What is the role of surgery in the treatment of borderline ovarian cancer?

Updated: Mar 18, 2019
  • Author: Andrew E Green, MD; Chief Editor: Warner K Huh, MD  more...
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Answer

Answer

Given the excellent prognosis for borderline ovarian tumors, hysterectomy and contralateral oophorectomy are not necessary (if the ovary appears normal) if the patient wishes to preserve fertility. If the patient is beyond childbearing age, then hysterectomy is a reasonable option. Removal of a normal, contralateral ovary should be based on existing data regarding ovarian physiology.

Results released in 2015 from a nationwide Danish register-based case-control study between 1982 and 2011 indicate that tubal ligation is effective in reducing the risk of epithelial ovarian cancer, especially endometrioid cancer. [6] The study included 13,241 women with epithelial ovarian cancer and 3,605 women with borderline ovarian tumor; the tumors were stratified on the basis of their histology.

Tubal ligation reduced the overall epithelial ovarian cancer risk by 13%; bilateral salpingectomy reduced epithelial ovarian cancer risk by 42%. [6] The investigators did not find an association between tubal ligation and risk of borderline ovarian tumors.

When a complex ovarian mass is discovered, surgery is often, if not always, indicated. Complete excision of the disease must be achieved if at all possible. Comprehensive staging should be a part of every operation. Although stage may or may not affect future treatment, it is of significant prognostic value and therefore is of value to the clinician and to the patient.

In one study, 77% of patients with invasive peritoneal implants also had noninvasive implants. Comprehensive debulking and staging decreases the chance of a sampling error that could result in an inaccurate diagnosis and prognosis.

In most instances, surgery is curative for patients with confirmed stage I disease. If the tumor is unilateral and adjacent to normal tissue, unilateral cystectomy can be performed; however, inspection of the capsule for signs of rupture should be performed before resection. If no normal adjacent tissue is present, oophorectomy or salpingo-oophorectomy should be performed. If the contralateral ovary is normal in appearance, a biopsy should not be performed on the adjacent ovary because of the risk of ovarian failure (if fertility is an issue).

Owing to the high association between surface proliferations and peritoneal implants, exploration of the peritoneum should be extensive and thorough. If possible, carefully evaluate and remove the implants. The type of implant (ie, invasive, noninvasive) should be noted by pathology, as it has significant prognostic value.

Contraindications to surgery include medical reasons (ie, the patient is too great a surgical risk secondary to other medical problems) or patient refusal. Otherwise, the masses should be surgically removed.


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