The challenging management of borderline ovarian tumors (BOTs) in women of childbearing age

Abstract

Borderline ovarian tumors (BOTs) account for approximately 15% of all epithelial ovarian cancers. In 80% of cases the diagnosis of BOTs is done at stage I and more than a third of BOTs occurs in women younger than 40 years of age wishing to preserve their childbearing potential; the issue of conservative surgical management (fertility-sparing treatment) is thus becoming of paramount importance. At early stages, the modalities of conservative treatment could range from mono-lateral cystectomy to bilateral salpingo-oophorectomy. Although cystectomy is the preferred method to promote fertility it can lead to an elevated risk of recurrence; therefore, an appropriate counseling about the risk of relapse is mandatory before opting for this treatment. Nevertheless, relapses are often benign and can be treated by repeated conservative surgery. Besides the stage of the disease, histological subtype is another essential factor when considering the proper procedure: as most mucinous BOTs (mBOTs) are more commonly unilateral, the risk of an invasive recurrence seems to be higher, compared to serous histotype, therefore unilateral salpingo-oophorectomy is recommended. In the appraisal of current literature, this review aims to gain better insight on the current recommendations to identify the right balance between an accurate staging and an optimal fertility outcome.

At what age endometriosis-associated ovarian cancer is diagnosed? The implications for women in the reproductive age

“…Overall, ovarian cancer is a postmenopausal disease, although, in about 12% of cases, it may develop in women < 44 years of age ( 14 ). This estimate includes numerous women with borderline and non-epithelial tumors, typically presenting at a young age ( 15 , 16 ). Overall, women with EAOC are older than those with benign endometrioma but younger than women with non-EAOC ovarian carcinomas, such as high-grade serous ovarian carcinoma.…”

Conservative treatment of borderline ovarian tumors: a retrospective study

“…Pregnancy rates in patients who have undergone conservative surgical treatment vary widely, ranging from 30–80% [ 33 , 34 , 35 ]. When cystectomy was performed, fertility outcomes were better if the patient’s age was less than 40 years, and it was histologically a non-serous BOT type.…”

Comparison of ultrasound−based ADNEX model with magnetic resonance imaging for discriminating adnexal masses: a multi-center study

“…However, when detected in the early stage, the 5-year overall survival rate is more than 90% ( 2 ), such as borderline ovarian tumors (BOTs) survival is 95% at 5 years ( 3 ). Therefore, accurate early diagnosis of adnexal tumors is not only crucial for improving patient survival by applying appropriate treatments, which differ according to the status of tumor ( 4 – 6 ), but also important for the young female patients who want to preserve their fertility potential ( 7 ). Benign masses can be observed via follow-up or locally excised via laparoscopic surgery and BOTs could even adopt a strategy of fertility-sparing surgery because of its excellent reproductive outcome and long-term survival ( 7 ), whereas malignant masses must to properly stage and debulking surgery performed by a gynecological oncologist ( 8 ).…”