Treatment of Low Malignant Potential (LMP) Ovarian Tumors
I wanted to ask a question about Low Malignant Potential (LMP) ovarian tumors. I was diagnosed with an ovarian LMP Serous tumor. I know that a hysterectomy is the common treatment. My question is, given the high survival rates for this kind of tumor, why such an aggressive treatment?
Scott Kamelle, MD and Ivor Benjamin, MD (Former co-Editor-in-Chief of OncoLink) from the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at the University of Pennsylvania Health System, respond:
Approximately 15 % of epithelial ovarian tumors are tumors classified as being of low malignant potential. The distinct biological and pathological nature of these tumors limits their capability for metastases (spread) and stromal invasion (invasion of the body of the ovaries). Because of this more indolent behavior, patients with these tumors tend to do better than those with the more aggressive invasive ovarian carcinomas (cancers). Unfortunately, the average age of occurrence for LMP ovarian tumors is 40. Fertility preservation is often an important consideration for a patient's decision regarding treatment. Fortunately the majority (82-90%) of patients present with Stage I tumors (involvement confined to only one ovary). The standard treatment of LMP tumors is total abdominal hysterectomy (removal of uterus and cervix) bilateral oophorectomy (removal of the ovaries), and a staging procedure which involves removal of pelvic and abdominal lymph nodes. Fortunately, approximately 99% of patients are alive at an average follow-up of 7 years for Stage I disease and 92% for Stage II.
However, if conception is an issue, more conservative surgical management such as unilateral oophorectomy (removal of only the one involved ovary) may be performed in conjunction with peritoneal sampling and future close surveillance that would include pelvic imaging studies (ultrasound or CT scan) and in some cases blood tests such as CA 125. Unfortunately, CA 125 is not as reliable a marker of recurrence in patients with LMP when compared with the invasive cancers. Up to 70% of patients have become pregnant following these conservative operations.
Adjuvant therapy, such as radiation or chemotherapy, for LMP tumors of the ovary is controversial and currently, insufficient information is available to make a definitive statement regarding these approaches. However many gynecologic oncologists would recommend chemotherapy for those patients with advanced disease namely tumor nodules that have spread within the abdominal cavity. Patients with advanced disease are not eligible for a conservative operation that would preserve fertility.