Fertility-sparing surgery and outcome in fertile women with ovarian borderline tumors and epithelial invasive ovarian cancer

Abstract

Objective The aim was to evaluate the outcome of fertility-sparing treatment in ovarian borderline tumors and early invasive ovarian cancer. Materials and methods All women diagnosed with an ovarian borderline tumor or early invasive ovarian cancer who were treated with fertility-sparing surgery at the University Hospital in Lund between 1988 and 2002 were identified and included in the study ( n = 23). Results During the follow-up period of a median 92 months, range 11–185 months, no relapse was found in the patients with Stage 1a tumors, including both borderline tumors ( n = 12) and invasive well-differentiated ( n = 9) and moderately differentiated ( n = 1) ovarian cancers. One patient with poorly differentiated ovarian cancer Stage 1c was 13 weeks’ pregnant at the time of the primary operation. Although, unilateral oophorectomy was performed she insisted on continuing the pregnancy. At 37 weeks she had a cesarean section and the ovarian cancer was disseminated. Chemotherapy was given but she died less than a year later. None of the other patients received chemotherapy. In total, 30 children were born to 15 patients. Prophylactic removal of the remaining ovary ± hysterectomy was accepted in only in six of the women after fulfilling their desire to have more children. Conclusions Young women with Stage 1a epithelial ovarian cancer and borderline tumors do not have to give up their fertility in order to receive successful and safe treatment of their disease. However, several of these patients do not accept the recommendation of prophylactic oophorectomy of the contralateral ovary and hysterectomy after completion of childbearing.