Treatment for Epithelial Tumors of Low Malignant Potential

Borderline epithelial tumors are also known as atypical proliferating tumors and used to be called low malignant potential tumors. These tumors look the same as invasive epithelial ovarian cancers when seen on an ultrasound or CT scan. Doctors can't be sure whether a tumor is invasive or borderline until a biopsy sample has been taken (usually during surgery) and checked in a lab.

Surgery for borderline tumors is similar to the surgery for invasive ovarian cancer, with the goals of removing the tumor along with full staging and debulking.

  • For women who have finished having children, the uterus, both fallopian tubes, and both ovaries are removed. Surgical staging is done to see if the tumor has spread outside the ovary or pelvis. Sometimes, this means removing the omentum and some lymph nodes, and doing washings of the abdomen and pelvis.
  • For women who want to be able to become pregnant in the future, only the ovary with the tumor and the fallopian tube on that side is removed. Rarely, just the part of the ovary containing the tumor is removed. These women still should have surgical staging to see if the tumor has spread. If the tumor is only in one ovary, the woman is usually observed without further treatment and monitored with ultrasound exams.

For tumors that haven't spread outside the ovary, Chemotherapy (chemo) and radiation therapy are not generally the first treatments used. Observation is often recommended for borderline tumors because they grow very slowly and even when they spread they are rarely fatal.

If the tumor has spread outside the ovary when it is first diagnosed, the surgeon will remove as much of it as possible (debulking). Treatment after surgery depends on whether the spread is invasive or not. When borderline tumors spread, the can form tumor implants (deposits) on the peritoneum (lining of the abdomen) and on the surface of organs in the abdomen and pelvis. Most often, these implants are non-invasive, meaning they haven't grown into the abdominal lining or organs.

  • For women with non-invasive spread from a borderline tumor, chemo has not been shown to be helpful after debulking surgery. These women are usually watched closely without further treatment.
  • For women whose tumor implants are invasive, chemo may be an option, but the benefit from chemo for these cancers is unclear. When chemo is used, it is usually the same as chemo given for invasive ovarian cancer.

If the tumor comes back after initial surgery, further debulking surgery might be considered. Chemo and, rarely, radiation therapy are also options for recurrent borderline tumors.

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Cannistra SA, Gershenson DM, Recht A. Ch 76 - Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2015.

Morgan M, Boyd J, Drapkin R, Seiden MV. Ch 89 – Cancers Arising in the Ovary. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE, Kastan MB, McKenna WG, eds. Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier; 2014: 1592.

National Comprehensive Cancer Network (NCCN)--Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. V2.2018. Accessed February 5, 2018, from https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf

 

Last Medical Review: April 11, 2018 Last Revised: April 11, 2018

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