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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK66031_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK66031_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK66031_"><span class="title" itemprop="name">Ovarian Low Malignant Potential Tumors Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: December 17, 2019.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062941__63">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of ovarian low-malignant potential tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062941__64">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062941__1"><h2 id="_CDR0000062941__1_">General Information About Ovarian Low Malignant Potential Tumors</h2><div id="CDR0000062941__59"><h3>Incidence and Mortality</h3><p id="CDR0000062941__16">Tumors of low malignant potential (i.e., borderline tumors) account for 15% of all
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epithelial ovarian cancers. Nearly 75% of these tumors are stage I at the time of
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diagnosis. These tumors must be recognized because their prognosis and
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treatment is clearly different from the frankly malignant invasive carcinomas.</p><p id="CDR0000062941__17">A review of 22 series (953 patients) with a mean follow-up of 7 years revealed
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a survival rate of 92% for patients with advanced-stage tumors, if patients with so-called
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invasive implants were excluded. The cause of death was determined to be
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benign complications of disease (e.g., small bowel obstruction), complications
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of therapy, and only rarely (0.7%), malignant transformation.[<a class="bk_pop" href="#CDR0000062941_rl_1_1">1</a>] In one
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series, the 5-, 10-, 15-, and 20-year survival rates of patients with low
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malignant potential tumors (all stages), as demonstrated by clinical life table
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analysis, were 97%, 95%, 92%, and 89%, respectively.[<a class="bk_pop" href="#CDR0000062941_rl_1_2">2</a>] In this series, mortality was stage
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dependent: 0.7%, 4.2%, and 26.8% of patients with stages I, II, and III,
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respectively, died of disease.[<a class="bk_pop" href="#CDR0000062941_rl_1_2">2</a>] Another large study showed early stage, serous
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histology, and younger age to be associated with a more favorable prognosis.[<a class="bk_pop" href="#CDR0000062941_rl_1_3">3</a>]
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In contrast to the excellent survival rates for early-stage disease reported above, the Federation Internationale de Gynecologie et d’Obstetrique Annual Report (#21) included 529 patients with stage I tumors with a 5-year actuarial survival rate of 89.1%. Similarly, good survival was found in a
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large prospective study.[<a class="bk_pop" href="#CDR0000062941_rl_1_4">4</a>] Nonetheless, these survival rates are clearly in
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contrast with the 30% survival rate for invasive tumors (all stages).</p></div><div id="CDR0000062941__60"><h3>Endometrioid tumor</h3><p id="CDR0000062941__2"> The less
|
|
common endometrioid tumor of low malignant potential should not be regarded as
|
|
malignant because it seldom, if ever, metastasizes. Malignant transformation
|
|
can, however, occur and may be associated with a similar tumor outside of the
|
|
ovary; such tumors are the result of either a second primary or rupture of the
|
|
primary endometrial tumor.[<a class="bk_pop" href="#CDR0000062941_rl_1_5">5</a>]
|
|
</p></div><div id="CDR0000062941_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062941_rl_1_1">Kurman RJ, Trimble CL: The behavior of serous tumors of low malignant potential: are they ever malignant? Int J Gynecol Pathol 12 (2): 120-7, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8463035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8463035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_1_2">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/1468692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1468692</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_1_3">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8383580" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8383580</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_1_4">Zanetta G, Rota S, Chiari S, et al.: Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol 19 (10): 2658-64, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11352957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11352957</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_1_5">Norris HJ: Proliferative endometrioid tumors and endometrioid tumors of low malignant potential of the ovary. Int J Gynecol Pathol 12 (2): 134-40, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8463037" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8463037</span></a>]</div></li></ol></div></div><div id="CDR0000062941__21"><h2 id="_CDR0000062941__21_">Stage Information for Ovarian Low Malignant Potential Tumors </h2><div id="CDR0000062941__56"><h3>Definitions: FIGO</h3><p id="CDR0000062941__54">The Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define ovarian low malignant potential tumors; the FIGO system is most commonly used.