurrence rate is high. Some authors suggest treating these as low-grade invasive carcinoma (also called micropapillary carcinoma).

Conflicting data exist with respect to overexpression of various oncogenes and tumor suppressor genes. Although TP 53 positivity and HER2 overexpression in invasive cancer have been associated with a worse prognosis, the same gene profile has conferred a survival advantage in borderline tumors. Q. 13: What is the “Recurrence and Survival Patients with stage I disease” ??  Ans: A recurrence rate of approximately 15%. The 5-year survival rate for such patients approaches 100%. However, the 10-year survival rate is 90-95%, depending on histologic findings.

In patients with stage II-IV disease, the prognosis is different; an increased stage is associated with a worse prognosis and only age at diagnosis and the presence of invasive implants are shown to influence prognosis.

recurrence, a median time to diagnosis of 3.1 years was reported if the recurrence was of the borderline type. In patients whose recurrence was invasive carcinoma, the median time to diagnosis was 8.3 years. It is believed that the former was a recurrence but that the latter was probably a new primary tumor. The cancer antigen 125 (CA-125) level was normal in 65% of the recurring cases. Death was noted only when invasive carcinoma was noted in the recurrence.

In patients with serous borderline tumors with invasive implants, the relapse rate was 31-45%, according to a study by Gershenson et al.

 The median time from diagnosis to recurrence was 24 months, although the time to progression of disease was significantly longer in patients who had no macroscopic disease remaining at the time of initial operation. Additionally, patients who received postoperative platinum-based chemotherapy had a significantly worse progression-free survival rate. However, the authors of this study believed that this finding might have been due to selection bias.