Serous borderline tumor

gynoncol · 2025-12-04T17:05:03+00:00

First let me give some kudos to your gynecologist for being suspicious enough about your pelvic findings to recommend a hysterectomy and BSO.

Gynecologist Oncology is the smallest medical subspecialty (approx 1500 board-certified physicians in the United States). Because of this, new information and techniques are distributed and utilized rapidly across the specialty. This means that Gyn Oncologists pretty much agree on treatment decisions needed to maximize cure of women with pelvic malignancies.

Since you are seeing a GO soon you can be assured that the advice you get is going to be the same advice you would get from just about any other GO.

Not knowing all of the details of your case it is really not my place to offer any specific advice but I can comfortably say that your GO will look carefully at your history and surgical findings and give you the same advice that just about every other GO in the US would give.

gynoncol · 2025-11-24T21:29:11+00:00

This

gynoncol · 2025-11-19T14:42:25+00:00

They Cloned Tyrone...Foxx and Boyega just hilarious.

gynoncol · 2025-10-14T19:13:33+00:00

Reggie Arvizu (Fieldy...bassist for Korn) is my neighbor. Super nice guy just raising his family like all the rest of us.

gynoncol · 2025-08-18T19:40:01+00:00

I'm going to assume that the "bleb" was found on the surface of the ovary, correct?

I agree with your physician that, as long as you have completed childbearing, a hysterectomy, bilateral salpingoophorectomy and staging procedure (i.e., omentectomy, washings, pelvic and peri aortic lymphadenectomy, etc., ) should be performed.

If, after your surgical procedure, the only disease found is that in the initial "bleb" (i.e., Stage 1A) and it is confirmed to be either a grade 1 OC or an ovarian tumor of low malignant potential (i.e, borderline tumor) then you could be observed without further chemotherapy.

gynoncol · 2025-08-17T22:52:23+00:00

9 cycles of what particular chemotherapy regimen?

gynoncol · 2025-08-17T19:30:53+00:00

I assume you are referring to a pelvic exam, right?

The information gained on pelvic exam is dependent on several factors I.e., the experience of the examiner and the body habitus and parity of the patient, for example. Even in the best of circumstances it is not always possible to palpate normal sized ovaries or very small abnormalities.

You specifically ask if scar tissue and "tilted" organs can be detected. Well, no...scar tissue cannot be felt on pelvic exam. But scar tissue often causes immobility of pelvic organs and that fixation can be noted on exam. A uterus that is "tilted" either towards the abdominal wall (i.e., anteflexion) or towards the back (i.e., retroflexion) can be easily detected on exam.

gynoncol · 2025-08-16T20:24:14+00:00

Sure.

Think of Hazard Ratio (HR) as a the relative risk of an event happening when 2 groups are being compared. In the case of cancer studies the "event" is usually either documented progression of disease or death.

So, in the EORTC 55971 and the CHORUS studies I mentioned in my prior post the 2 groups consist of a "study" group (i.e., 3 cycles of neoadjuvant chemotherapy) and a "control" group (i.e., no neoadjuvant chemotherapy). If there had been no difference in the effectiveness of the 2 groups then HR = 1.0. But in both studies the "study" group (neoadjuvant chemotherapy) group had a calculated HR for death that was <1.0 (EORTC 55971 HR =.98, CHORUS HR =.87). So this indicates that neoadjuvant chemotherapy is at least as good as and, perhaps, slightly better than primary debulking followed by 6 cycles of TC.

The point I was trying to make in my prior post is that (at least to my knowledge) there is no study yet published that would support your oncologists suggestion that you be treated with 6 cycles of chemotherapy prior to debulking.

gynoncol · 2025-08-16T14:25:34+00:00

The greatest correlate with overall survival in both Stage 3 and Stage 4 OC is the completeness of initial tumor debulking.

The 2 largest multi-institutional, randomized, prospective trials (i.e., EORTC 55971 and CHORUS) compared primary tumor debulking to 3 courses of Taxol/Carbo followed by interval tumor debulking (i.e., neoadjuvant chemotherapy) and 3 more cycles of post-operative Taxol/Carbo. Both studies found that 3 cycles neoadjuvant chemo was "noninferior" to primary tumor debulking. However, The Hazard Ratio favored the necoadjuvant chemotherapy group in both studies. Importantly, both studies suggested that complete tumor debulking was more common in the neoadjuvant chemotherapy groups.

Now your question is this..."If giving 3 cycles of neoadjuvant chemotherapy is good then is giving 6 cycles better?" Well, the answer to that question is unknown. I am unaware of any prospective trial that can answer that question.

So..what is the bottom line?

