Ovarian low malignant potential tumors: Treatment - Patient Information [NCI PDQ]

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Ovarian Low Malignant Potential Tumors Treatment (PDQ®)

General Information about Ovarian Low Malignant Potential Tumors

Ovarian low malignant potential tumor is a disease in which precancerous cells (cells that may, or are likely to, become cancer) form in the tissue covering the ovary.

Ovarian low malignant potential tumor is considered precancerous (or premalignant), a condition that may (or is likely to) become cancer. This disease seldom spreads beyond the ovary. When disease is found in one ovary, the other ovary also should be checked carefully for signs of disease.

The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
• The type of cancer.
• The size of the tumor.
• The patient’s general health.

In most cases, ovarian low malignant potential tumor can be treated successfully.

These tumors are usually found early. Most women, however, survive even advanced stage ovarian low malignant potential tumors. Patients who do not survive usually die from complications of the disease (such as a small bowel obstruction) or the side effects of treatment, but rarely because the tumor has spread.

Stages of Ovarian Low Malignant Potential Tumors

After ovarian low malignant potential tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.

The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Certain tests or procedures are used to determine stage. Staging laparotomy (a surgical incision made in the wall of the abdomen to remove ovarian tissue) may be used. Most patients are diagnosed with stage I disease.

The following stages are used for ovarian low malignant potential tumor:

Stage I

In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.

• Stage IA: Cancer is found in a single ovary.
• Stage IB: Cancer is found in both ovaries.
• Stage IC: Cancer is found in one or both ovaries and one of the following is true:
  • cancer is found on the outside surface of one or both ovaries; or
  • the capsule (outer covering) of the tumor has ruptured (broken open); or
  • cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

Stage II

In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.

• Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
• Stage IIB: Cancer has spread to other tissue within the pelvis.
• Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

Stage III

Pea, peanut, walnut, and lime show tumor sizes.

In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

• Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).
• Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.
• Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.

Cancer that has spread to the surface of the liver is also considered stage III disease.

Stage IV

In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer is found in the tissues of the liver.

Ovarian low malignant potential tumors almost never reach stage IV.

Recurrent Ovarian Low Malignant Potential Tumors

Recurrent ovarian low malignant potential tumor is cancer that has recurred (come back) after it has been treated. The cancer may come back in the other ovary or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with ovarian low malignant potential tumor.

Different types of treatment are available for patients with ovarian low malignant potential tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Two types of standard treatment are used:

Surgery

The type of surgery (removing the tumor in an operation) depends on the extent of the disease and the woman’s plans for having children. Surgery may include the following:

• Unilateral salpingo-oophorectomy: Surgery to remove one ovary and one fallopian tube.
• Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
• Total hysterectomy and bilateral salpingo-oophorectomy: Surgery to remove the uterus, cervix, and both ovaries and fallopian tubes. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
• Partial oophorectomy: Surgery to remove part of one ovary or part of both ovaries.
• Omentectomy: Surgery to remove the omentum (a piece of the tissue lining the abdominal wall).

Even if the doctor removes all disease that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any tumor cells that are left. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Ovarian Low Malignant Potential Tumors

Early Stage Ovarian Low Malignant Potential Tumors (Stage I and II)

Surgery is the standard treatment for early stage ovarian low malignant potential tumor. The type of surgery usually depends on whether a woman plans to have children.

For women who plan to have children, surgery is either:

• unilateral salpingo-oophorectomy; or
• partial oophorectomy.

To prevent recurrence of disease, most doctors recommend surgery to remove the remaining ovarian tissue when a woman no longer plans to have children.

For women who do not plan to have children, treatment may be hysterectomy and bilateral salpingo-oophorectomy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I borderline ovarian surface epithelial-stromal tumor and stage II borderline ovarian surface epithelial-stromal tumor.

Late Stage Ovarian Low Malignant Potential Tumors (Stage III and IV)

Treatment for late stage ovarian low malignant potential tumor may be hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A lymph node dissection may also be performed.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III borderline ovarian surface epithelial-stromal tumor and stage IV borderline ovarian surface epithelial-stromal tumor.

Recurrent Ovarian Low Malignant Potential Tumors

Treatment for recurrent ovarian low malignant potential tumor may include the following:

• Surgery.
• Surgery followed by chemotherapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent borderline ovarian surface epithelial-stromal tumor.

Changes to This Summary (08/02/2007)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made and images were added to this summary.

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PDQ IS A COMPREHENSIVE CANCER DATABASE AVAILABLE ON NCI'S WEB SITE.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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Date Last Modified: 2007-08-02

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