Ovarian low malignant potential tumour Treatment

Finding the Right Path: How Treatment is Chosen for Borderline Ovarian Tumors

When a woman receives a diagnosis of an ovarian low malignant potential tumor, her treatment journey begins with understanding what makes these growths different. These tumors contain abnormal cells that could turn into cancer, but in most cases they do not. The primary goal of treatment is to remove the tumor, prevent recurrence, and preserve quality of life—including the possibility of having children if that is important to the patient.12

Treatment decisions depend on several important factors. Doctors consider the size and location of the tumor, whether it has spread beyond the ovary, the patient's age, her overall health, and crucially, whether she wishes to become pregnant in the future. Because borderline tumors typically affect younger women—often in their 40s—fertility preservation is frequently a central concern in treatment planning.33

The stage of disease also plays a vital role. Nearly 75% of borderline ovarian tumors are discovered at stage I, meaning the disease is confined to the ovary. This early detection contributes to the excellent prognosis these tumors carry. Even when found at more advanced stages, survival rates remain remarkably high compared to invasive ovarian cancers.45

Medical guidelines from organizations like the National Comprehensive Cancer Network provide detailed recommendations for managing these tumors. However, treatment is highly individualized, with shared decision-making between patient and doctor at the heart of the process. What works best for one woman may not be the right choice for another, particularly when balancing cancer control against preserving fertility or avoiding premature menopause.33

Standard Treatment: Surgery as the Cornerstone of Care

For nearly all women with borderline ovarian tumors, surgery is the primary and often the only treatment needed. The surgical approach can range from removing just the tumor itself to more extensive procedures, depending on individual circumstances. The key principle is to remove all visible disease while preserving as much normal tissue as possible, especially in women who wish to maintain fertility.26

The most common surgical procedure is removal of the affected ovary, known as unilateral adnexectomy. This surgery takes out the ovary and the fallopian tube on the same side. For women who have completed their families or do not wish to preserve fertility, doctors may recommend more complete surgery. This can include a total hysterectomy (removal of the uterus and cervix) along with bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes).27

For younger women who want to preserve their ability to have children, more conservative surgery is often possible. Doctors may perform only a cystectomy, which removes just the tumor while leaving the ovary intact. This approach preserves the maximum amount of ovarian tissue and maintains hormone production, avoiding surgical menopause. However, cystectomy does carry a higher risk of recurrence—up to 30%—compared to removing the entire ovary, which has a recurrence rate of about 15%. The important point is that even when tumors recur, they are typically borderline rather than malignant, and can be successfully treated again.33

The choice between laparoscopic (minimally invasive) and open surgery depends on several factors including the size of the mass, the surgeon's experience, and whether extensive staging procedures are needed. Laparoscopic surgery involves smaller incisions and is generally preferred when feasible, as it typically results in faster recovery, less pain, minimal scarring, and reduced risk of complications. The critical goal during laparoscopic surgery is to remove the tumor intact without spillage into the abdominal cavity.33

During surgery, doctors perform several important procedures beyond tumor removal. Peritoneal washings are collected before the tumor is removed—this involves flushing the abdominal cavity with fluid and examining it under a microscope for abnormal cells. The surgeon carefully inspects the pelvis and abdominal organs for any visible disease and takes biopsies of suspicious areas. In select cases, additional staging procedures may be performed, which can include removing the omentum (a fatty tissue layer in the abdomen), examining the diaphragm, and removing any visible disease deposits.33

One challenge surgeons face is that the final diagnosis often isn't confirmed until after surgery. Agreement between frozen section analysis (done during surgery) and final pathology results can be as low as 55%. This means doctors sometimes need to make treatment decisions after what turns out to be incomplete staging. When this happens, consultation with a gynecologic oncologist helps determine whether additional surgery is needed.33

After surgery, most women require regular follow-up but no additional treatment. Follow-up typically involves visits every six months to check for signs of recurrence. For women who had conservative surgery preserving fertility, these check-ups are particularly important because of the higher recurrence risk. However, the excellent long-term survival rates—with 5-year survival of 97%, 10-year survival of 95%, and 20-year survival of 89%—provide reassurance that even with surveillance needs, the outlook is very favorable.45