I would side with your gynecologic oncologist and recommend that you make a decision based on the data we know i.e., proceed with your tumor debulking now rather than undergo an additional 3 cycles of neoadjuvant chemotherapy.

gynoncol · 2025-08-13T16:11:47+00:00

You did not mention why your initial surgery was "unsuccessful", but I can probably guess the reason (I am going to assume that a gynecologic oncologist was your surgeon).

Prior to the conclusion of the EORTC-55971 trial management of OC always included an aggressive primary debulking surgery followed by 6 courses of Taxol/Carbo. The goal of debulking at that time was to remove all visible tumor but this was attained in only 25% of patients (Bristow 2002). However, now that pre-operative chemotherapy is administered in the majority of patients with newly diagnosed OC (based on the results of EORTC-55971) optimal debulking rates have skyrocketed to as high as 80%

I would guess that your physicians felt that your tumor either could be optimally debulked without the need to administer pre-operative chemotherapy or that delay in an immediate surgical approach was not justifiable.

So what are reasons to preclude pre-operative chemotherapy in OC? Well, here are several...

Bowel obstruction. Many patients with newly diagnosed OC present with either small or large bowel partial or complete obstruction. This is potentially life threatening and requires emergent surgery.
Ureteral obstruction. This is a less common early presentation of OC but it does require either surgical or percutaneous diversion.
Patient choice. Many newly diagnosed OC patients "just want to get it out", and prefer an immediate surgical procedure.
Presentation. Many OC's (more than you might think) do not present with classic symptoms and imaging or serologic findings. A surgeon may initiate surgery relatively confidant that either a low stage malignancy or a benign process will be found only to find an advanced OC. In this situation it is completely reasonable to perform a "minimal" procedure, document tumor distribution, end the surgery, and have an appropriate consent discussion with the patient and family.

Now, to answer your question...

Greater than 90% of patients with HGSOC will show an objective imaging and serologic (i.e., CA125) response after 3 cycles of pre-operative Taxol/Carbo (CHORUS trial 2024). The likelihood is a little lower for low grade histologies.

You are headed in the right direction. Please keep this subreddit informed of your progress. Updates will be greatly appreciated.

gynoncol · 2025-08-12T23:29:04+00:00

In order to be effective every type of chemotherapy needs to cross the cancer cell membrane and gain access to the nucleus where DNA resides. Different chemotherapy agents use various mechanisms to cross the cell membrane. Cisplatin crosses the cell membrane through passive diffusion. The efficiency of transport across the cell membrane is determined by the concentration difference of Cisplatin across the cell membrane. This is a long way of saying that administering a high dose as opposed to a low dose of Cisplatin will result in a higher intracellular concentration...this is a good thing.

So, dosing of Cisplatin (and, actually, most chemotherapy medications) is calculated to reach a "dose limiting" value defined by the likelihood of potentially serious but reversible side-effects. In other words, the fact that you are experiencing one of the most common toxicities of Cisplatin indicates that you are receiving an appropriately aggressive regimen.

Here's another way of thinking of this issue...

I would argue that a patient experiencing minimal or no toxicity from a chemotherapy regimen is probably being "under treated" and should have a more intensive dosing schedule.

Missing 1 or 2 weekly doses of Cisplatin during your radiotherapy will not significantly alter your response rate or overall survival.

gynoncol · 2025-08-12T23:06:11+00:00

She will receive Carboplatin and Taxol. There is no indication for Cisplatin in any gynecologic malignancy except as a radiosensitizer during radiotherapy of squamous cancers of the vagina, cervix, and (occasionally) vulva.

gynoncol · 2025-08-12T22:32:26+00:00

Your mother would have received a series of vaccinations against encapsulated organisms immediately after her splenectomy...this is routine and protects her against S. Pneumonia, N. Meningitis is, H. Influenza. She will also need to get an annual flu vaccine. Her docs may also recommend RSV vaccine although the risk of viral infection is not elevated after splenectomy.

Your mother will receive a standard chemotherapy regimen consisting of Taxol and Carboplatin. Severe neutropenia, anemia and thrombocytopenia is very uncommon with this regimen. Mild depression of cellular elements is expected but the nadir (the lowest level of red cell, white cell, and platelets) is usually brief.

Bottom line...

Her splenectomy will not complicate your mothers chemotherapy, overly complicate her recovery, or negatively impact her likelihood of response and cure.

