Introduction: Who Should Undergo Diagnostics

Ovarian low malignant potential tumors, also called borderline ovarian tumors, often appear without warning in the early stages. Many women do not realize anything is wrong until the tumor grows larger. This is why knowing when to seek medical help is important for early detection and successful treatment.^[1]

Women should consider diagnostic testing if they experience certain symptoms that persist or worsen over time. These signs include pain or swelling in the lower belly area, discomfort in the pelvis, or digestive troubles such as bloating, gas, or constipation. Because these symptoms can easily be mistaken for common stomach or bowel problems, many women dismiss them at first. However, if these issues do not go away on their own or become more frequent, it is important to talk to a doctor.^[2]

It is especially important to seek diagnostics if you notice unusual changes in your body, such as vaginal bleeding that is not part of your normal menstrual cycle, pain during or after sex, feeling full soon after eating, or needing to urinate more often than usual. These signs may indicate that something is affecting the ovaries or nearby organs, and early testing can help identify the cause.^[5]

Women who have used fertility drugs for more than one year without becoming pregnant may be at higher risk for developing these tumors. Women who have never been pregnant may also face a slightly increased risk. Although family history of ovarian cancer has been linked to some risk, borderline tumors do not appear to have a strong hereditary pattern like invasive ovarian cancers do.^[2][3]

Borderline ovarian tumors are typically diagnosed in women during their 40s, which is significantly younger than the average age for invasive ovarian cancer. This means that many women affected by these tumors are still in their reproductive years and may wish to have children in the future. Early and accurate diagnosis allows doctors to plan treatment that preserves fertility whenever possible.^[7][13]

Diagnostic Methods: Identifying and Distinguishing the Tumor

Diagnosing ovarian low malignant potential tumors requires a combination of careful physical examination, imaging tests, and laboratory work. Because these tumors can look similar to both benign cysts and invasive cancers, doctors use multiple methods to get a clear picture before making treatment decisions.^[1]

Medical History and Physical Examination

The diagnostic process begins with a thorough discussion of your personal and family health history. Your doctor will ask about your symptoms, how long they have been present, and whether they have changed over time. This conversation helps the doctor understand your overall health and identify any risk factors that might be relevant.^[1]

A physical exam is the next step. This includes a pelvic exam, during which the doctor examines the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor inserts a speculum into the vagina to look at the vagina and cervix for signs of disease. A Pap test of the cervix may also be done at this time. Then, the doctor inserts one or two gloved, lubricated fingers into the vagina while pressing on the lower abdomen with the other hand. This allows the doctor to feel the size, shape, and position of the uterus and ovaries. A gloved finger may also be inserted into the rectum to check for lumps or abnormal areas.^[1][10]

The pelvic exam helps the doctor detect any unusual masses or swelling in the ovaries. However, because the ovaries are small and located deep in the pelvis, a physical exam alone cannot provide enough information to make a diagnosis. Additional tests are needed to see what is happening inside the body.^[2]

Ultrasound Imaging

An ultrasound is one of the most common and useful imaging tests for diagnosing ovarian tumors. This test uses high-energy sound waves that bounce off internal tissues and organs to create pictures, called a sonogram. The images can be printed and reviewed by the doctor to look for signs of a tumor.^[1]

There are two types of ultrasound used for ovarian imaging. An abdominal ultrasound involves moving a transducer (a small device that sends sound waves) over the outside of the belly. A transvaginal ultrasound involves inserting an ultrasound wand into the vagina to get a closer and clearer view of the ovaries. Transvaginal ultrasound is often preferred because it provides more detailed images of the ovaries and can better show the size, shape, and characteristics of any masses.^[5][11]

Ultrasound can reveal important details about a tumor, such as whether it is solid or filled with fluid, whether it has thickened walls or partitions inside, and whether it has unusual projections or growths. Borderline tumors often share some features with invasive cancers, such as papillary projections (finger-like growths), thickened internal walls, and multiple fluid-filled compartments. However, a significant number of borderline tumors can also appear as simple, single-chambered cysts, which makes diagnosis more challenging.^[7][13]

If a tumor is found in one ovary, the other ovary should also be carefully checked. Although most borderline tumors occur in only one ovary, both ovaries need to be examined to make sure the disease has not spread.^[2]

Advanced Imaging: CT, MRI, and Chest X-Ray

When ultrasound findings suggest a tumor, doctors may order additional imaging tests to gather more detailed information. A CT scan (computed tomography scan) uses X-rays and a computer to create cross-sectional images of the body. A CT scan can show the size and location of the tumor, whether it has spread to nearby tissues, and whether other organs are affected.^[2][14]

An MRI scan (magnetic resonance imaging) uses magnets and radio waves to produce detailed pictures of the body’s soft tissues. MRI is particularly helpful in distinguishing between benign, borderline, and malignant tumors. It provides clearer images of the ovaries and surrounding structures, helping doctors determine the best treatment approach.^[5][11]

A chest X-ray may also be performed to check whether the tumor has spread to the lungs. Although borderline ovarian tumors rarely spread to distant organs like the lungs or liver, this test is sometimes included as part of a comprehensive evaluation.^[14]

