Serous Borderline Tumor - staging surgery?

[rainsunshine]

I had a paratubal cyst (near the fimbriated end) removed Nov 7th, 08. NO frozen section during the procedure. The cyst was thought to be benign even after the surgery.

I got the pathology report last week and it is Borderline Tumor.

Serous Borderline Cystic Tumor. Capsule is Intact.

Grade 1/3
Location: left ovary
Size: 2.4*2.2*1.2
Tumor on external surface: negative
Tumor capsule: received with intact wall
Extent: limited to ovary
Lymphatic channel/ vascular invasion: negative

My questions are:

1. The surgery was done by an ob/gyn...the procedure is cystectomy only and no sample of other organs...should i consider a complete staging surgery by a gyn-oncologist to make sure everything else is ok?

2. Is there any way to tell if this is LMP or the other more serious kind? What does Grade 1/3 mean? Should I get a second opinion for the pathology report?

3. Is paratubal tumors different than overian tumors?

4. Is it true patients treated by cystectomy were 3 times more likely to recur than those treated by oophorectomy?

5. Is it safe to have a baby? If it recur when I am pregnant, it will be a complicated situation.

6. My Dr. recommend a 6 month follow up schedule: ultrasound and CA125. Do you think I should insist a more frequent follow up?

Sorry i have so many questions. I am really anxious…I am waiting for your reply ..thanks so much for your help.

[Annekathryn Goodman, M.D.]

Hi There,
thank you for your complete information. You have had good care and you are going to be ok. Here are my answers to your questions:

1. The surgery was done by an ob/gyn...the procedure is cystectomy only and no sample of other organs...should i consider a complete staging surgery by a gyn-oncologist to make sure everything else is ok?

You can see a gyn onc for a second opinion. We usually like to review the pathology to be sure we agree with the diagnosis. We usually would not recommend full staging until you have completed your family

2. Is there any way to tell if this is LMP or the other more serious kind? What does Grade 1/3 mean? Should I get a second opinion for the pathology report?  YES

3. Is paratubal tumors different than overian tumors? YES

4. Is it true patients treated by cystectomy were 3 times more likely to recur than those treated by oophorectomy?  YES

5. Is it safe to have a baby?  YES
If it recur when I am pregnant, it will be a complicated situation. NO

6. My Dr. recommend a 6 month follow up schedule: ultrasound and CA125. Do you think I should insist a more frequent follow up?  NO, that sounds just right

best wishes

[grafel]

A related discussion, atypical proliferative serous tumor was started.

[rainsunshine]

A related discussion, Borderline Tumor - second opnion was started.

[Annekathryn Goodman, M.D.]

Hi There,

Thank you again for your excellent questions.
I am a little confused by the story you heard.

a primary lung cancer has a particular microscopic appearance. This appearance is quite different from an ovarian cancer.  

The ovary can be a location of metastatic disease. The most common cancer to spread to the ovary is endometrial cancer (from the lining of the uterus) and colon cancer.  Rarely, a very advanced lung cancer can travel to many other sites (usually bone, brain, and liver) including the ovary.

However, all these other cancers have a very distinct microscopic look and would not be confused with a borderline ovarian cancer  (that would be like looking at a flower that is a rose and mistaking it for a tulip)

This unfortunate person developed a lung cancer.  Unfortunately lung cancer has become the leading cause of cancer death in women who smoke.

As a public service announcement to anyone who smokes - PLEASE STOP

best wishes

[rainsunshine]

Thanks for your response Dr. Goodman!

I heard something really sad yesterday and I became very worried about my situation.
Someone who was diagnosed borderline ovarian tumor 3 years ago just found out that she has late stage Lung cancer and the tumor diagnosed 3 years ago was neither borderline nor originated from the ovaries. The scary part is: she has had only minor symptoms (occasional coughing) that nobody even paid attention to.

I felt sorry for her and can't help but wondering: How do we know if ovarian borderline tumors are primary? Can we tell for sure from the pathology reports?

Is staging surgery the only way to find out if I have peritoneal implants? What does PET scan do? Do you think it is a good idea just for peace of mind?

What is the treatment protocol for borderline tumor with implants?

I am so confused and scared....please help! Thanks so much!
rs

[Annekathryn Goodman, M.D.]

hey there
it looks completely confined to the inside.
You are in good shape
take care

[rainsunshine]

Thanks Dr. Goodman!

I have got a second opinion for the pathology report.  It agrees with the first diagnose: Serous borderline tumour.

I am still very worried and have some questions:  

1. The tumour is Un-staged as no staging was done.  Other organs “looked” fine in the laparoscope surgery, but no sample was taken, no lymph node, and my uterus fibroid (around 2.8cm*2.8cm) was untouched. I know it is kind of a dilemma as I still want to have a baby, and staging surgery will affect my fertility….but the uncertainty is absolutely killing me…Am I putting my health and long-term wellbeing at risk by preserving my fertility? I would rather try other options (adopting, etc) if the risk is too high. Please let me know your thoughts.

2. I remember reading another post of yours mentioning different staging borderline tumors have very different probability of recurring…with stage 1 has very low probability to recur and stage 3 has a much higher probability to recur….now that I don’t having staging done…am I missing the best opportunity to treat the disease? Will it be too late if i try to have a baby now and wait and see how it progress?

3. Is there any way to tell/predict the staging from my current path report below? What does Grade 1/3 mean? Is it related to staging?

Serous Borderline Cystic Tumor. Capsule is Intact.

Grade 1/3
Location: left ovary
Size: 2.4*2.2*1.2
Tumor on external surface: negative
Tumor capsule: received with intact wall
Extent: limited to ovary
Lymphatic channel/ vascular invasion: negative

Thanks so very much I am really grateful for your help.
RS

[Annekathryn Goodman, M.D.]

Hi There  - here are some thoughts:

1. How are paratubal tumors different than overian tumors? Are they more likely to recur or less...what are the prognosis for paratubal tumors?

Paratubal means next to the tube. In and of itself what is important is how the tumor looks microscopically (borderline versus invasive cancer)  and not so much where it is

2. if patients treated by cystectomy were 3 times more likely to recur than those treated by oophorectomy. should i choose to do oophorectomy now? Sitting around doing nothing and waiting for the tumor to come back makes me feel extremly nevous.


You absolutely can choose to have the whole ovary removed but that will reduce your fertility

3. If it recur, what is the likelyhood to be Malignant?

there is a small chance but more commonly it will be a borderline tumor again

4. If it recur when i am pregnant, can i remove the tumor and not affecting the baby?

for a slow growing tumor like a borderline, I would wait until after your baby is born and then remove the whole ovary

best wishes

[rainsunshine]

Thank you so much Dr. Goodman. I was trying to do some borderline related reserch since my diagnos....There are very limited info avaiable and lots of them are contradictory. You have no idea what it means to me to get my questions answerd by an expert like youself.

It would be very much apprecited if you could take a look at a couple of follow up questions:  

1. How are paratubal tumors different than overian tumors? Are they more likely to recur or less...what are the prognosis for paratubal tumors?

2. if patients treated by cystectomy were 3 times more likely to recur than those treated by oophorectomy. should i choose to do oophorectomy now? Sitting around doing nothing and waiting for the tumor to come back makes me feel extremly nevous.

3. If it recur, what is the likelyhood to be Malignant?

4. If it recur when i am pregnant, can i remove the tumor and not affecting the baby?

Thanks again! Happy holidays to you and your family!

rs