Borderline Cancer

[Maidey]

I am a 53 year old who recently had a complete hysterectomy after a suspicious cyst was found on my left ovary. Initially they started with a laparoscopy, but in seeing my right ovary, felt that there was more involvement and a complete hysterectomy was warranted. Biopsies of my organs(ovaries, cervix, uteraus, aorta, abdomen, bowel, etc.)were also taken.  The original hospital pathology came back with a diagnosis of both borderline and invasive cancers.  My case was sent to another hospital and oncologist, who redid the pathology and found only borderline cancer.  My original doctor has offered to send my pathology and reports to Mass. General, which I will be requesting.  We are most concerned by the fact that the original abdominal biopsy came back as invasive cancer along with the other biopsies from the first hospital.  In trying to educate myself, it seems that borderline cancer is only associated with ovarian cancer, so how is my abdominal biopsy explained as borderline?  I have tried to find clear information on borderline cancer, biopsy discrepancies and abdominal cancer possibilities.  Can you explain any of these ambiguities and advise websites or other avenues for us to pursue?  Should we just have our slides and reports sent to Mass General or should we be seen by an oncologist? Should we be having further tests on my abdomen? Thank you for your expertise, time and help.  Maidey

[Annekathryn Goodman, M.D.]

Dear Maidey,
I apologize for my delay in responding. Just to summarize your experience:
-You underwent the removal of your uterus, right and left tubes and ovaries, staging biopsies.
-The pathology showed an ovarian neoplasm on the ? right ovary and the abdominal wall? Were any of the other specimens involved?
-You have two different pathology reports - one suggesting you have both a borderline and invasive ovarian tumor, and a second opinion that all the involved specimens have only borderline tumor.
Is that right?

I strongly recommend a third opinion for the pathology reports. Borderline and invasive cancers are treated very differently. Borderline ovarian tumors are malignancies that have the potential to metastasize and to recur. However, borderline tumors are treated by surgical excision. It is rare to consider chemotherapy. An invasive ovarian cancer is treated by surgical excision followed by chemotherapy.

The diagnosis of borderline is made when the tumor cells are "noninvasive". That is they do not penetrate other tissues (or invade other tissues). The abnormal cells sit on the surface of the ovary.  The confusing part is that when borderline tumors spread off the ovary of metastasize, the areas of metastasis (called implants) can look "invasive" or growing into the tissue. It is important for your slides to be reviewed by pathologists who have seen alot of this type of tumor.

I would recommend that you also meet with a gyn oncologist to help guide you through this confusing information.
best wishes to you