Treatment of Stage IIA Serous Borderline Ovarian Tumor
For stage IIA serous borderline ovarian tumors, comprehensive surgical staging alone is the recommended treatment, with no role for adjuvant chemotherapy or radiation therapy. 1, 2
Surgical Management
Standard Surgical Approach
The cornerstone of treatment is complete surgical staging performed through a midline laparotomy by a gynecologic oncologist. 3, 4 This must include:
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy 5, 3
- Infracolic omentectomy 5, 4
- Peritoneal washings for cytologic evaluation 3, 4
- Multiple peritoneal biopsies from the pelvic peritoneum, paracolic gutters, and diaphragmatic surfaces 5, 3
- Pelvic and para-aortic lymph node sampling (at least sampling of suspicious/enlarged nodes) 5
- Appendectomy if mucinous histology (not typically required for serous tumors) 5, 4
Fertility-Sparing Options
For young patients desiring fertility preservation with stage IIA disease, conservative surgery is NOT recommended as stage IIA represents extension to the uterus or fallopian tubes, making uterine preservation oncologically inappropriate. 5 Fertility-sparing surgery (unilateral salpingo-oophorectomy with uterine preservation) is only appropriate for stage IA disease with favorable histology. 5, 4, 6
Post-Surgical Treatment
No Adjuvant Therapy Required
Adjuvant chemotherapy or radiation therapy is NOT indicated for borderline tumors, even with stage IIA disease. 1, 2 This recommendation is based on:
- A large randomized trial of 253 patients with stage I-II borderline tumors showing 99% corrected survival with surgery alone, with no survival benefit from adjuvant therapy 1
- Prospective data demonstrating 81% disease-free survival at 5+ years with surgery alone for advanced-stage serous borderline tumors with noninvasive implants 2
- Adjuvant therapy only adds toxicity (bowel complications from radiation, neurotoxicity from cisplatin, bone marrow toxicity from alkylating agents) without improving survival 1
Critical Distinction from Invasive Carcinoma
This differs fundamentally from stage IIA invasive epithelial ovarian carcinoma, where adjuvant chemotherapy with carboplatin (AUC 5-7) is recommended. 5 The guidelines for invasive carcinoma explicitly state that stage IIA disease should receive adjuvant chemotherapy, but borderline tumors are biologically distinct entities with excellent prognosis after surgery alone. 5, 1
Follow-Up Strategy
- Clinical examination and routine ultrasonography are the mainstays of surveillance 7
- CA-125 monitoring may be considered, though its role is less established for borderline tumors than for invasive disease 3
- Recurrences occur in 15-35% of conservatively managed cases but are typically borderline histology again, easily treatable, and do not impact survival 6, 7
Common Pitfalls to Avoid
- Do not treat borderline tumors with the same chemotherapy protocols used for invasive epithelial ovarian cancer - this represents overtreatment 1
- Ensure adequate surgical staging - incomplete staging may miss the true extent of disease and lead to inappropriate management 4
- Confirm pathology with expert review - frozen section accuracy for borderline tumors is suboptimal, and final pathology may change management 6
- Do not perform "second-look" surgery - there is no role for this in borderline tumors 5