August 17, 1994
Media Contact:Joann Rodgers
Phone: (410) 955-6680
Young women with early or stage I ovarian tumors of low malignant potential (TLMP) are safe if surgeons remove only the tumor, sparing the other ovary and protecting fertility, according to experts at The Johns Hopkins Medical Institutions.
Traditionally, such tumors are treated aggressively with removal of both ovaries, in addition to the uterus, plus chemotherapy or radiation therapy, because doctors assumed they would develop into ovarian cancer. But at a recent National Institutes of Health Consensus Conference, experts agreed with a recommendation by Hopkins gynecologic pathologist Cornelia L. Trimble, M.D., that TLMP diagnosed early can be treated more conservatively.
In a study of 953 TLMP patients, published in the International Journal of Gynecologic Pathology in 1993, Trimble and gynecologic pathologist Robert J. Kurman, M.D., reported a 99 percent survival rate after five years among patients who had a tumor confined to only the ovary and a 92 percent five-year survival rate among women with advanced TLMP.
"In our opinion, these tumors should be viewed as benign tumors, in the same light as we view fibroids," says Kurman. 'The risk of developing cancer in a TLMP is similar to that of developing cancer in a fibroid, but we don't recommend aggressive cancer therapy for fibroids."
Treatment of ovarian tumors should include complete surgical staging of these tumors according to guidelines of the International Federation of Gynecology and Obstetrics. An independent pathologic review may be suggested to confirm the diagnosis of these tumors.
For younger women, conservative treatment means retaining the possibility of pregnancy. Retrospective studies suggest that pregnancy is safe after conservative treatment of these tumors, says Trimble. These studies imply that women who have had TLMP who become pregnant do not have an additional risk of developing ovarian cancer."
Survival rates for ovarian cancer have not changed although physicians believe they have improved the quality of life for the 20,000 women diagnosed with ovarian cancer each year in the United States. There are no effective screening tests. Pregnancy, breast-feeding and the use of oral contraceptive pills appear to reduce risk.