[<a class="bk_pop" href="#CDR0000062941_rl_21_1">1</a>,<a class="bk_pop" href="#CDR0000062941_rl_21_2">2</a>]</p><div id="CDR0000062941__55" class="table"><h3><span class="title">Table 1. Carcinoma of the Ovary<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK66031.2/table/CDR0000062941__55/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062941__55_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:left;vertical-align:top;"></th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">I</td><td colspan="1" rowspan="1" style="vertical-align:top;">Growth limited to the ovaries.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ia</td><td colspan="1" rowspan="1" style="vertical-align:top;">Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Growth limited to both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ic<sup>b</sup></td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor either stage Ia or Ib, but with tumor on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">II</td><td colspan="1" rowspan="1" style="vertical-align:top;">Growth involving one or both ovaries with pelvic extension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIa</td><td colspan="1" rowspan="1" style="vertical-align:top;">Extension and/or metastases to the uterus and/or tubes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIb</td><td colspan="1" rowspan="1" style="vertical-align:top;">Extension to other pelvic tissues.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIc<sup>b</sup></td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor either stage IIa or IIb, but with tumor on surface of one or both ovaries, or with capsule(s) ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">III</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastases equals stage III. Tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIIa</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIIb</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIIc</td><td colspan="1" rowspan="1" style="vertical-align:top;">Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IV</td><td colspan="1" rowspan="1" style="vertical-align:top;">Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allot a case to stage IV. Parenchymal liver metastasis equals stage IV.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Adapted from FIGO Committee on Gynecologic Oncology.[<a class="bk_pop" href="#CDR0000062941_rl_21_1">1</a>]</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>In order to evaluate the impact on prognosis of the different criteria for allotting cases to stage Ic or IIc, it would be of value to know if rupture of the capsule was spontaneous, or caused by the surgeon; and if the source of malignant cells detected was peritoneal washings, or ascites.</p></div></dd></dl></div></div></div></div><div id="CDR0000062941_rl_21"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062941_rl_21_1">FIGO Committee on Gynecologic Oncology: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 105 (1): 3-4, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19322933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19322933</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_21_2">Ovary, fallopian tube, and primary peritoneal carcinoma. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 681-90.</div></li></ol></div></div><div id="CDR0000062941__11"><h2 id="_CDR0000062941__11_">Early-Stage Ovarian Low Malignant Potential Tumors</h2><p id="CDR0000062941__4">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 a study, 7 of 27 patients with presumed localized disease were
|
|
upstaged following complete surgical staging.[<a class="bk_pop" href="#CDR0000062941_rl_11_1">1</a>] 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.[<a class="bk_pop" href="#CDR0000062941_rl_11_2">2</a>,<a class="bk_pop" href="#CDR0000062941_rl_11_3">3</a>] In one of these
|
|
studies, the yield for serous tumors was 30.8% compared with 0% for
|
|
mucinous tumors.[<a class="bk_pop" href="#CDR0000062941_rl_11_4">4</a>] In 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%).[<a class="bk_pop" href="#CDR0000062941_rl_11_5">5</a>]
|
|
</p><p id="CDR0000062941__3">In early-stage disease (stage I or II), no additional treatment is indicated for a
|
|
completely resected tumor of low malignant potential.[<a class="bk_pop" href="#CDR0000062941_rl_11_6">6</a>] When a patient wishes
|
|
