Borderline ovarian tumors

There are benign, malignant, and borderline tumors in the ovaries. Benign tumors usually do not transform into malignant ones, but they can cause pain and torsion of the ovarian vessels, and in some cases they can occur without symptoms at all. Malignant tumors often behave aggressively, progress rapidly and metastasize. They require complex treatment, such as radical surgery and chemotherapy before and/or after surgery. Borderline tumors among ovarian neoplasms occupy a special place – the name itself well describes the essence of this disease, they have some features of both malignant and benign tumors. Technically, they are not benign and are accompanied by frequent relapses when choosing organ-preserving treatment, but they are also not malignant and do not require chemotherapy. Borderline tumors are insidious because they affect more often young women 30-45 years old, who very often have not yet managed to realize their reproductive function.

Oftenwith borderline tumors no specific symptoms are observed, which complicates their diagnosis. As a rule, they are detected for the first time according to the histology of the removed cyst, when the gynecologist performs surgery for presumably benign ovarian cysts. If the cyst looks suspicious for malignancy, rapid histology is always required during surgery, and upon confirmation of the diagnosis, an oncogynecologist is called to the operating room, who performs laparoscopic removal of the omentum and additional biopsies. This tactic helps patients avoid a second operation and repeated anesthesia.

Approximately 10% of borderline ovarian tumors degenerate into malignant neoplasms upon recurrence. This means that the tumor, which, according to histological examination, was previously borderline, returns after a while, but as malignant. Unfortunately, even the most modern diagnostic technologies (such as ultrasound, CT, MRI, cancer markers) do not allow to diagnose a "borderline tumor" with 100% accuracy before surgery. Externally, borderline neoplasms can look both benign and malignant, and only intraoperative or postoperative histology will be able to accurately determine the diagnosis. There are also no specific symptoms by which a doctor could diagnose an ovarian tumor, unless the tumors become very large and exert pressure on neighboring organs, which is extremely rare in the case of borderline tumors.

Realizing that every tenth patient will die from a recurrence of a borderline tumor, doctors today are much more wary of each case of this disease. We perform organ-preserving operations for young women so that the patients are ready for childbearing in the future and preserve hormonal function. Such treatment methods do not worsen the prognosis of the disease for a woman's life, but they are associated with a higher risk of recurrence – up to 40-50%. Such relapses require repeated and often not the only surgery. However, in the vast majority of cases, even if it is necessary to expand the scope of surgery, such interventions should be performed laparoscopically – this is the world standard that we follow in the European Medical Center. Unfortunately, this cannot be said about the majority of oncological institutions in Russia, where laparoscopy is not performed in such cases. Oral surgery for borderline tumors is the exception rather than the rule.

If the patient has not yet had pregnancy and childbirth, we recommend organ-preserving operations at the EMC, and even if a relapse has occurred and we are forced to perform repeated laparoscopic operations, it is usually possible to preserve part of the ovary for subsequent ovulation stimulation by a reproductive specialist in the IVF protocol. We receive eggs for cryopreservation (freezing) and their further fertilization before the possible onset of the next (second, third, etc.) recurrence, which may already require the complete removal of the remaining ovary. Thus, the uterus in this disease in young women is almost never removed, even in common forms of borderline tumors. Such patients can become pregnant within a few months after surgery and independently carry their biologically native child.

Many clinics in Russia offer chemotherapy as part of the treatment of borderline ovarian tumors after surgery. This is fundamentally wrong, because these formations do not actually respond to chemotherapy. All that women get from such treatment is the toxic effects of therapy in the form of neuropathy (numbness of the hands, feet, hearing loss, etc.) and bone marrow damage. It has also been proven that the likelihood of recurrence from chemotherapy does not decrease, so all that is required as part of proper treatment is to perform a histological diagnosis during surgery in case of a suspicious formation on the ovary, and if it shows that we have a borderline tumor, laparoscopically perform the necessary manipulations to determine the stage and exclude the spread of the tumor beyond the ovary..

At EMC, we do not offer our patients with borderline tumors chemotherapy and do not perform radical surgery for borderline tumors, when both ovaries are removed along with appendages and uterus, if we are talking about young women with still functioning ovaries.