Mucinous Borderline Tumor

[Gail8247]

I am a 51 year old, mid- menapausal  - I had surgery in April 2, 2008 - a basket ball size tumor, with 9 liters of fluid was removed from my left ovary through a 14 inch incision.  While in surgery the removed  "mucinous neoplasm", was sent it to path and upon receiving the results, they then did a total historectomy, leaving nothing.  My CA-125 prior to surgery was within normal limits, which from what I have been able to find is not unusual for this type of tumor.

The Final Diagnosis Path report verified Mucinous Borderline Nuclear Grade 1 tumor - with a Pathologic Staging of pT1aNxMx (I have figured out the T1a means Limited to overies - one ovary - capsule intact -  no idea what NxMx means but would like to know - can you tell me, please)  No malignant cells in ascites or peritoneal washings.

I feel very lucky that while it was cancer, that it was caught early and was still encapsuled.  I am however concerned about the Staging, I am told that it's not unusal for Borderline Stage 1 to be mis-staged.  It has been suggested that I have the samples, and slides sent somewhere else for a second opinion.

I am told that I will be meeting with an GYN/OC in the next couple weeks (as soon as they get the appointment set up) for follow up, but that this particular GYN/OC does not do chemo for boderline tumors.  I have done alot of reading on the web and found many stories just like mine, who find out in another 4 to 6 months they have to go in for more surgery and chemo.  

Where do I go from here?  

Thank you for your expertise.

[Annekathryn Goodman, M.D.]

Hi There,
thank you for your excellent question.
N mans nodes
M means metastases

Nx means nodes not checked
Mx mean no information about spread

Borderline tumors are malignancies of the skin lining of the ovary. The term epithelium is used for the skin or surface lining of the ovary even though this lining is most definitely not skin.

Epithelial ovarian tumors can be benign, borderline, and frankly invasive.
There are several different epithelial cell types: serous, mucinous, endometrioid, clear cell, brenner's or transitional cell, and undifferentiated (clear cell and undifferentiated are usually only present in invasive cancers).

Only invasive ovarian cancers require chemotherapy as part of therapy.

It is not appropriate to give chemotherapy for borderline tumors. The reason for this is that borderline tumors grow very slowly. Chemotherapy only affects cells that are undergoing cell division at the time that the chemo is administered. So if a borderline tumor only divides once every three months, giving chemo today only causes side effects but does not affect cells that are not undergoing cell division.

the important thing about large mucinous tumors is making sure that enough of the tumor has been looked at microscopically to be sure that there is no invasive component. the gyn onc that you will meet with will probably send of the slides for review

best wishes

[Gail8247]

I have been able to determine what the NxMx means, should I be concerned they didn't check the lymph nodes?

Thanks Again
Gail

[Teresa222]

I too, would like to know what determines a doctors decision to check or not to check the lymph nodes. Does anyone know?
Teresa

[Gail8247]

I appreciate your response, it was very helpful, but have one lingering question.  I understand borderline tumors are slow - but my tumor grew from the size of a catalope to the size of a basketball in less than a month.  How can it grow so fast, and the cancer cells not?

Thanks again for your expetise.

Gail

[Annekathryn Goodman, M.D.]

Hi There
I suspect that it did not grow fast. It may not have previously been identified. However it sure is hard to look back and sort things out in retrospect.
best wishes