Atypical proliferative serous (borderline) tumor

[Lovestorun]

I had a TAH, BSO, and omentectomy 4 weeks ago.  I had APST on both ovaries, both fallopian tubes, the uterus, omentum and bladder.  I also had positive pelvic washings.  The APST arose from a cystadenofibroma from the right ovary.  There were numerous omental implants.  The tumor on my bladder is still there.  The pathology was sent to John Hopkins and it came back noninvasive.  What are the changes of this recurring, esp since the bladder tumor is still present.  

This is what the pathology report states, "Portion of omentum - numerous noninvasic implants of atypical proliferative (borderline) serous tumor.  Right ovary and fallopian tube - APST arising within a serous cystadnofibroma, 8.5 cm in maximal dimension comlex mass involving right ovary, with extensive surface involvement. Noninvasive implants involve the bilateral adnexal/paratubal soft tissue, surface of left ovary and uterine serosa.

The reason this was even found was because my doctor stated something was going on with my urine.  I had RBC's and WBC's, negative nitrates, slight bacteria.  I was on antibiotics for 11 days with little change.  I was sent to a urologist who did a CT scan, and the abnormalities started to show up.

The APST is still on my bladder.  How can we be sure this is noninvasive?  I am concerned because of the abnormal urinalysis.  Can this continue to spread?  How in the world did I end up with so much of it?  I am 50 years old and really didn't have any symptoms other than developing severe left flank pain about 5 months ago.  Do I need to followup with a gyne oncologist?

I also have been slightly queazy in my stomach for about 5 months.  I have not mentioned this as I'm not sure it's related. It comes and goes, but I usually have this a few times a week.

My brother was dx'd with stage 4 colon cancer at the age of 43.  I had a colonoscopy 2 years ago which was fine.  I am 50 yrs old.

Thanks for your help.  I greatly appreciate it.

DC

[Lovestorun]

A related discussion, follow  up was started.

[Annekathryn Goodman, M.D.]

Thank you for your response.
The CA 125 will be a good tool to follow up
please keep in touch

[Lovestorun]

Thank you for your response. It has helped.  This has been so confusing. My gyne told me it was benign and would not recur but wants me to see a gyne oncologist because there was so much of it.  I have an apt on Wednesday, and because of your note, I am going to seek a second opinion as well, regardless of what the gyne onc tells me.  This seems to be an area where opinions vary, much to my dismay.

It is reassuring that these are slow growing.  I am concerned about my stomach and will mention that to the doctor on Wednesday, and also about the abnormality in the UA and if that is an indication that the bladder tumor has turned invasive.

By the way, I forgot to mention that my CA-125 was 220 about 8 weeks prior to surgery, and then dropped to 130 about 4 weeks prior to surgery.

It also amazes me that this has spread so much because I had yearly exams with my gyne and am surprised he didn't find it sooner.  He actually did a transvaginal US about 3 yrs ago and didn't see it and never mentioned it on exam.

Thanks again.  You are straight forward and I appreciate that.

DC

[Annekathryn Goodman, M.D.]

Dear DC,
thank you for your question.
No one really understands why tumors of various types grew and develop.  Your tumor is a low grade malignancy.
that means, it is slow growing and it is malignant.
By malignant : it has the properties of spreading and recurring.

Unlike invasive ovarian cancer which is rapidly growing and is treated with both surgery and chemotherapy, borderline tumors are treated by surgery alone.Because it is so slow growing, it is not killed by chemotherapy.

You have a stage 3 borderline tumor (involvement in the upper abdomen).
Many advanced borderline tumors are completely cured and never recur after the majority of the tumor is surgically removed.Other women with borderline tumors which have spread like yours experience tumor regrowth or even a transformation into the more aggressive invasive cancer.

We do not have sophisticated enough tools to be able to predict behavior based on available information.

You have received the best treatment. It would be ill advised to consider chemotherapy at this time.
The standard recommendation is close check ups: exams, CA 125 blood work, CT scans.

There are some women where because of concern about residual tumor get a repeat laparoscopy in 6 months to check inside the abdomen.

I know it is spooky to go through what you have just experienced.  There is a really high likelihood that you will be fine .

With your family history, you should consider genetic testing and also a colonoscopy.
best wishes