What is the management of borderline ovarian tumor after removal?

Management of Borderline Ovarian Tumors After Removal

Observation without adjuvant therapy is the standard approach for most patients with borderline ovarian tumors (BOTs) after surgical removal, as these tumors have an excellent prognosis with very low risk of invasive recurrence. 1

Post-Surgical Management Based on Risk Factors

Standard Management

• Observation is the primary approach after complete surgical removal of BOTs 1
• No adjuvant chemotherapy is recommended for most BOTs, as they have a clinically indolent course with good prognosis 1
• Regular surveillance is essential, especially since recurrences can occur late (70% after 5 years, 30% after 10 years) 1

Risk Stratification for Follow-up

• Higher risk factors for recurrence:
  • Age <40 years 2
  • Advanced initial FIGO stage 2
  • Fertility-sparing surgery (2-24% recurrence risk) 2
  • Residual disease after initial surgery for serous BOT 2
  • Presence of peritoneal implants (invasive or non-invasive) 1, 2
  • Serous histology (higher recurrence risk than mucinous when treated conservatively) 2

Special Considerations for Invasive Implants

• For serous BOTs with invasive implants, closer monitoring is required 1
• Despite some debate, there is no proven benefit of adjuvant chemotherapy even in cases with invasive implants 1

Surveillance Protocol

Duration

• Follow-up must extend beyond 5 years, as recurrences often occur late 1, 2
• Some recurrences may occur as late as 10-20 years after initial treatment 3

Components of Surveillance

• Regular clinical examinations are recommended during follow-up 2
• For patients who had elevated CA-125 at diagnosis, continued monitoring of CA-125 levels is recommended 1, 2
• For patients who underwent fertility-sparing surgery:
  • Endovaginal and transabdominal ultrasound examinations are recommended 2
  • Special attention should be paid to the remaining ovary 1

Imaging

• CT scans may be used when recurrence is suspected based on symptoms, examination findings, or CA-125 elevation 1
• PET-CT scans can be useful when CT scans are indeterminate 1
• Routine ultrasound imaging is recommended, especially for conservatively treated patients 3

Management of Recurrence

• Most recurrences of BOTs are borderline in nature rather than invasive carcinomas 4
• Surgical management is typically effective for recurrent disease 1
• Less than 5% of BOT recurrences eventually progress to invasive cancers 1
• Many patients with recurrent BOTs can be successfully treated with additional surgery 1

Completion Surgery Considerations

• For serous BOTs, completion surgery (removal of remaining ovarian tissue) is not recommended after conservative treatment once childbearing is complete 2
• There is insufficient evidence to make recommendations about completion surgery for mucinous BOTs 2

Fertility Considerations

• For young patients who underwent fertility-sparing surgery, fertility preservation counseling is recommended 5
• If infertility persists after conservative management, ovarian induction or in vitro fertilization may be considered in selected cases 6

Prognosis

• Overall survival rate exceeds 80% at 5 years 1
• 10-year overall survival is >94% even with recurrences 2
• Risk of invasive recurrence is very low, estimated at 0.5-3.8% 4, 2

This management approach balances oncologic safety with quality of life considerations, particularly for younger patients who may desire future fertility.