Endometrioid Borderline Tumor of Ovary

Endometrioid Borderline Tumor of Ovary

Article
Sexual Health
Women's Health
+2
Contributed byMaulik P. Purohit MD MPHMar 21, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Endometrioid Tumor of Ovary with Low Malignant Potential

What is Endometrioid Borderline Tumor of Ovary? (Definition/Background Information)

  • Endometrioid Borderline Tumor of Ovary is an ovarian tumor with low or borderline malignant potential. It is less common than other types of tumor and the causal factors are unknown
  • Tumors of the ovaries can be benign, borderline or low malignant potential (LMP), or malignant tumors. Thus, not all ovarian tumors are cancers
  • Benign tumors are not cancerous and do not spread or metastasize. Borderline or low malignant potential (LMP) tumors are usually benign, but some of them can behave like cancers. Malignant tumors are cancers that spread and metastasize
  • Endometrioid Borderline Tumor of Ovary is a slow-growing epithelial tumor that occurs as a combination of cystic and solid mass within the ovary. Some of them can be locally aggressive, meaning that the tumor may spread to surrounding areas
  • The tumor usually occurs in one ovary; however, both ovaries may also be affected. These tumors are considered to be of endometrial type based upon their appearance under a microscope
  • Endometrioid Borderline Tumor of Ovary usually presents with signs and symptoms, such as abdominal pain, vaginal bleeding, and increased abdominal girth
  • A majority of these ovarian tumors do not cause any significant complications. However, a few complications may include metastasis to local and distant organs, and side effects from cancer therapy
  • Endometrioid Borderline Tumor of Ovary is treated using a combination of chemotherapy (drugs), radiation therapy, and surgical procedures. With prompt and appropriate treatment, the prognosis is generally excellent. Metastasis of the tumor is rare

Who gets Endometrioid Borderline Tumor of Ovary? (Age and Sex Distribution)

  • Endometrioid Borderline Tumor of Ovary can occur worldwide in women of any race or ethnic group, between the ages of 22-77 years
  • Infants and young children are usually not affected
  • Though such ovarian tumors do not usually run within families, rare cases have been reported of such instances

What are the Risk Factors for Endometrioid Borderline Tumor of Ovary? (Predisposing Factors)

The risk factors, in general, for ovarian cancers include the following. Some individuals may have multiple risk factors that compound the risk for Endometrioid Borderline Tumor of Ovary.

  • Increasing age: A majority of women who are diagnosed with ovarian cancer are over the age of 55 years
  • Childbearing status: Studies have found that women, who have had at least one child before the age of 30 years, have a lower risk
  • Breastfeeding status: It has been found that women who breastfeed are at a lower risk of ovarian cancer
  • Body weight: Women who are overweight are at an increased risk of developing cancer of the ovaries
  • Genetics: Women with BRCA-1 and BRCA-2 genetic mutations have an elevated risk

Note: Studies have found that currently two mutations in the BRCA-1 and BRCA-2 genes can increase the risk. Breast cancer gene 1 (BRCA-1) and breast cancer gene 2 (BRCA-2) are inherited types of mutations. Women with BRCA-1 mutation have a 50% higher risk and women with BRCA-2 mutation have a 20% higher risk of ovarian cancer. However, it is important to note that a majority of women who get Endometrioid Borderline Tumor of Ovary do not have either the BRCA-1 or the BRCA-2 gene mutations. Also, the presence of these mutations does not mean that the individual will develop the condition.

  • Hormone replacement therapy (HRT) in post-menopausal women increases the risk for ovarian cancer
  • Family history: Women with a family history of ovarian cancer may have an increased risk
  • Past history of breast cancer, colorectal cancer, or endometrial cancer: Having a past diagnosis of these cancers increase the risk of developing ovarian cancer
  •  Smoking: Some studies have shown that long-standing smoking can increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Endometrioid Borderline Tumor of Ovary? (Etiology)

The exact cause of Endometrioid Borderline Tumor of Ovary is unknown. In some cases, genetic defects may play a role.

What are the Signs and Symptoms of Endometrioid Borderline Tumor of Ovary?

The signs and symptoms of Endometrioid Borderline Tumor of Ovary depend on a number of factors such as:

  • Size of the tumor
  • Histological type of tumor
  • Whether a single ovary or both the ovaries are involved
  • The tumor is a cystic mass or a solid mass
  • Whether the tumor produces hormones
  • Spread of tumor locally
  • Rupture of the cystic mass
  • Extent of bleeding within the tumor

Following are the common signs and symptoms associated with this tumor type:

  • Abdominal pain (the pain is usually a pelvic pain)
  • Abdominal swelling due to the mass or due to fluid accumulation in the belly (called ascites)
  • Increased abdominal girth due to fluid accumulation (ascites)
  • Persistent feeling of abdominal bloating with nausea or vomiting
  • Changes in bowel movements, such as constipation
  • Feeling full soon after eating less (having a feeling of satiety after eating less)
  • Loss of appetite
  • Weight loss
  • Fatigue, feeling tired easily
  • Frequent urination (polyuria) and difficulty while urinating
  • Frequent pain during sex (dyspareunia)
  • Abnormal menstrual bleeding

Some of the other features of Endometrioid Borderline Tumor of Ovary include:

  • Endometrioid Borderline Tumor of Ovary is a slow-growing tumor that usually presents as a single mass in the ovary
  • The nodule is typically less than 5 cm in size (along the largest dimension), however some may grow to greater sizes
  • Some cases, where this ovarian tumor grew up to 40 cm, have been reported
  • Large tumors may occasionally rupture spilling cyst contents into the belly

How is Endometrioid Borderline Tumor of Ovary Diagnosed?