to retain childbearing potential, a unilateral salpingo-oophorectomy is
|
|
adequate therapy.[<a class="bk_pop" href="#CDR0000062941_rl_11_7">7</a>,<a class="bk_pop" href="#CDR0000062941_rl_11_8">8</a>] In the presence of bilateral ovarian cystic neoplasms,
|
|
or a single ovary, a partial oophorectomy can be employed when fertility is
|
|
desired by the patient.[<a class="bk_pop" href="#CDR0000062941_rl_11_9">9</a>] 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.[<a class="bk_pop" href="#CDR0000062941_rl_11_4">4</a>] In a 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.[<a class="bk_pop" href="#CDR0000062941_rl_11_5">5</a>,<a class="bk_pop" href="#CDR0000062941_rl_11_10">10</a>] 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,[<a class="bk_pop" href="#CDR0000062941_rl_11_4">4</a>]
|
|
physicians favor removal of remaining ovarian tissue as it is at risk of
|
|
recurrence of a borderline tumor, or even rarely, a carcinoma.[<a class="bk_pop" href="#CDR0000062941_rl_11_2">2</a>,<a class="bk_pop" href="#CDR0000062941_rl_11_7">7</a>]
|
|
</p><div id="CDR0000062941__TrialSearch_11_sid_3"><h3>Current Clinical Trials</h3><p id="CDR0000062941__TrialSearch_11_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062941_rl_11"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062941_rl_11_1">Yazigi R, Sandstad J, Munoz AK: Primary staging in ovarian tumors of low malignant potential. Gynecol Oncol 31 (3): 402-8, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/3181811" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3181811</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_2">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/2010103" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2010103</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_3">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/1894170" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1894170</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_4">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/11576258" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11576258</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_5">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/1468692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1468692</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_6">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8276300" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8276300</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_7">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8383580" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8383580</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_8">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/3173929" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3173929</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_9">Rice LW, Berkowitz RS, Mark SD, et al.: Epithelial ovarian tumors of borderline malignancy. Gynecol Oncol 39 (2): 195-8, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2227595" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2227595</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_11_10">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8406194" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8406194</span></a>]</div></li></ol></div></div><div id="CDR0000062941__12"><h2 id="_CDR0000062941__12_">Advanced-Stage Ovarian Low Malignant Potential Tumors</h2><p id="CDR0000062941__5">Patients with advanced disease should undergo a total hysterectomy, bilateral
|
|
salpingo-oophorectomy, omentectomy, node sampling, and aggressive cytoreductive
|
|
surgery. Patients with stage III or IV disease with no gross residual tumor have
|
|
had a 100% survival rate in some series regardless of the follow-up
|
|
duration.[<a class="bk_pop" href="#CDR0000062941_rl_12_1">1</a>,<a class="bk_pop" href="#CDR0000062941_rl_12_2">2</a>] The 7-year survival rate of patients with gross residual
|
|
disease was only 69% in a large series [<a class="bk_pop" href="#CDR0000062941_rl_12_3">3</a>] and appears to be inversely
|
|
proportional to the length of follow-up.[<a class="bk_pop" href="#CDR0000062941_rl_12_3">3</a>]
|
|
</p><p id="CDR0000062941__6">For patients with more advanced-stage disease and microscopic or gross residual
|
|
disease, chemotherapy and/or radiation therapy are not indicated. Scant evidence exists that postoperative chemotherapy or radiation therapy alters the
|
|
course of this disease in any beneficial way.[<a class="bk_pop" href="#CDR0000062941_rl_12_1">1</a>,<a class="bk_pop" href="#CDR0000062941_rl_12_3">3</a>-<a class="bk_pop" href="#CDR0000062941_rl_12_6">6</a>] In a study of
|
|
364 patients without residual tumor, adjuvant therapy had no effect on disease-free or corrected survival when stratified for disease stage.[<a class="bk_pop" href="#CDR0000062941_rl_12_7">7</a>] Patients
|
|
without residual tumor who received no adjuvant treatment had a survival rate
|
|
equal to or greater than the treated groups. Currently, no controlled
|
|
studies have compared postoperative treatment with no treatment.