Blood Tests

Blood tests can provide additional clues about the presence of an ovarian tumor. One common test is the CA 125 assay, which measures the level of CA 125, a protein released by cells into the bloodstream. Elevated levels of CA 125 can indicate the presence of an ovarian tumor, although this test is not specific to borderline tumors and can be elevated in other conditions as well, including endometriosis and pelvic inflammatory disease.^[14]

While the CA 125 test is helpful, it cannot definitively diagnose a borderline tumor on its own. It is used alongside imaging tests and other evaluations to build a complete picture of what is happening in the body.^[3]

Biopsy: The Definitive Diagnosis

A biopsy is the only way to confirm whether a tumor is benign, borderline, or cancerous. During a biopsy, the doctor removes a small sample of tissue from the tumor and sends it to a laboratory, where a specialist called a pathologist examines the cells under a microscope.^[2][5]

Most biopsies for borderline ovarian tumors are performed during surgery. In many cases, the entire tumor or ovary is removed and then checked for cancer cells. Sometimes, the pathologist can examine the tissue during the surgery itself, in a process called an intraoperative frozen section. This allows the surgeon to make immediate decisions about how much tissue to remove. However, agreement between frozen section results and final pathology can be as low as 55%, meaning that further treatment decisions may need to be made after the final results are available.^[7][13]

The pathologist looks at the structure and behavior of the cells to determine whether they are borderline. Borderline tumors contain abnormal cells that grow in an unusual way but do not invade the surrounding tissue like cancer cells do. This distinction is critical for planning treatment and predicting outcomes.^[5]

Surgical Exploration and Staging

Surgery plays a dual role in diagnosing and treating borderline ovarian tumors. During surgery, the doctor carefully examines the pelvis and abdomen to look for any signs of disease spread. This includes inspecting the surface of the ovaries, the fallopian tubes, the uterus, the lining of the abdomen, and other organs.^[7]

The surgeon may collect samples of fluid from the abdomen, called peritoneal washings, to check for cancer cells. Any suspicious areas are biopsied. These steps help determine the stage of the tumor, which describes how far the disease has spread. Nearly 75% of borderline tumors are diagnosed at stage I, meaning the tumor is confined to one or both ovaries.^[8][12]

Staging procedures for borderline tumors may include removal of the affected ovary and fallopian tube, examination of the other ovary, collection of abdominal washings, removal of a fatty tissue called the omentum, and inspection of the diaphragm and other abdominal organs. However, routine lymph node removal is not typically performed for borderline tumors, although it may be considered in select cases.^[7][13]

The choice between a laparoscopic (minimally invasive) or open surgical approach depends on the size of the tumor, the patient’s prior surgical history, and the surgeon’s experience. Laparoscopic surgery is preferred in most cases because it results in faster recovery, less scarring, and fewer complications. However, care must be taken to avoid rupturing the tumor during removal, as spillage into the abdominal cavity can affect outcomes.^[5][11]

Diagnostics for Clinical Trial Qualification

Clinical trials are research studies that test new treatments or new ways of using existing treatments. For patients with ovarian low malignant potential tumors, clinical trials may offer access to innovative therapies or more precise diagnostic methods. However, enrollment in a clinical trial requires meeting specific eligibility criteria, and diagnostic tests play a key role in determining whether a patient qualifies.^[1]

To be considered for a clinical trial, patients typically need to have a confirmed diagnosis of borderline ovarian tumor. This requires a biopsy and pathology report that clearly identifies the tumor as borderline rather than benign or invasive. The pathology report must also describe the tumor’s characteristics, such as its cell type (serous, mucinous, endometrioid, or other) and whether it shows any features of invasive disease.^[5][11]

Staging information is also important for trial eligibility. Clinical trials often specify which stages of disease are being studied. For example, some trials may focus on early-stage tumors (stages I and II), while others may include advanced-stage tumors (stages III and IV) or recurrent disease. Accurate staging requires surgical exploration, imaging studies, and pathology results that document the extent of disease spread.^[8][12]

Imaging tests such as ultrasound, CT scans, and MRI scans are used to assess the size and location of the tumor, as well as to monitor response to treatment during the trial. Baseline imaging is typically performed before treatment begins, and repeat imaging is done at regular intervals to measure changes in the tumor.^[2][14]

Blood tests, including CA 125 levels, may also be required as part of the trial enrollment process. These tests help researchers track disease activity and evaluate how well the treatment is working. Some trials may also require genetic testing or molecular profiling of the tumor to identify specific markers or mutations that could influence treatment outcomes.^[3][14]

Patients must also meet general health criteria to participate in a clinical trial. This includes having adequate kidney, liver, and heart function, as well as being able to tolerate the treatments being studied. Blood tests, urine tests, and other assessments are used to evaluate overall health and ensure that participation in the trial is safe.^[1]

Before joining a clinical trial, patients undergo a thorough review of their medical history, diagnostic test results, and current health status. This process, called screening, ensures that the trial is appropriate for the patient and that the patient meets all the necessary requirements. Patients should discuss with their doctor whether a clinical trial is a good option and what diagnostic tests will be needed to qualify.^[1]