BORDERLINE OVARIAN CANCER(Ovarian Carcinomas of Low Malignant potential)

• Are subset of epithelial ovarian tumors approximately 20% of ovarian epithelial cancers and usually have an excellent prognosis

• The cells of these epithelial tumors do not invade the stroma of the ovary.

• Tend to occur in young women during the reproductive years

PATHOGENESIS• Epithelial cells of the ovaries are derived from

malignant transformation of the epithelium cells of the surface of the ovary. These cells come from primitive mesoderm and are capable of undergoing metaplasia

• The 2 major histologic tumor subtypes are serous and mucinous. With serous being more common 15% of all serous epithelial tumors while mucinous type is 10% of all mucinous tumors ( Pathologic basis of diseases 8th ed. Mitchell et.al)

Borderline Serous type

Borderline Mucinous type

RISK FACTORS

• Family history• Increasing age• Early menarche(< 12 y/o)• Infertility• Nulliparity• Late onset menopause (>50 y/o)• Obesity (BMI > 30)

CLINICAL MANIFESTATION

INITIAL SYMPTOMS• Bloating• Early Satiety• Dyspepsia• Abdominal pain• Pelvic pain

LATER SYMPTOMS

• Urinary frequency• Constipation• Fatigue• Dyspareunia• Menstrual

changes

DIAGNOSTICS

• Cancer antigen (CA)-125 levels is elevatedin 80% of epithelial cell cancers

• Preoperative Transvaginal Color doppler ultrasound – used to assess the possibility of malignancy of ovarian masses, the blood flow from borderline tumors is similar to that of malignant neoplasms: 90%-92%

MANAGEMENT

• Surgery: is the mainstay of treatment which offers the best treatment for borderline tumors such as unilateral adnexectomy or unilateral oophorectomy

• after surgery , epithelial ovarian cancer is treated with combination of chemotherapy most commonly IV carboplatin and paclitaxel

• The tumor marker CA-125 and Imaging studies, used to evaluate the success of treatment and to diagnose recurrent disease