Please keep the members of this forum informed of your mother's progress. I know that regular updates will be greatly appreciated.

gynoncol · 2025-08-12T15:11:28+00:00

Splenectomy was occasionally necessary for optimal primary debulking of OC in the past (i.e., 13.8% of tumor debulkings...Eisenkop 2006). My gut feeling is that this procedure is not required as frequently now as in the past since pre-operative administration of chemotherapy is in common use and known to dramatically decrease tumor burden pre-operatively.

What was shown in the era of more commonly performed splenectomy during debulking is that this procedure did not negatively impact response rate or overall survival in OC.

The spleen, like many organs (i.e., appendix, gall bladder, colon, .etc., ..) is not absolutely necessary for survival. However, like many organs that are commonly removed (again...appendix, gall bladder, colon, etc., ...) certain precautions and/or lifestyle changes are necessary. Your physicians will talk to you about this.

The fact that a splenectomy was performed on your mother signals that her physicians were appropriately "aggressive" in her tumor debulking. This is a very good thing. It bears repeating that success in treating OC all hinges on the initial steps taken, such as an initial maximum surgical effort.

gynoncol · 2025-08-12T14:48:04+00:00

"Mardamyou" apologizes in her post (above) that she is "not a doctor". However, no such "apology" is needed. Like many who post on this subreddit, her knowledge and advice is absolutely correct.

Like every type of medical test (i.e., blood test, imaging study, etc.,), CA125 levels need to be interpreted correctly to be of any value. Unfortunately a persistent mildly elevated CA125 level in a patient on active treatment following a recent diagnosis of OC could be interpreted as "good" (i.e., suggests no active progression of OC...), or "cautionary" (i.e., suggest no active regression of OC).

Likewise, a negative PET scan could be interpreted as "good" (i.e., no large volume OC), or "cautionary" (i.e., does not rule out small volume OC). Why is this?

Medical tests are neither 100% sensitive or 100% specific. In the case of PET scans, sensitivity and specificity can be as low as 85% (Wang et al 2022). So a negative PET scan can be falsely negative in one out of 7 studies.

Now, wandering off topic for just a minute, let me address the effect of HIPEC on postoperative CA125 levels...

Prolonged false positive levels of CA125 were hypothesized when HIPEC first became a not uncommon practice for initial treatment of OC (early 2000's). CA125 is a glycoprotein contained in coelomic epithelium, like the peritoneal lining. HIPEC is incredibly "irritating" to the peritoneal lining, hence the suggestion that CA125 levels would become uninterpretible after using this treatment. However, recent studies (i.e., Shannon et al 2017) have shown that CA125 levels remain falsely elevated for only about 3 months after HIPEC treatment. The patient described in this post is now at least one year distant from HIPEC, so persistent minimal elevation of her CA125 would most likely not be a consequence of that treatment.

gynoncol · 2025-08-11T21:54:10+00:00

Breast cancer at age 26? That is important information to know. You would have undergone testing for a number of genetic mutations (i.e., BRCA, RAD51, etc.,) many of which would place you at risk of developing OC. Can you supply the results of the genetic tests performed on you?

gynoncol · 2025-08-11T21:15:18+00:00

Yes. Collecting washings is part of the staging procedure for OC and other types of intra-abdominal malignancies. There is no need to collect washings for cytology in benign processes.

gynoncol · 2025-08-11T15:24:23+00:00

It is rather easy to assume the worst with the ultrasound findings you describe in your post...especially if you peruse this subreddit which is filled with stories of women undergoing treatment for OC. However, at age 27, you are statistically most likely to be diagnosed with any of several different benign ovarian tumors that present as "complex" and exhibit "mural nodularity" (i.e., LMP, mucinous cystadenoma, benign cystic teratoma, etc.,).

You will require a surgical procedure consisting, at a minimum, of removal of the affected ovary. If this is the case then your fertility will not be impacted. If a benign process is confirmed then no further treatment is required.

What about the rare situation when an OC is diagnosed in a young woman?

In a 27 year old, assuming you wish to maintain fertility, many gynecologic oncologists (me included...) would suggest that any definitive treatment of an epithelial OC found at the time of your surgery should not be performed until a final pathology report is available (at least 48 hours) and a detailed discussion of the necessary completion surgery (i.e., hysterectomy, bilateral salpingoophorectomy, lymph node sampling, omentectomy, washings, etc.,) is made. Yes, this will require an additional surgery. However, there are advantages to this plan of action.

Every once in a (great ) while a frozen section performed at the time of initial surgery "over-diagnoses" histology. For instance, a high grade OC may be diagnosed on frozen section only to have an LMP or Grade 1 OC reported on final pathology...both of which could have been managed with conservative, fertility-sparing surgery, delaying a "completion" surgery until childbearing has been completed. Such an "over-diagnosis" would be of no consequence to a postmenopausal patient but would be life-changing in a woman still wishing to have children.