The following are the diagnostic tools for Endometrioid Borderline Tumor of Ovary:

  • A thorough physical examination with particular emphasis on pelvic examination and a complete medical history is very vital
  • Complete blood count (CBC) with differential of white blood cells
  • Liver function test (LFT)
  • Blood tests called serum tumor markers that include:
    • CA-125 test
    • Human chorionic gonadotropin (HCG)
    • Alpha-fetoprotein (AFP)
    • Lactate dehydrogenase (LDH)
    • Inhibin (hormone)      
    • Estrogen levels
    • Testosterone levels
  • Exploratory laparoscopy (diagnostic laparoscopy): This is a procedure wherein the abdomen is examined using a minimally invasive technique. During this procedure, a tissue biopsy and tissue for culture are performed. A minimally invasive approach helps decrease the complications and length of stay at the hospital. A diagnostic laparoscopy is also helpful in the staging of the tumor
  • A tissue biopsy of the tumor: A tissue biopsy is performed and sent to the laboratory for pathological examination

A pathologist examines the biopsy under a microscope. After putting together the clinical findings, special studies on tissues (if needed), and the microscope findings, the pathologist arrives at a definitive diagnosis. Sometimes, the pathologist may perform special studies that may include immunohistochemical stains, histochemical stains, molecular testing, and very rarely, electron microscopic studies. Examination of the biopsy under a microscope by a pathologist is considered to be the gold standard in arriving at a conclusive diagnosis.

Radiological imaging studies such as:

  • X-ray of the abdomen and pelvic region
  • Barium enema x-ray
  • CT scan of the abdomen and pelvic region
  • MRI scan of abdomen and pelvic region
  • Ultrasound scans of the pelvic region; usually transvaginal ultrasonography (TVS) and abdominal ultrasound scans are performed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Endometrioid Borderline Tumor of Ovary?

The complications due to Endometrioid Borderline Tumor of Ovary may include:

  • There may be a rapid growth of the tumor which may cause the fast-growing tumor to invade into surrounding tissues causing tissue damage. However, distance metastasis of the tumor from its primary site is not very common (even though it can occur)
  • Recurrence of the ovarian tumor after surgery
  • There may be side effects from the chemotherapy (such as toxicity) and radiation therapy administered

How is Endometrioid Borderline Tumor of Ovary Treated?

The treatment for Endometrioid Borderline Tumor of Ovary may include any of the following - chemotherapy, surgery, or radiation therapy. In most cases, a combination of chemotherapy (drugs), radiation therapy, and surgical procedures is employed by the healthcare provider to treat the condition. In many cases, a complete excision of the tumor, usually results in a cure.

  • The surgery may involve a total abdominal hysterectomy (complete removal of the uterus), removal of both the ovaries and fallopian tubes (called bilateral salpingo-oophorectomy, omentectomy (removal of fat around the intestines), biopsy of lymph nodes within the abdomen, or the removal of other tissues in the pelvis and abdomen as needed
  • If the tumor is present in only one ovary, then the surgeon may perform a procedure called unilateral salpingo-oophorectomy. In this procedure only the affected ovary and fallopian tube are removed; the uterus is not removed (there is no hysterectomy performed). The unaffected ovary and fallopian tube is also not removed
  • If the tumors are not completely removed, then they may recur after a period of time. Hence, it is important to completely remove them through surgery, if possible
  • Post-operative care is important: A minimal physical activity is advised, until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important (to monitor the status of the tumor)

The healthcare provider will determine and plan the best course of treatment on a case-by-case basis.

How can Endometrioid Borderline Tumor of Ovary be Prevented?

The cause of Endometrioid Borderline Tumor of Ovary is unknown. Hence, there are no known methods to prevent the tumor occurrence.

  • Early diagnosis with close monitoring and treatment of the tumor is important. A timely tumor recognition and prompt treatment will help in having optimal outcomes
  • Due to its metastasizing potential and chances of recurrence, regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations are often needed
  • The US Preventive Services Task Force (USPSTF) currently does not have any recommendation for screening against ovarian cancer for the general population. Tests such as blood serum CA125 level or trans-vaginal ultrasonography are not really helpful as screening tools
  • The National Cancer Institute (NCI) recommends that women who are at high risk for ovarian cancer take regular (annual) examinations. The healthcare provider may perform studies such as ultrasonography examinations and CA125 testing as part of one’s annual physical examination

What is the Prognosis of Endometrioid Borderline Tumor of Ovary? (Outcomes/Resolutions)

  • The prognosis of Endometrioid Borderline Tumor of Ovary is excellent with treatment (despite the fact that the tumor may be present in different parts of the abdomen in some cases)
  • The presence of implants (metastasis) in the abdomen or pelvis does not necessarily imply a bad prognosis
  • In general, tumors that have a lower stage, have a better prognosis than tumors that are staged higher

Additional and Relevant Useful Information for Endometrioid Borderline Tumor of Ovary:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/womens-health/

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On the Article

Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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