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Early Stage Ovarian Low Malignant Potential Tumors
The value of complete staging has not been demonstrated for early stage cases,
but the opposite ovary should be carefully evaluated for evidence of bilateral
disease. Although the impact of surgical staging on therapeutic management is
not defined, in one study 7 of 27 patients with presumed localized disease were
upstaged following complete surgical staging.[1] In two other studies, 16%
and 18% of patients with presumed localized tumors of low malignant potential
were upstaged as a result of a staging laparotomy.[2,3] In one of these
studies, the yield for serous tumors was 30.8% (4/13) compared to 0% (0/12) for
mucinous tumors.[4] In yet another study, patients with localized
intraperitoneal disease and negative lymph nodes had a low incidence of
recurrence (5%), whereas patients with localized intraperitoneal disease and
positive lymph nodes had a statistically significantly higher incidence of
recurrence (50%).[5]
In early stage disease (stage I/II), no additional treatment is indicated for a
completely resected tumor of low malignant potential.[6] When it is desirable
to retain childbearing potential, a unilateral salpingo-oophorectomy is
adequate therapy.[7,8] In the presence of bilateral ovarian cystic neoplasms,
or a single ovary, partial oophorectomy can be employed when fertility is
desired by the patient.[9] Some physicians stress the importance of limiting ovarian
cystectomy to stage IA patients in whom the margins of the cystectomy specimens
are free of tumor.[4] In one large series, the relapse rate was higher with
more conservative surgery (cystectomy >unilateral oophorectomy >TAH, BSO);
differences, however, were not statistically significant and survival was
nearly 100% for all groups.[5,10] When childbearing is not a consideration, a
total abdominal hysterectomy and bilateral salpingo-oophorectomy is appropriate
therapy. Once a woman has completed her family, most, but not all,[4]
physicians favor removal of remaining ovarian tissue as it is at risk of
recurrence of a borderline tumor, or even rarely, a carcinoma.[2,7]
References
- Yazigi R, Sandstad J, Munoz AK: Primary staging in ovarian tumors of low malignant potential. Gynecol Oncol 31 (3): 402-8, 1988.
[PUBMED Abstract]
- Snider DD, Stuart GC, Nation JG, et al.: Evaluation of surgical staging in stage I low malignant potential ovarian tumors. Gynecol Oncol 40 (2): 129-32, 1991.
[PUBMED Abstract]
- Leake JF, Rader JS, Woodruff JD, et al.: Retroperitoneal lymphatic involvement with epithelial ovarian tumors of low malignant potential. Gynecol Oncol 42 (2): 124-30, 1991.
[PUBMED Abstract]
- Piura B, Dgani R, Blickstein I, et al.: Epithelial ovarian tumors of borderline malignancy: a study of 50 cases. Int J Gynecol Cancer 2 (4): 189-197, 1992.
[PUBMED Abstract]
- Leake JF, Currie JL, Rosenshein NB, et al.: Long-term follow-up of serous ovarian tumors of low malignant potential. Gynecol Oncol 47 (2): 150-8, 1992.
[PUBMED Abstract]
- Tropé C, Kaern J, Vergote IB, et al.: Are borderline tumors of the ovary overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors. Gynecol Oncol 51 (2): 236-43, 1993.
[PUBMED Abstract]
- Kaern J, Tropé CG, Abeler VM: A retrospective study of 370 borderline tumors of the ovary treated at the Norwegian Radium Hospital from 1970 to 1982. A review of clinicopathologic features and treatment modalities. Cancer 71 (5): 1810-20, 1993.
[PUBMED Abstract]
- Lim-Tan SK, Cajigas HE, Scully RE: Ovarian cystectomy for serous borderline tumors: a follow-up study of 35 cases. Obstet Gynecol 72 (5): 775-81, 1988.
[PUBMED Abstract]
- Rice LW, Berkowitz RS, Mark SD, et al.: Epithelial ovarian tumors of borderline malignancy. Gynecol Oncol 39 (2): 195-8, 1990.
[PUBMED Abstract]
- Casey AC, Bell DA, Lage JM, et al.: Epithelial ovarian tumors of borderline malignancy: long-term follow-up. Gynecol Oncol 50 (3): 316-22, 1993.
[PUBMED Abstract]
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