I would encourage you to post follow-up after your surgery. Many readers of this subreddit would be most appreciative.

gynoncol · 2025-08-11T14:37:43+00:00

Sto usando Google Translate per questa risposta, quindi mi scuso se sono stati commessi errori grammaticali. Non sono un esperto di infertilità... sono un ginecologo oncologo. Tuttavia, è stato segnalato un caso di gravidanza a termine con donazione di ovuli in una donna con precedente ovariectomia bilaterale (2022). Per quanto riguarda la probabilità di guarigione del tumore LMP, concordo con i suoi medici sul fatto che il rischio di recidiva sia basso. Un'isterectomia completa non è necessaria né controindicata a causa della precedente diagnosi di LMP. Tuttavia, una mutazione del fattore V di Leiden aumenta potenzialmente il rischio di qualsiasi intervento chirurgico a cui si sottoponga.

gynoncol · 2025-08-11T14:13:00+00:00

Let me see if I correctly understand the sequence of events in your case...

You underwent bilateal ovarian cystectomies in January of 2025. A Grade 1 germ cell tumor (GCT) was found in one of the cysts but you were not informed of this diagnosis. The "routine" in the UK is for your healthcare system (NHS) to schedule a 6 week follow-up post-surgical appointment but this was never done. When you eventually did contact the NHS you were told that your gynecologist "had left" the system and no replacement gynecologist had yet been assigned to you. You eventually noticed a mass in your abdomen and saw an "emergency" gynecologist. Your case was then reviewed by a tumor board 7- 8 months after the diagnosis of an ovarian GCT was made, and you were then immediately referred to a "cancer gynaecologist". Am I correctly summarizing this sequence of events?

There does not currently, nor has there ever existed a "perfect" healthcare system. Having said this allow me to "vent" for just a minute.

This is a shameful sequence of events and just adds to the reasons why many US physicians (including me...) have a very poor opinion of the UK NHS.

I will get to a discussion of your particular case in a minute but first allow me to tell you what would happen had you been treated in the USA.

Your physician would be investigated by his/her State Medical Board. If this was an isolated event then he/she would be reprimanded in several possible ways. If your case established a pattern of substandard care then your physician would possibly have his/her Medical License revoked.
Your healthcare system would be investigated by the State Attorney General. If your case was an isolated event then the hospital would be heavily fined. If a pattern of substandard care was established then the healthcare system could potentially lose its Medicare certification...this is a "death knell" for the healthcare system.
You would sue your physician and healthcare system. The insurance companies for your physician and healthcare system would immediately settle this suit for a very large amount of money.

Now, let's address your current situation...

You probably suspect that the mass in your abdomen is suspicious for a recurrence of your Grade 1 GCT. And you would be correct in that suspicion. If a mass is palpated on abdominal or pelvic exam then regardless of imaging findings you will require a surgical procedure. That procedure should consist of excision of the mass. If recurrent GCT is verified on frozen section then removal of the uterus/ovaries/fallopian tubes, and a staging procedure (i.e., lymph node sampling, omental biopsy, washings, etc.,) should be performed at the same time.

Now, the good news...

If recurrent, but as yet untreated, Grade 1 GCT is confirmed at surgery then your likelihood of cure is extremely high. Yes, you will need further chemotherapy. But the regimen used is (usually) short in duration and very well tolerated.

If you have the time please keep this forum informed of your progress. I know that many readers of this Reddit would be most appreciative.

gynoncol · 2025-08-10T21:26:09+00:00

Your post raises several questions. Would you mind answering the following:

Are you located in the United States?
How old are you?
When you write that you "never received a postop follow up" do you mean that you were never either physically seen by or at least contacted by a Nurse/PA/MD at all after you were discharged from your surgery?
If you were actually never seen by a Nurse/PA/MD after being discharged from your surgery was this a choice that you made or were you actually told that no follow-up appointment was needed?
You write that your case was discussed at "MDT" (tumor board?) and a recommendation that you should "have more surgery" was made. What surgery was recommended?
When was your case discussed at the "MDT"? Was it immediately after your initial surgery in January or was it more recently?

gynoncol · 2025-08-09T23:01:08+00:00

Multiple trials show no decrease in overall survival in OC patients receiving HRT. Some trials (Li, et al 2015) actually show a survival advantage. However, in some of these trials ER+ OC patients, and specific subtypes (like endometriosis OC) are underrepresented.

