Borderline Ovarian Tumor Diagnosis: What Patients Should Know About Detection and Treatment

Getting a borderline ovarian tumor diagnosis can feel overwhelming, but understanding what these tumors are and how they’re detected can help you navigate this journey with more confidence. 

These unique growths sit somewhere between benign cysts and cancerous tumors, affecting mostly younger women in their reproductive years.

The path to diagnosis often starts with vague symptoms that are easy to dismiss. And while borderline ovarian tumors (BOTs) have an excellent prognosis, with survival rates around 95% at 5 years and 90% at 10 years, getting the right diagnosis matters for your treatment and your future.

Are Borderline Ovarian Tumors Considered Cancer?

This is usually the first question patients ask. Here’s what borderline ovarian tumors different from other types of ovarian cancer:

• They don’t invade the supportive tissue (stroma) of the ovary
• They grow slowly and in a more controlled manner than cancer cells
• About 75% are diagnosed at stage I, confined to the ovaries
• They’re sometimes called “tumors of low malignant potential” or “atypical proliferative tumors”

Here’s where it gets complicated. While BOTs aren’t as aggressive as other types of ovarian cancer, they’re not entirely benign, either. Around 15% of all ovarian tumors fall into this borderline category. They have abnormal cells that can, very rarely, transform into cancer cells later. This is why proper diagnosis and follow-up matter so much.

Think of BOTs as occupying a gray zone. They have some features of cancer under the microscope — like increased cell division — but lack the invasive behavior that defines true malignancy.

Understanding the Borderline Ovarian Tumor Diagnosis Process

The journey to a borderline ovarian tumor diagnosis rarely follows a straight line. Most women don’t experience symptoms when tumors are small. Instead, these tumors often show up during routine exams or imaging for unrelated issues.

When borderline ovarian tumor symptoms do appear, they’re frustratingly vague:

• Pelvic or abdominal pain or pressure
• Bloating or swollen abdomen
• Pain during or after intercourse
• Irregular vaginal bleeding
• Feeling full quickly when eating

Sound familiar? These mirror the symptoms of many other conditions, including ovarian cancer symptoms. This overlap is why many women see multiple doctors before getting answers: something our founder Emily experienced firsthand in her own ovarian cancer diagnosis journey.

The Diagnostic Tests You Can Expect

Initial examination: Your doctor will likely start with a pelvic exam, gently pressing on your abdomen to feel for lumps or tender areas. They’ll also perform an internal exam to check if your ovaries and uterus feel normal. It’s uncomfortable but important.

Imaging studies: Ultrasound is your first stop. You might have:

• Abdominal ultrasound: A probe moves across your belly
• Transvaginal ultrasound: Provides clearer images of your ovaries

Ultrasound alone can’t definitively diagnose BOTs. Gray-scale and color Doppler ultrasound have limited value in characterizing these tumors specifically.

When ultrasound results are unclear, additional imaging becomes necessary. Both CT and MRI can provide valuable information, and your doctor will recommend the best option based on your specific situation.

CT scans are often the next step because they’re widely available and fast. They can quickly show the size and location of masses and help rule out other conditions. However, MRI offers the most detailed view of ovarian tumors. Magnetic resonance imaging combines excellent soft-tissue contrast with high spatial resolution, making it particularly useful for characterizing borderline tumors. BOTs typically appear as large, round or oval masses with well-defined margins on MRI. They’re usually cystic with papillary projections or nodules, features that help radiologists distinguish them from other masses.

Your doctor will consider factors like availability, urgency, and what specific information they need when deciding between CT and MRI.

Blood tests: The CA-125 tumor marker, commonly used in ovarian cancer screening, isn’t particularly useful for detecting BOTs. This test might be elevated, normal, or somewhere in between, making it unreliable for diagnosis.

The Crucial Role of Surgery in Diagnosis

The only way to definitively diagnose a borderline ovarian tumor is through surgery and pathological examination.

