Management of borderline tumors of the ovary: state of the art.
Evidence published during several decades has shown that there is a group of epithelial ovarian tumors having histological and biological features between those of clearly benign and frankly malignant tumors. In 1963, FIGO accepted an intermediate group of ovarian carcinomas of low malignant potential. In 1973, WHO adopted the term borderline malignancies to describe these tumors. Borderline tumors represent approximately 10% to 15% of all epithelial ovarian malignancies. There are considerable discrepancies in the reported incidence of ovarian tumors of borderline malignancies. Some centers do not recognize tumors of this type and include them among invasive cancers. The prognosis for patients with borderline tumors is generally considered to be excellent. Although the standard treatment for older patients is abdominal hysterectomy and bilateral salpingo-oophorectomy, many young patients who have not completed childbearing can be safely treated with unilateral salpingo-oophorectomy coupled with comprehensive surgical staging, thereby preserving fertility potential. Even ovarian cystectomy has been reported, but the recurrence rate in the ovary approximates 15%. Many experts strongly believe that surgery is the only effective treatment for borderline tumors. Others routinely use postoperative chemotherapy for at least some subsets of patients with peritoneal implants. Currently, insufficient information is available to make a definitive statement regarding the efficacy of postoperative therapy. Nevertheless, clinicians are faced with the difficult task of making treatment recommendations to anxious patients. In the past, extensive application of automated methods for analytical cytology has resulted in large quantities of data on ploidy abnormalities in different types of human cancers. The main purpose has been to obtain additional parameters for the characterization of various types of malignancy to give more precise information on their biological behavior. Data from the Norwegian Radium Hospital showed that the majority of borderline tumors have DNA diploid tumors and good prognosis, DNA aneuploidy indicates high risk. Several other investigators have shown the same results on DNA ploidy as a predictor of recurrence and survival, but a few others have shown conflicting results. Early studies suggest that p53 mutation does not appear to play a role in the pathogenesis of these tumors. Studies on other molecular markers have not yet uncovered a reliable predictor of biologic behavior. However, it is hoped that future studies of genetics and molecular biology of these tumors will lead to useful laboratory tests.
Tropé
C
C
The Norwegian Radium Hospital, Montebello, Oslo.
Kaern
J
J
D003131:Combined Modality Therapy; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis