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Fact sheet 10

Borderline ovarian tumours

We, Ovacome, are a support network forpeople affected by ovarian cancer in theUK. We provide information and support,raise awareness and put you in touch withothers who are suffering from ovariancancer.

If you are diagnosed with a borderlineovarian cancer (BOC), you can feel veryworried and uncertain. However, mostwomen who develop this condition arecompletely cured by surgery and neverneed any more treatment.

This fact sheet explains BOC and describesthe best care for the small group of womenwho have more difficult cases of BOC.

There is a glossary with this fact sheet, toexplain words you may not be familiar with.

What is borderline ovarian cancer(BOC)?

BOC is probably best defined by what it isnot. Ordinary ovarian cancer is when cellsgrow uncontrollably on the surface of theovary and are able to spread to other

organs.

Most cases of ordinary ovarian cancer arefound at an advanced stage (stage 3 or 4).

This is when the cancer has spread beyondthe ovary.

Although BOC arises from the same type ofcells on the surface of the ovary, theirgrowth is much more controlled, and theyare usually not able to invade other tissues.

For this reason, some doctors prefer the termborderline ovarian tumour rather thanborderline ovarian cancer.

Because BOC behaves in a much lessaggressive way, in most women the conditionhas not spread beyond the ovary when it isdiagnosed (stage 1 disease). This means

that for women who have had surgery toremove an early disease, the risk of it comingback is very small (less than 5%). Mostexperts recommend that no special follow-upis needed after surgery for stage 1 BOC.

The difficult cases

There are three situations which can causeyou greater concern or uncertainty.

1. Borderline ovarian tumours whichhave spread beyond the ovary.

2. Mucinous borderline tumours involvingthe ovary, when tests suggest thesecould be tumours from a tumour in theappendix.

3. Stage-1 borderline ovarian tumours inyoung women treated with limitedsurgery to allow you to keep yourovary. There could be an increasedrisk of the disease coming back in theovary you have kept.

Borderline ovarian tumours whichhave spread beyond the ovary

A small number of cases of women with BOC

have cancer which has spread as depositsto other organs, usually the peritonealmembrane.

Non-invasive implants

Most of these deposits do not invade theunderlying tissue. If these non-invasive

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implants are present, it is rare for them tocause problems, even if they stay aftersurgery.

We do not know the absolute correct way tocare for women with non-invasive implantsof BOC, because research studiescomparing different treatments (including

observation) have not been performed.

Most women with BOC with non-invasivedeposits to the peritoneum (stage 2 or 3)have no other problems, and no treatment(such as chemotherapy or radiotherapy) isknown to reduce the risk of problems. Atpresent, the best care involves regularfollow-up care to check for signs that theremaining deposits have grown.

Invasive implants

In a very small number of women thedeposits of BOC show a tendency to invadethe tissues. This behaviour is more likeconventional ovarian cancer, suggestingmore chance of a tumour growing in thefuture.

For women with invasive deposits, theoutlook is generally better than for women

diagnosed with the equivalent stage ofordinary ovarian cancer, as the tumour stilldoes not necessarily behave as cancerdoes.

There is still a question as to whether totreat women with invasive implants of BOCwith chemotherapy immediately, or to waituntil there is definite evidence of thecondition getting worse. Close observationand repeated scans often show that thecondition hardly changes over time. Thismeans that you may not needchemotherapy in the long term.

It is important to be aware of the limits ofchemotherapy in treating stage-3 BOC withinvasive implants. The chance of therebeing a benefit is quite low, and the diseasecannot be completely removed. This meanit is reasonable to be cautious with

chemotherapy and put off using it until it isneeded.

Repeated surgery can be valuable in certaincases. Samples of tumours taken during anoperation may show a change in how thetumour is behaving. If pathology results showthat the tumour has features likeconventional ovarian cancer, then standardtreatment for ordinary ovarian cancer can berecommended.

Mucinous borderline ovariantumours

Most borderline ovarian tumours areclassified as serous from their appearanceunder the microscope.

A smaller number have a differentappearance and are called mucinous.

Sometimes a small, undetected mucinoustumour can develop in the appendix, andspread to the ovary. This can give theappearance of a primary ovarian tumour,when in fact it is a secondary tumour.

It is important to consider this possibility in allcases of mucinous borderline ovarian cancer,so that a separate appendix tumour is not leftbehind at surgery.

It is difficult to decide the type of ovariantumour (serous or mucinous) at the time ofthe operation. So surgeons must carefullyinspect the whole abdomen, including theappendix, to look for a hidden primarytumour.

After surgery the pathologist may use specialtests to tell apart a mucinous borderlinetumour which has arisen from the appendix

from one which was originally from the ovary.

Multidisciplinary teams dealing with ovariantumours should always discuss these casesin detail, so they can make sure you receivethe correct advice and treatment.

Stage-1 borderline ovarian tumoursin young women treated with limitedsurgery

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If you are a young woman with a borderlineovarian tumour, you may want to keep anovary so you can have children in thefuture. In this situation, a surgeon mayremove the affected ovary, but leave theapparently normal ovary and uterus(womb). The surgeon must examine theabdomen carefully, to check if any cancer

has spread.

In about 20% of these cases, the tumourcomes back in the ovary that is left.

This means you need regular check-upsafter surgery. Follow-ups include ultrasoundexaminations every six months for abouttwo years, then yearly. Later it may beappropriate for women who have had theirfamily to have the remaining ovary

removed. This removes the risk of problemsin the future, and means they will not haveto go for follow-ups.

If you would like more information or youwould like to discuss anything to do withovarian cancer, phone our support line on0845 371 0554, Monday to Friday from 9amto 4pm. Or, you can visit our website atwww.ovacome.org.uk.

Written by Richard Osborne, ConsultantOncologist, Poole Hospital, Dorset.

Reviewed J uly 2009

ovacomePO Box 6294, London W1A 7WJPhone: 0845 371 0554Website: www.ovacome.org.uk

Email: ovacome@ovacome.org.uk

http://www.ovacome.org.uk/http://www.ovacome.org.uk/http://www.ovacome.org.uk/http://www.ovacome.org.uk/

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Borderline ovarian tumours page 4 of 5 Ovacome 2009

Glossary

Biopsy Removal of a small piece of tissue from an

organ or part of the body so it can be examinedunder a microscope.

Chemotherapy Treating a disease with medication, such ascytotoxic drugs (drugs that kill cancer).

Malignant Malignant tumours have the ability to invadeand destroy surrounding tissues and canspread to other organs.

Mucinous tumours Mucinous borderline ovarian tumours are a

less common type of borderline ovariantumour. They look different under themicrosope, showing glandular structures.

Multidisciplinary Team (MDT) Several members of different hospitaldepartments who meet to discuss thetreatment plan for individual patients.

Pathology The branch of medicine that deals withexamining parts of the body that havediseases.

Peritoneal membrane Membrane that lines the abdomen and coversother internal organs.

Primary tumour The first cancerous tumour to develop in aparticular part of the body.

Radiotherapy Treating a disease with radiation.

Secondary tumour A tumour that comes back in a different placefrom where it started, or spreads (also called

metastasis).

Serous tumours Serous borderline ovarian tumours are themost common type of borderline ovariantumour. They come from the surfacemembrane of the ovary and have a particularappearance under the microscope.

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Ultrasound scan Using sound waves to build up a picture oforgans inside the body, through a probe placedon the abdomen or in the vagina.

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