Borderline Ovarian Cancer: Understanding Diagnosis and Treatment

Borderline ovarian cancer, sometimes referred to as borderline ovarian tumors (BOT) or ovarian tumors of low malignant potential (LMP), is a unique form of ovarian cancer that falls between benign and malignant tumors.

In this article, we’ll explore the nuances of borderline ovarian cancer (also commonly called borderline ovarian tumor, or BOT), from its diagnosis and treatment to the emotional aspects of coping with this less common but significant condition.

Understanding Borderline Ovarian Cancer

Borderline ovarian cancer occupies a unique position between benign and malignant tumors. Histologically, it’s characterized by atypical epithelium that doesn’t invade the stroma, or supportive tissue, of the ovary. 

This key feature distinguishes it from more aggressive forms of ovarian cancer. Typically affecting younger women, the median age at diagnosis ranges from 40 to 50 years. Borderline ovarian cancer is relatively rare, with an estimated incidence of about 5 women per 100,000 annually.

Are Borderline Ovarian Tumors Considered Cancer?

The classification of borderline ovarian tumors as cancer is a subject of ongoing debate in the medical community. While these tumors exhibit some features of malignancy, such as abnormal cell growth, they lack the invasive properties of typical ovarian cancer. 

The World Health Organization (WHO) classifies borderline ovarian tumors as a distinct category, separate from benign and malignant ovarian neoplasms. However, due to their potential for recurrence and the need for long-term monitoring, many experts consider borderline ovarian tumors to be a form of low-grade cancer.

Types of Borderline Ovarian Tumors

Borderline ovarian tumors can be classified into two main types based on their histological characteristics: serous and mucinous.

Serous borderline ovarian tumors (SBOTs): SBOTs are the most common type of BOTs, accounting for approximately 65% of all cases. They are characterized by the presence of complex papillary structures lined by stratified epithelium with mild to moderate atypia. 

Interestingly, SBOTs are often found alongside low-grade serous ovarian carcinoma (LGSOCs) in pathology reports. Some doctors hypothesize that SBOTs may have the potential to develop into LGSOCs over time, although this relationship is not yet definitively established. 

Here are some practical tips for patients with SBOTs:

• Discuss the potential risk of developing LGSOCs with your healthcare team and understand the importance of long-term follow-up and monitoring.
• Attend all scheduled check-ups and inform your doctor about any new symptoms or concerns.
• Consider seeking a second opinion from a gynecologic oncologist who specializes in ovarian tumors to ensure you receive the most appropriate care.

Mucinous borderline ovarian tumors (MBOTs): MBOTs are less common than SBOTs, representing approximately 35% of all BOTs. They are characterized by the presence of glands or cysts lined by atypical mucinous epithelium, often with a complex branching architecture. 

MBOTs are generally not associated with the development of invasive carcinomas, unlike SBOTs. 

• While MBOTs have a lower risk of developing into invasive carcinomas, it’s still essential to follow up with your healthcare team regularly to monitor your condition.
• Discuss the appropriate frequency of check-ups and any necessary tests with your doctor.
• Be aware of any changes in your symptoms and report them to your healthcare provider promptly.

It’s essential for patients to understand the type of borderline ovarian tumor they have been diagnosed with, as this information can help guide discussions with their healthcare team about prognosis, treatment options, and long-term management. Don’t hesitate to ask questions and express your concerns to your healthcare team, as they are there to support you throughout your journey.

Borderline Ovarian Cancer: Diagnosis and Staging

Diagnosing borderline ovarian cancer involves a series of tests similar to those used for other ovarian cancers:

• Imaging Tests: Ultrasounds, CT scans, and MRIs help visualize the ovarian tumor and assess its size and extent. There is currently no definitive way to confirm a diagnosis without a biopsy. At Not These Ovaries, we are funding research to identify ways to diagnose ovarian cancer. 
• Surgical Biopsy: A gynecologic oncologist surgeon will typically obtain a tissue sample during surgery for an initial pathology, but it can take up to two weeks to have a complete pathology report. The biopsy results will confirm the diagnosis and provide more information about the tumor’s characteristics.

These tests are crucial in determining the location and spread of the tumor, which can help guide treatment decisions. It’s essential to discuss the results of these tests with your healthcare team to fully understand the extent of the disease.