|
|
</p><p id="CDR0000062941__7">In a review of 150 patients with borderline ovarian tumors, the survival of
|
|
patients with a residual tumor of less than 2 cm was significantly
|
|
better than survival for those with a residual tumor from 2 to 5 cm and more than 5 cm.[<a class="bk_pop" href="#CDR0000062941_rl_12_8">8</a>] Whether invasive implants imply a worse prognosis
|
|
remains an unsettled question. Some investigators have correlated invasive
|
|
implants with poor prognosis, [<a class="bk_pop" href="#CDR0000062941_rl_12_9">9</a>] while others have not.[<a class="bk_pop" href="#CDR0000062941_rl_12_2">2</a>,<a class="bk_pop" href="#CDR0000062941_rl_12_10">10</a>] Some studies
|
|
have suggested that it may be possible to use DNA ploidy of the tumors to
|
|
identify those patients who will develop aggressive disease.[<a class="bk_pop" href="#CDR0000062941_rl_12_11">11</a>,<a class="bk_pop" href="#CDR0000062941_rl_12_12">12</a>] A study
|
|
could not correlate DNA ploidy of the primary serous tumor with survival but
|
|
found that aneuploid invasive implants were associated with a poor
|
|
prognosis.[<a class="bk_pop" href="#CDR0000062941_rl_12_13">13</a>] Currently, no evidence indicates that treatment of patients with aneuploid
|
|
tumors would have an impact on survival. No significant association was found
|
|
between p53 and HER-2/neu overexpression and tumor recurrence or survival.[<a class="bk_pop" href="#CDR0000062941_rl_12_14">14</a>]
|
|
</p><p id="CDR0000062941__8">In the face of clinical progression, further tumor reductive surgery followed
|
|
by chemotherapy is certainly indicated. If the symptom-free interval is long,
|
|
using chemotherapy after a secondary cytoreductive procedure is not advisable.
|
|
If, on the other hand, the disease symptomatically recurs rapidly, chemotherapy
|
|
may be beneficial. Reports have surgically documented the efficacy of
|
|
chemotherapy on some patients with microscopic or gross residual
|
|
disease.[<a class="bk_pop" href="#CDR0000062941_rl_12_15">15</a>,<a class="bk_pop" href="#CDR0000062941_rl_12_16">16</a>] A Gynecologic Oncology Group study used melphalan chemotherapy for patients with
|
|
progressive disease and used cisplatin for melphalan failures.[<a class="bk_pop" href="#CDR0000062941_rl_12_17">17</a>]
|
|
</p><div id="CDR0000062941__TrialSearch_12_sid_4"><h3>Current Clinical Trials</h3><p id="CDR0000062941__TrialSearch_12_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062941_rl_12"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062941_rl_12_1">Barnhill D, Heller P, Brzozowski P, et al.: Epithelial ovarian carcinoma of low malignant potential. Obstet Gynecol 65 (1): 53-9, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/2981419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2981419</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_2">Bostwick DG, Tazelaar HD, Ballon SC, et al.: Ovarian epithelial tumors of borderline malignancy. A clinical and pathologic study of 109 cases. Cancer 58 (9): 2052-65, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3756820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3756820</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_3">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/1468692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1468692</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_4">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8406194" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8406194</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_5">Tumors of the ovary: neoplasms derived from coelomic epithelium. In: Morrow CP, Curtin JP: Synopsis of Gynecologic Oncology. 5th ed. New York, NY: Churchill Livingstone, 1998, pp 233-281.</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_6">Sutton GP, Bundy BN, Omura GA, et al.: Stage III ovarian tumors of low malignant potential treated with cisplatin combination therapy (a Gynecologic Oncology Group study). Gynecol Oncol 41 (3): 230-3, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1869100" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1869100</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_7">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. [<a href="https://pubmed.ncbi.nlm.nih.gov/8383580" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8383580</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_8">Tamakoshi K, Kikkawa F, Nakashima N, et al.: Clinical behavior of borderline ovarian tumors: a study of 150 cases. J Surg Oncol 64 (2): 147-52, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9047253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9047253</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_9">Bell DA, Scully RE: Serous borderline tumors of the peritoneum. Am J Surg Pathol 14 (3): 230-9, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2305929" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2305929</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_10">Michael H, Roth LM: Invasive and noninvasive implants in ovarian serous tumors of low malignant potential. Cancer 57 (6): 1240-7, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/2417697" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2417697</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_11">Friedlander ML, Hedley DW, Swanson C, et al.: Prediction of long-term survival by flow cytometric analysis of cellular DNA content in patients with advanced ovarian cancer. J Clin Oncol 6 (2): 282-90, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/3276825" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3276825</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_12">Kaern J, Trope C, Kjorstad KE, et al.: Cellular DNA content as a new prognostic tool in patients with borderline tumors of the ovary. Gynecol Oncol 38 (3): 