Borderline Ovarian Tumors (BOT)
What is it?
Borderline Ovarian Tumors (BOT) are a heterogeneous group of neoplasms with some, but not all, histological features of malignancy. Prognosis is favorable; median of 5-year survival is 95-99% in early stages and 90-95% in advanced stages.
The histological subtypes of borderline ovarian tumors correspond to those of invasive ovarian tumors:
- serous histotype, most frequent (60%), often with bilateral presentation, in 5-10% of cases may be associated with extra-ovarian implants;
- mucinous histotype (30-35%), most frequently characterized by voluminous cysts and usually unilateral;
- rare histotypes, including endometrioid, clear cell and Brenner cell BOTs.
Which are the symptoms?
Borderline tumors of the ovary are commonly found incidentally at routine ultrasound checks. The majority of borderline tumors of the ovary are asymptomatic, that is, they do not give rise to any obvious clinical manifestations. When present, the symptoms are very similar to those of ovarian carcinoma:
- pain;
- abdominal bloating;
- frequent need to urinate;
- vaginal bleeding;
- alterations in alvus;
- inappetence.
How is it diagnosed?
In suspected cases of borderline ovarian cancer, transvaginal ultrasonography is the main instrumental examination to formulate a diagnostic suspicion; it should be performed by experienced practitioners in the field of gynecologic oncology. It may be useful for differential diagnosis purposes to assay CA125.
Suggested exams
How is it treated?
The primary treatment in suspected borderline ovarian cancer is surgery, with a usually laparoscopic approach; the goal is removal of all macroscopically present disease. In postmenopausal women, the standard is bilateral adnexectomy, with hysterectomy.
Unilateral adnexectomy with surgical staging is the treatment to be offered to women of reproductive age.
In some cases, ultraconservative surgery, such as enucleation of the borderline tumor while preserving the healthy ovarian parenchyma, is possible.
In the mucinous histotype of BOT, appendectomy and evaluation of the gastrointestinal tract are recommended to rule out intestinal primitiveness of the tumor.
Taking into account the possibility of recurrence, referral to the onco-fertility outpatient clinic after diagnosis is recommended to evaluate possible indication for oocyte cryopreservation.
Where do we treat it?
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