Staging

Borderline ovarian tumors are staged using the FIGO staging system, which ranges from Stage I to Stage IV. However, unlike invasive ovarian cancers, BOTs are less likely to spread beyond the ovaries and are generally associated with a more favorable prognosis 

• Stage I: The tumor is confined to one or both ovaries. 
• Stage II: The tumor involves one or both ovaries with pelvic extension or primary peritoneal cancer. 
• Stage III: The tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional lymph node metastasis.
• Stage IV: Distant metastasis beyond the peritoneal cavity. 

It’s important to note that while the staging system is the same, the prognosis and treatment options for BOTs may differ from those of invasive ovarian cancers. In most cases, surgery is the primary treatment for BOTs, and the extent of the surgery depends on the stage and the patient’s individual circumstances, such as their desire for fertility preservation.

Understanding the stage of your BOT is essential for determining the most appropriate treatment plan and discussing your prognosis with your healthcare team. However, it’s crucial to keep in mind that BOTs generally have a more favorable prognosis compared to invasive ovarian cancers, and the treatment approach may be tailored accordingly.

Creating a Treatment Plan for Borderline Ovarian Cancer

The treatment approach for borderline ovarian cancer typically differs from that of malignant ovarian cancer due to its less aggressive nature. Here’s what you need to know:

• Surgery: This is the primary treatment. The goal? Remove as much of the tumor as possible while preserving fertility when feasible. Choosing a gynecologic oncologist for your surgery can make a world of difference. Research shows that surgery success rates nearly double when performed by these specialists compared to general surgeons. 
• Debulking: In more advanced cases, debulking surgery might be necessary. This procedure aims to remove as much of the cancer as safely as possible. Depending on how far the cancer has spread, it might involve removing parts of other organs, lymph nodes, or the omentum. For younger patients wanting to preserve fertility, surgeons may be able to remove just one ovary and some lymph nodes if it’s safe to do so. 
• Oophorectomy: Sometimes, removing one or both ovaries (oophorectomy surgery) may be recommended. This is more likely if the disease is advanced or if you’ve completed childbearing.
• Chemotherapy: Unlike malignant ovarian cancer, chemotherapy is NOT recommended for borderline ovarian cancer. Surgery and ongoing surveillance are the current standard of care for borderline ovarian cancer.
• Second Opinion: With the rarity of a borderline ovarian cancer diagnosis, we strongly recommend you get a second opinion from another specialized physician. It is, unfortunately, commonly misdiagnosed as low-grade serous ovarian carcinoma (LGSOC).

The Emotional Rollercoaster

A borderline ovarian cancer diagnosis can evoke a mix of emotions similar to those experienced with other cancers:

• Fear and Uncertainty: The uncertainty of the disease and its potential impact on fertility can be emotionally challenging. 
• Coping Strategies: Seeking support from loved ones, mental health professionals, or support groups can provide valuable assistance in navigating these emotions.
• Menopause: A hysterectomy in younger women will cause menopause quickly, as most gynecologic oncologists do not recommend hormone replacement therapy (HRT), which will have material impacts on the female patient. Learning essential menopause nutrition tips will help nourish your body and alleviate symptoms.

Support Systems and Resources

Building a strong support network and accessing resources can help individuals and their loved ones cope with borderline ovarian cancer:

• Medical Team: Engage with a healthcare team that specializes in ovarian cancer to ensure you receive the most appropriate care.
• Fertility Preservation: If fertility preservation is a concern, consult with a fertility specialist to explore options before treatment.
• Support Groups: Connect with others who have experienced borderline ovarian cancer to share experiences and gain insight.

Borderline ovarian cancer may be less aggressive than other forms of ovarian cancer, but it still presents unique challenges and uncertainties. By understanding the diagnosis process, exploring treatment options tailored to individual needs, addressing emotional well-being, and accessing support systems, individuals and their loved ones can navigate this journey with resilience.

Not These Ovaries is committed to providing support, information, and hope for those affected by borderline ovarian cancer. Our ovarian cancer research fund aims to improve outcomes and develop better treatments, and your support enables us to continue this vital work. Together, we can make a difference in the lives of those impacted by ovarian cancer.