Gynaecology: Borderline ovarian tumours

Borderline ovarian tumours are abnormal cells that form in the tissue covering the ovary. They are not cancer and are usually cured with surgery.

Around 15 out of 100 ovarian tumours (15%) are borderline tumours. They are also described as atypical proliferative tumours and often referred to as tumours of low malignant potential.

They are different to ovarian cancer because they do not grow into the supportive tissue of the ovary (the stroma). They tend to grow slowly and in a more controlled way than cancer cells.

Borderline tumours usually affects individuals aged between 20 and 40. They are usually diagnosed at an early stage. This is when the abnormal cells are still in the ovary.

Sometimes some abnormal cells break away from the tumour and settle elsewhere in the body. This is usually the abdomen. Very rarely do they start to grow into the underlying tissue.

The main treatment for borderline tumours is surgery. Most Individuals are cured and have no further problems. There is a small risk of the tumour coming back. Very rarely, the borderline tumour cells change into cancer cells.

Small borderline tumours do not usually cause symptoms. Doctors might find the tumour while you are having tests for something else. Larger or more advanced borderline tumours might cause symptoms.

Symptoms can include:

• pain or a feeling of pressure in the tummy area (pelvis or abdomen)

• a swollen abdomen

• pain during or after sex

• vaginal bleeding not related to your period

Staging shows the size of the tumour and whether it has spread. Doctors use the same staging system for borderline tumours as for ovarian cancer. There are 4 stages, from 1 to 4:

• stage 1 is the earliest stage where the borderline tumour is within the ovary

• stage 2 generally means the abnormal cells have spread within the pelvis, for example to the womb, fallopian tubes, bladder or the back passage (rectum)

• stage 3 means the cells have spread outside the pelvis into the abdominal cavity

• stage 4 is the most advanced. It means the cells have spread to another part of the body, such as the lungs

Most Individuals have a stage 1 borderline ovarian tumour.

Types

There are different types of borderline ovarian tumours.  Around 50 out of 100 borderline tumours (around 50%) are serous type, and around 45 out of 100 borderline tumours (around 45%) are mucinous type.  

Other rare types include:

• endometriod

• clear cell

• seromucinous

• borderline brenner tumours

For many Individuals, surgery involves removing:

• both ovaries and fallopian tubes

• the womb, including the cervix

 This operation is called a total abdominal hysterectomy (TAH) and bilateral salpingo oophorectomy (BSO).

Your doctor (gynaecological oncologist) may remove just the affected ovary and fallopian tube if:

• the tumour is only within the ovary

• you plan on having children in the future

During the operation your doctor will look closely at the inside of your pelvis and abdomen. They will take samples. This is to check for any signs that the tumour has spread.

They might also remove part of the fatty tissue close to your ovaries called the omentum.

If you have a mucinous type of borderline ovarian tumour, your doctor might also remove your appendix. This is because mucinous tumours can sometimes start in the appendix. And then spread to the ovary.

Most people are cured with surgery. If a borderline tumour does come back, you may have more surgery. Your doctor will talk to you about the type of surgery you need.

We have information about having a hysterectomy and your recovery afterwards in the ovarian cancer section. Remember this section is about ovarian cancer. Some of the information may not be relevant.

Follow up appointments are to check how you are and whether you have any problems. You might have scans to check if the tumour has come back. Most borderline ovarian tumours do not come back.

Once you have fully recovered from surgery, you will be followed up by the Clinical Nurse Specialist (CNS) team for 5 years. It may be possible that you can go into PIFU (Patient Initiated Follow up) .This depends on your pre-surgical tumour marker (CA125).

At the moment, there is no clear evidence on what the best follow up is. How often you have follow up appointments, and for how long can vary.

Being diagnosed with a borderline ovarian tumour can be a confusing and difficult time. It is usual to feel a wide range of emotions. Talk to your doctor or gynaecology specialist nurse about how you are feeling. They can also help to answer any questions you might have.

Contact details

CIC - Julie Thomas CNS 07766524805 and Sian Storey CNS 07816 199654

WCH- Lisa Lowe CNS 01946 523234 or 07816199713

Reference – Cancer Research UK   Cancer Research UK

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