Ovarian Low Malignant Potential Tumors Treatment (PDQ®)

General Information About Ovarian Low Malignant Potential Tumors

Ovarian low malignant potential tumors have abnormal cells that may become cancer, but usually do not. This disease usually remains in the ovary. When disease is found in one ovary, the other ovary should also 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 work). Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Early ovarian low malignant potential tumor may not cause any symptoms. If symptoms do occur, they may include the following:

• Pain or swelling in the abdomen.
• Pain in the pelvis.
• Gastrointestinal problems, such as gas, bloating, or constipation.

These symptoms may be caused by other conditions. If the symptoms get worse or do not go away on their own, check with your doctor.

The prognosis and treatment options depend on the following:

• The stage of the disease (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
• What type of cells make up the tumor.
• The size of the tumor.
• The patient's general health.

These tumors are usually found early. However, even advanced stage ovarian low malignant potential tumors can be treated successfully. 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

The process used to find out whether abnormal cells have 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.

In stage I, the tumor is found in one or both of the ovaries. Stage I is divided into stage IA, stage IB, and stage IC.

• Stage IA: The tumor is found in a single ovary.
• Stage IB: The tumor is found in both ovaries.
• Stage IC: The tumor is found in one or both ovaries and one of the following is true:
  • abnormal cells are found on the outside surface of one or both ovaries; or
  • the capsule (outer covering) of the tumor has ruptured (broken open); or
  • tumor 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).

In stage II, the tumor 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: The tumor 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: The tumor has spread to other tissue within the pelvis.
• Stage IIC: The tumor has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and tumor 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).

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

In stage III, the tumor 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 tumor 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: The tumor has spread to the peritoneum but is 2 centimeters or smaller in diameter.
• Stage IIIC: The tumor has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.

The spread of tumor cells to the surface of the liver is also considered stage III disease.

In stage IV, tumor cells are found in one or both ovaries and have metastasized (spread) beyond the abdomen to other parts of the body.

The spread of tumor cells to tissues in the liver is also considered stage IV disease.

Ovarian low malignant potential tumors almost never reach stage IV.

Recurrent Ovarian Low Malignant Potential Tumors

Ovarian low malignant potential tumors may recur (come back) after they have been treated. The tumors may come back in the other ovary or in other parts of the body.

Treatment Option Overview

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. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer, tumors, and related conditions. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. 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.

The type of surgery (removing the tumor in an operation) depends on the size and spread of the tumor 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.Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.
• 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 lower the risk that the tumor will come back, is called adjuvant therapy.

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 cerebrospinal fluid, 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.

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

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the medical research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for disease are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way diseases will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose disease has not gotten better. There are also clinical trials that test new ways to stop a disease from recurring (coming back) or reduce the side effects of treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Some of the tests that were done to diagnose the disease may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the disease has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Ovarian Low Malignant Potential Tumors

A link to a list of current clinical trials is included for each treatment section. For some stages, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

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 U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I borderline ovarian surface epithelial-stromal tumor and stage II borderline ovarian surface epithelial-stromal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

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 U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III borderline ovarian surface epithelial-stromal tumor and stage IV borderline ovarian surface epithelial-stromal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

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 U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent borderline ovarian surface epithelial-stromal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Ovarian Low Malignant Potential Tumors

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer
• Understanding Cancer Series: Cancer
• Cancer Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer: Supportive and Palliative Care
• Cancer Library
• Information For Survivors/Caregivers/Advocates