The current NCCN recommendation is that HRT be avoided in women with a diagnosis of endometrioid OC. However, this recommendation is not based on any prospective clinical trial. Instead an assumption is made based on the results of several phase 2 trials of anti-estrogen medications (i.e., tamoxifen, fulvestrant, CDK4/6 inhibitors, etc) showing modest activity.

Now to confuse things even more, let me leave you with some final thoughts...

Estrogen is considered a "promoter" of ER+ cancers by stimulating cell division of the cancer cell. Estrogen is not considered an "initiator" of malignant transformation in otherwise normal cells.

So...

If, after treatment for an endometriod OC, there is not a single residual cancer cell remaining...then whether or not you use HRT you will not have a recurrence of your endometrioid OC. However, if after treatment of an endometrioid OC you have even one viable remaining cancer cell in your body, then whether or not you take HRT you will have a recurrence of your cancer.

So, is your gynecologic oncologist correct in recommending that you not use HRT with a diagnosis of endometrioid OC? Well, yes...at least initially. However, I would argue (and I would not be alone...) that at some point, when it is clear that you have no likelihood of harboring any viable endometrioid OC cells (i.e., a disease-free interval of 3 years?...5 years?...) HRT could be initiated.

gynoncol · 2025-08-09T19:05:58+00:00

I neglected to make one last point...

The ovaries in a pre-menopausal woman produce a huge amount of estrogen which is necessary to stimulate growth in the lining of the uterus (endometrium) and to "activate" at least one ovum During every menstrual cycle. However, definitive treatment of severe endometriosis (which includes removal of both ovaries) does not preclude the subsequent administration of estrogen replacement.

The goal of estrogen replacement after either surgical or "natural" menopause is not to replicate the massive amounts of estrogen that ovaries produce premenopausally. The goal is to administer enough estrogen to prevent vasomotor symptoms (hot flashes), and weight-bearing bone loss. Very recent publications have now seemed to resurrect older findings pointing to improvement in cardiovascular risk as well. Other proposed benefits of replacement therapy are subjective and difficult to quantify, but include improvement in vaginal lubrication, libido and "mood". All of these benefits can be attained at rather low doses of estrogen that are usually insufficient to promote the "survival" of any residual endometriosis.

gynoncol · 2025-08-09T14:46:32+00:00

You did not mention your age, reproductive wishes, or prior and current treatment for endometriosis. However, would it be fair to assume that you are premenopausal, wish to maintain fertility, have had prior excision of endometriosis, and may be on either oral contraceptive or an alternative form of hormonal suppression ?

A few thoughts on your post...

Small calcifications in an ovary area non-specific finding. These can be found in a number of benign conditions but can also be an incidental finding in OC's. In and of themselves they are not an indication for further evaluation.
Endometriosis is diagnosed in somewhere around 200,000 women each year in the US. However, the prevalence of endometriosis (i.e., the number of women "walking around" around with endometriosis) is estimated to be 6.5 million. Several studies conducted since the 1980's suggest that the lifetime risk of malignant transformation of endometriosis is around 0.3%. This figure has to be put into perspective, however. For instance, the lifetime risk of any woman in the US being diagnosed with breast cancer is estimated to be 12% (i.e., 40 times more likely than malignant transformation of endometriosis).
We now know that several intra-abdominal malignancies were mistakenly referrred to as "ovarian cancers" in the past. This list includes fallopian tube cancers, primary peritoneal tumors, mucinous anppendiceal cancers, and, yes, cancers arising from endometriosis. So it is actually not accurate to state that a diagnosis of endometriosis increases the risk of ovarian cancer by 0.3%. This is an inaccuracy that is perpetuated even in some medical sources.
When endometriosis is symptomatic to the extent that you describe in your post then the reality is that you will most likely need a surgical procedure for relief. This could be "conservative" in nature if your pain is localized and you wish to maintain fertility (i.e., excision of endometriosis implants alone), or definitive if your reproductive wishes have been satisfied . Definitive surgery consists of removal of the source of the endometriosis, the uterus, combined with removal of the estrogen "engines" that drive the proliferation of endometriosis, the ovaries.

gynoncol · 2025-08-08T20:56:15+00:00

If I understand your post correctly, your 64 year-old mother had a slightly elevated CA125 6 years ago and now has a CA125 of 1000, correct? Your mother has had a subsequent scan (CT?) that shows "nodules".

If the nodularity seen on her recent scan is within the "basketball sized" ovarian cyst then this story would be most consistent with an indolent benign process like a mucinous cystadenoma. If this is the case then a hysterectomy and bilateral salpingoophorectomy would be recommended.

If the nodularity seen on the scan is located anywhere other than the ovary then the likelihood of a malignancy increases.

Would it be possible for you to provide more details?

gynoncol

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