Serous Borderline Ovarian Tumors Flashcards
What are clinical risk factors associated with SBOT?
What are clinical protective factors?
Factors that increase risk
- Low parity
- Infertility
- HRT use
- Pelvic inflammatory disease (PID)
- ? Fertility drugs
Factors that decrease risk:
- Higher parity
- OC use
- Breast feeding
- SBOT account for __% of serous EOC
- Occur in younger or older patients?
- Stage I = ____% of patients
- SBOT account for 15% of serous EOC
- Occur in younger patients
- Stage I = 65% of patients
What is the clinical presentation of SBOT?
Symptomatology similar to invasive cancer, BUT
- Twice as likely to be asymptomatic (16% vs 8%)
- Pre-diagnostic duration longer (6 vs 4 mos)
- Twice as likely to be diagnosed at routine exam (28% vs 16%)
Physical Exam: no difference
CA 125 elevated in: 67%+
- Stage I: 59%
- Stage II-IV: 86%
What is the histologic subtype distribution of BOT?
- Serous: 50-55% (UTD say 65-70%)
- Typical vs Micropapillary
- Bilateral in 30-50%
- Mucinous: 35-45% (UTD says ~ 11%)
- Unilateral, large
- Seromucinous (formerly endocervical mucinous): 5-7%
- Brenner: 3-5%
- Endometrioid: 2-3%
- Unilateral, cystic/solid components
- Clear Cell: < 1%
Micropapillary features are present in ___% of SBOT and are associated with increased likelihood of _____ and _____.
Micropapillary features are present in 10 to 15 percent of serous borderline tumors and associated with an increased likelihood of both invasive peritoneal implants and of recurrence
Risk factors for recurrent SBOT?
Pathological:
- Micropapillary pattern
- Microinvasion: <= 3 mm or <= 10 mm2
- Presence of peritoneal implants
- Noninvasive
- Invasive (LGSC)
Clinical
- Age at diagnosis
- Baseline serum CA 125
- FIGO stage
- Residual disease
- Conservative surgery
Proportion of stage I among SBOT? MBOT?
SBOT
- 70%
MBOT
- Overwhelming majority stage I (one study was 100% - n = 15)
Serous Borderline tumor with typical pattern is classified as
APST
Serous Borderline tumor with micropapillary/cribiform pattern is classified as ________
Non-invasive low-grade serous carcinoma
SBOT mutation prevalence
- BRAF mutation?
- KRAS mutation?
- NRAS mutation?
- BRAF mutation
- 20 - 40%
- KRAS mutation
- 40%
- NRAS mutation
- 0%
What do you preoperatively counsel patients with an adnexal mass?
- Determine optimal surgical approach based on individual factors
- Regardless of patient age, always consider possibility of borderline tumor or cancer
- Consider issue of fertility-sparing surgery
- Plan for frozen-section examination
- Be prepared if discover apparent early stage borderline tumor or invasive cancer: Staging
- Be prepared if discover advanced stage borderline tumor or invasive cancer: CRS
Is laparotomy associated with worse oncologic outcomes for SBOT compared to open?
No
How do you surgical treat SBOT?
- unilateral masses?
- Bilateral masses?
- For unilateral ovarian mass:
- Ovarian cystectomy
- USO
- For bilateral ovarian masses:
- Bilateral ovarian cystectomies
- USO + ovarian cystectomy
- BSO
- Frozen section examination
- Individual decision regarding hysterectomy
- Cytologic washing should be routine
- Omentectomy should be routine
- Peritoneal biopsies should be routine
- Careful inspection & palpation with removal of abnormal areas
- Routine lymphadenectomy not recommended
What’s the recurrence risk following cystectomy for SBOT?
15 - 35%
Is there a role for LND in SBOT?
- In Serous BOT
- Frequency of LN involvement low
- No difference in OS: Lymphadenectomy vs no lymphadenectomy
- LN involvement not prognostic
- Most compelling argument for comprehensive paraaortic and pelvic lymphadenectomy is related to discordance between FS Dx and final Dx
What’s the accuracy of frozen section for BOT?
- Expertise of pathologists varies
- If FS diagnosis is BOT, about 10% of cases will have final diagnosis of invasive cancer
- Accuracy of FS much less for mucinous tumors compared to serous tumors
- If FS diagnosis is serous tumor:
- Decision regarding lymphadenectomy should be made
What’s the treatment and prognosis for stage I SBOT?
- Treatment: Surgery alone
- Outcomes:
- Serous: 99% cure
What’s the treatment and outcomes for stage II-IV SBOT?
- Treatment:
- Noninvasive implants: Surgery alone
- Invasive implants: Postoperative Therapy (CT or HT)
- Outcomes:
- Noninvasive implants: 20-35% lifetime risk of relapse as LGSC
- Invasive implants: Behaves as invasive LGSC with median OS = 90-100 mos
Treatment surveillance following FSS?
Treatment surveillance if patient has non-invasive peritoneal implants?
Fertility-sparing surgery (USO or ovarian cystectomy)
- Up to 35% recurrence in ovary (almost always SBOT)
- TV US every 3-6 months
- CA 125
Non-invasive peritoneal implants
- 20-35% lifetime risk of relapse as LGSOC
- 10% lifetime risk of persistent/recurrent SBOT
- CA 125
- CT chest/abdomen/pelvis every 6-12 months
Compare recurrence rate between SBOT with non-invasive implants vs invasive implants.
Compare mortality rate between SBOT with non-invasive implants vs invasive implants.
Recurrence rate
- 18% vs 6%
Mortality rate
- 36% vs 25%
Median time from diagnosis of SBOT to LGS?
5.6 years
Difference in outcomes between FSS vs RS for SBOT?
No difference in oncologic outcomes