452-7, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2172121" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2172121</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_13">de Nictolis M, Montironi R, Tommasoni S, et al.: Serous borderline tumors of the ovary. A clinicopathologic, immunohistochemical, and quantitative study of 44 cases. Cancer 70 (1): 152-60, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1606537" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1606537</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_14">Eltabbakh GH, Belinson JL, Kennedy AW, et al.: p53 and HER-2/neu overexpression in ovarian borderline tumors. Gynecol Oncol 65 (2): 218-24, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9159328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9159328</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_15">Fort MG, Pierce VK, Saigo PE, et al.: Evidence for the efficacy of adjuvant therapy in epithelial ovarian tumors of low malignant potential. Gynecol Oncol 32 (3): 269-72, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2920945" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2920945</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_16">Gershenson DM, Silva EG: Serous ovarian tumors of low malignant potential with peritoneal implants. Cancer 65 (3): 578-85, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2297647" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2297647</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062941_rl_12_17">Barnhill DR, Kurman RJ, Brady MF, et al.: Preliminary analysis of the behavior of stage I ovarian serous tumors of low malignant potential: a Gynecologic Oncology Group study. J Clin Oncol 13 (11): 2752-6, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7595734" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7595734</span></a>]</div></li></ol></div></div><div id="CDR0000062941__18"><h2 id="_CDR0000062941__18_">Changes to This Summary (12/17/2019)</h2><p id="CDR0000062941__19">The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.</p><p id="CDR0000062941__65"><b><a href="#CDR0000062941__21">Stage Information for Ovarian Low Malignant Potential Tumors</a></b></p><p id="CDR0000062941__66">Added American Joint Committee on Cancer as <a href="#CDR0000062941__54">reference 2</a>.</p><p id="CDR0000062941__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062941__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000062941__AboutThis_1"><h2 id="_CDR0000062941__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062941__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062941__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of ovarian low-malignant potential tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062941__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062941__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062941__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062941__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062941__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewers for Ovarian Low Malignant Potential Tumors Treatment are:</p><ul><li class="half_rhythm"><div>Leslie R. Boyd, MD (New York University Medical Center)</div></li><li class="half_rhythm"><div>Franco M. Muggia, MD (New York University Medical Center)</div></li></ul><p id="CDR0000062941__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062941__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062941__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062941__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062941__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062941__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062941__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Ovarian Low Malignant Potential Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/ovarian/hp/ovarian-low-malignant-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/ovarian/hp/ovarian-low-malignant-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389466]</p><p id="CDR0000062941__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062941__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062941__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062941__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062941__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66031.2/?report=reader">PubReader</a></li><li><a href="/books/NBK66031.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK66031" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK66031" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Ovarian Low Malignant Potential Tumors Treatment (PDQ®): Health Professional Version. 2019 Dec 17. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK66031.5/">NBK66031.5</a></span> May 1, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK66031.4/">NBK66031.4</a></span> December 22, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK66031.3/">NBK66031.3</a></span> September 3, 2020</li><li><span class="bk_col_itm">NBK66031.2</span> December 17, 2019 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK66031.1/">NBK66031.1</a></span> February 25, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062941__1" ref="log$=inpage&link_id=inpage">General Information About Ovarian Low Malignant Potential Tumors</a></li><li><a href="#CDR0000062941__21" ref="log$=inpage&link_id=inpage">Stage Information for Ovarian Low Malignant Potential Tumors </a></li><li><a href="#CDR0000062941__11" ref="log$=inpage&link_id=inpage">Early-Stage Ovarian Low Malignant Potential Tumors</a></li><li><a href="#CDR0000062941__12" ref="log$=inpage&link_id=inpage">Advanced-Stage Ovarian Low Malignant Potential Tumors</a></li><li><a href="#CDR0000062941__18" ref="log$=inpage&link_id=inpage">Changes to This Summary (12/17/2019)</a></li><li><a href="#CDR0000062941__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65806/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" 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