Borderline ovarian tumours: Current concepts and management

Since borderline ovarian tumours came into light in the early 1970s, they continued to present a challenge to doctors and patients equally. The majority of affected women present with an early stage disease, and they are usually 10-15 years younger than those with ovarian cancer. Most ovarian borderline tumours are either serous or mucinous. In general, borderline ovarian tumours have a very good prognosis; however, this is much dependant on the histological subtype, disease stage and the presence or absence of invasive implants. The micropapillary serous pattern is often associated with invasive implants and unfavourable outcome; this emphasises the importance of adequate surgical staging as a prognostic indicator. Mucinous borderline ovarian tumours demonstrate an overwhelmingly benign course. It is now established that cases of pseudomyxoma peritonei are all related to gastrointestinal primary either occult or obvious. So far, no pre-operative test can identify ovarian cyst as borderline with a high degree of certainty. Therefore, maintaining a high index of suspicion, arrangement for frozen section and thorough examination of the abdominal cavity are indispensable, as well as adequate counselling. Conservative surgery in younger patients with stage I disease is a reasonable option; fertility outcome is favourable, however, there is a relatively higher risk of recurrence. This option can even be considered in advanced stages but without invasive implants; fortunately most recurrences can be salvaged surgically. It is now well established that patients with treated stage I disease do not required any adjuvant chemotherapy in view of the excellent long term survival of nearly 100%. Prospective trials are needed for those with advanced stage especially in the presence of invasive implants before a conclusion can be reached. Regular follow up is necessary for early detection and successful management of recurrences, particularly in those who were inadequately staged, managed conservatively or demonstrate high risk histological features.