This might feel overwhelming. But remember, surgery serves two purposes: diagnosis and treatment. During the operation, your surgeon will:

• Remove part or all of the affected ovary
• Carefully examine your pelvis and abdomen
• Take tissue samples from various areas
• Send everything to pathology for microscopic examination

The pathologist looks for specific features that define BOTs, such as atypical epithelial proliferation without stromal invasion. They’ll also determine the subtype:

• Serous BOTs (about 50% of cases)
• Mucinous BOTs (about 45% of cases)
• Rare types like endometrioid, clear cell, or seromucinous borderline tumors

Learn more about serous and mucinous borderline ovarian tumors.

Borderline Ovarian Tumor Treatment Options

Once diagnosed, borderline ovarian tumor treatment is primarily surgical. The good news? Surgery alone cures most women with BOTs.

Your treatment depends on several factors:

For Women Past Menopause

The standard approach involves removing:

• Both ovaries and fallopian tubes
• The uterus, including the cervix

This operation, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, provides the most definitive treatment.

For Women Who Want to Preserve Fertility

If you’re still in your reproductive years and the tumor is confined to one ovary, you might be a candidate for fertility-sparing surgery. This means removing only:

• The affected ovary and fallopian tube
• Preserving the uterus and opposite ovary

Understanding your fertility options before surgery is crucial. Many women with BOTs go on to have successful pregnancies after conservative surgery.

Additional Surgical Considerations

During any BOT surgery, your surgeon will also:

• Thoroughly inspect your abdomen and pelvis
• Remove tissue samples for staging
• Often remove the omentum (fatty tissue near the ovaries)
• For mucinous BOTs, remove the appendix (since these tumors can originate there)

Chemotherapy isn’t typically needed for BOTs. These tumors don’t respond well to chemo anyway, one reason why surgical excellence matters so much.

Borderline Ovarian Tumor Follow-Up: Your Long-Term Care Plan

After surgery, follow-up care focuses on detecting the chance of recurrence. Most BOTs don’t come back, but when they do, it’s usually within the first 5 years.

Your Follow-Up Schedule

The intensity of follow-up depends on:

• Your initial stage
• The type of borderline ovarian tumor 
• Whether you had fertility-sparing surgery

A typical schedule might look like:

• First 2 years: Every 3 to 4 months
• Years 3 to 5: Every 6 months
• After 5 years: Annually

Women who kept an ovary need closer monitoring since they have a slightly higher recurrence risk, though it’s still low at around 10-15%.

What Follow-Up Involves

Each visit typically includes:

• Physical and pelvic examination
• Ultrasound of remaining ovaries (if applicable)
• Discussion of any symptoms
• Blood tests (though CA-125 isn’t always useful)

Some doctors recommend periodic CT or MRI scans, especially for women with advanced-stage disease or invasive implants.

Managing Recurrence Risk

If a borderline tumor does return, it’s usually as another borderline tumor, not cancer. Treatment is typically another surgery. The transformation to cancer is rare, occurring in less than 1% of Stage I BOTs.

Risk factors for recurrence include:

• Young age at diagnosis (under 40)
• Advanced stage at diagnosis
• Presence of invasive implants
• Conservative surgery with ovarian preservation

The Importance of Expert Care

Not all gynecologists are equally experienced with BOTs. Consider seeing a gynecologic oncologist, a specialist in female reproductive cancers. They have the expertise to:

• Perform optimal staging surgery
• Make real-time surgical decisions
• Coordinate your long-term care

Studies show that women treated by gynecologic oncologists have better surgical staging and outcomes.

Moving Forward With Hope

With appropriate surgery and follow-up, most women diagnosed with BOTs live normal, healthy lives. Many go on to have children. The key is getting the right diagnosis, the right surgery, and the right follow-up care.

At Not These Ovaries, we’re committed to funding research that improves outcomes for all women facing ovarian tumors: borderline and beyond. Because whether you’re dealing with BOTs, low-grade serous ovarian cancer, or other rare subtypes, you deserve treatments designed specifically for your diagnosis.

Your journey with a borderline ovarian tumor might feel uncertain at times. But remember: these tumors have an excellent prognosis. With the right care team and follow-up plan, you can move forward with confidence, knowing you’re taking the right steps to protect your health and your future.