In rare situations where borderline tumors have spread beyond the ovary to other areas, surgery still remains the primary treatment approach. Doctors remove as much visible tumor as possible. Spread to distant organs like the lungs or liver is uncommon. In select cases after surgery, doctors may consider endocrine (hormone) therapy, though this is not a standard recommendation for all patients.266

Chemotherapy is generally not used for borderline ovarian tumors unless there is evidence of transformation to invasive cancer. If pathology reveals that the tumor has become malignant, then doctors will discuss additional treatment options including chemotherapy and palliative care to manage symptoms and support emotional wellbeing.22

Treatment in Clinical Trials: Exploring New Frontiers

Because surgery alone is so effective for borderline ovarian tumors, and because these tumors have such favorable outcomes, there is limited information in the provided sources about specific experimental drugs or therapies being tested in clinical trials exclusively for this condition. The excellent prognosis with standard surgical treatment means that aggressive new interventions are rarely needed or investigated specifically for borderline tumors.

However, patients with borderline ovarian tumors who have access to major cancer centers may find opportunities to participate in research. Clinical trials for gynecologic conditions often exist at academic medical centers, and participation can contribute to advancing medical knowledge even when standard treatments are already highly effective. Patients interested in clinical trial participation should discuss this option with their gynecologic oncologist.77

Research continues to explore the molecular characteristics of borderline tumors and their connection to low-grade ovarian cancers. Understanding these molecular pathways may eventually lead to targeted therapies for the small percentage of patients whose tumors transform or recur with more aggressive features. Some borderline tumors can progress to become low-grade serous carcinomas, and research into this transformation process continues at specialized cancer centers.58

Most common treatment methods

• Conservative Surgery (Fertility-Sparing)
  • Cystectomy: removal of tumor only, leaving the ovary intact—preserves maximum ovarian tissue but has higher recurrence rate (up to 30%)
  • Unilateral adnexectomy: removal of affected ovary and fallopian tube on one side only
  • Preservation of uterus and opposite ovary to maintain fertility
  • Preferred for younger women desiring future pregnancy
  • Recurrences are typically borderline and highly treatable
• Radical Surgery (Definitive Treatment)
  • Total hysterectomy: removal of uterus and cervix
  • Bilateral salpingo-oophorectomy: removal of both ovaries and fallopian tubes
  • Omentectomy: removal of fatty tissue layer in abdomen (in select cases)
  • Removal of visible disease deposits throughout abdomen
  • Lower recurrence risk compared to conservative surgery
  • Appropriate for women who have completed childbearing or wish to avoid premature menopause symptoms
• Minimally Invasive Surgical Approaches
  • Laparoscopic surgery performed through small incisions
  • Results in faster recovery, less pain, and minimal scarring
  • Reduced risk of post-surgical complications compared to open surgery
  • Focus on removing tumor intact without spillage into abdominal cavity
  • Choice between laparoscopic and open approach depends on tumor size, surgical history, and surgeon experience
• Surgical Staging Procedures
  • Peritoneal washings collected and examined for abnormal cells
  • Careful inspection of pelvis and abdominal organs for visible disease
  • Biopsies of suspicious areas
  • Diaphragm examination in comprehensive staging
  • Lymph node sampling considered only in select cases (not routine for borderline tumors)
• Surveillance and Follow-Up Care
  • Regular doctor visits approximately every 6 months after surgery
  • Monitoring for signs of tumor recurrence
  • Long-term follow-up necessary as recurrences can occur years after initial treatment
  • Particularly important for women who had fertility-sparing surgery
  • Individualized surveillance plans based on pathology and surgical approach
• Hormone Therapy (Select Cases)
  • Endocrine therapy considered in specific situations after surgery
  • Not standard treatment for all borderline tumor patients
  • May be discussed for tumors with spread beyond the ovary