Fertility-Preserving Treatment Options for Mucinous Ovarian Carcinoma
Fertility-sparing surgery is safe and recommended for patients with early-stage mucinous ovarian carcinoma who wish to preserve fertility, specifically for those with stage IA low-grade (expansile subtype) and selected IC1 stages. 1
Assessment and Management Approach
Initial Evaluation
- All patients with mucinous ovarian carcinoma who wish to preserve fertility should be managed in an oncofertility clinic 1
- Expert ultrasound assessment is the recommended first-line imaging procedure 1
- If expert ultrasound is unavailable, the IOTA ADNEX model in combination with CA-125 is recommended to differentiate between benign, borderline, early or advanced-stage disease 1
- For mucinous tumors, careful evaluation of the gastrointestinal tract should be performed to rule out metastatic disease, as primary mucinous ovarian tumors are rare 1
Surgical Management for Fertility Preservation
- Unilateral salpingo-oophorectomy (USO) with surgical staging is the recommended approach for patients with malignancy apparently confined to one ovary 1
- Minimally invasive surgical techniques can be used, with careful attention to avoid tumor rupture 1
- Comprehensive surgical staging should still be performed to rule out occult higher-stage disease 1
- Appendectomy should be performed in all mucinous tumors to rule out appendiceal origin 1
- It is not recommended to biopsy the unaffected ovary unless there is suspicion of involvement 1
Fertility Preservation Strategies
- Cryopreservation of gametes rather than ovarian tissue is recommended for patients wishing to preserve fertility 1
- For patients with mucinous ovarian carcinoma specifically, unilateral salpingo-oophorectomy is preferred over cystectomy as it decreases recurrence risk without impairing fertility 2
Disease-Specific Considerations
Early-Stage Disease (Most Common Presentation)
- Fertility-sparing surgery is appropriate for stage IA low-grade mucinous carcinoma (expansile subtype) and selected IC1 stages 1
- For stage IA or IB disease, fertility preservation has excellent outcomes with appropriate surgical staging 3, 4
Advanced Disease
- For higher-risk histology or more advanced early-stage disease, adjuvant chemotherapy may be recommended, which carries a 3-10% risk of ovarian failure 4
- Advanced mucinous ovarian carcinoma responds poorly to standard platinum-based chemotherapy, and prognosis is poor 5
- For women with high-grade disease, bilateral salpingo-oophorectomy with uterine conservation could be considered to allow pregnancy through egg donation 1
Important Considerations and Pitfalls
- Distinguishing between primary mucinous ovarian carcinoma and metastatic disease is crucial, as treatment approaches differ significantly 5
- The expansile subtype of mucinous carcinoma has better prognosis than the infiltrative subtype 1, 3
- Recurrence risk is higher with cystectomy compared to salpingo-oophorectomy (49.1% vs 5.3% at 5 years), while pregnancy rates remain similar (41.8% vs 45.9%) 2
- Patients should be counseled that fertility preservation options are limited to early-stage disease; advanced mucinous ovarian carcinoma typically requires more aggressive treatment 5
By following these evidence-based recommendations, patients with mucinous ovarian carcinoma can be offered appropriate fertility-preserving options while maintaining optimal oncologic outcomes.