Borderline & Germ-Cell Ovarian Tumours

The short answer: when a young woman or teenager is told she has a “tumour” on her ovary, it is frightening, but most ovary lumps at this age are harmless cysts. Two less common types need special care: borderline ovarian tumours, which are not true cancers and are usually treated by surgery alone, and germ-cell tumours, which are cancers but are among the most treatable, usually with surgery and sometimes chemotherapy. In both, it is often possible to keep the womb and the healthy ovary, so the chance of a future pregnancy can usually be protected. Many families first search for this as ovary me ganth (ओवरी में गांठ).

Most ovary lumps in young women are not cancer

Ovarian cysts are very common in teenagers and young women. Most are functional cysts that form as part of the monthly cycle and go away on their own. Others, such as dermoid cysts and endometriomas (“chocolate cysts”), are not cancer either, although some need an operation. Our guide on which ovarian cysts to watch and which to worry about explains the usual approach.

A lump is looked at more carefully if it is large, has solid parts, grows quickly, or comes with raised tumour marker blood tests. In that situation two uncommon groups are considered in young women: borderline tumours and germ-cell tumours. Ovarian cancer of the common (epithelial) type is much less frequent at this age. You can read about all types on our ovarian cancer page.

What is a borderline ovarian tumour?

A borderline ovarian tumour, also called a tumour of low malignant potential, sits between a harmless cyst and a cancer. Under the microscope the cells look more active than normal, but they do not grow into the surrounding tissue the way a cancer does. That is why borderline tumours are not true cancers.

They are found more often in women in their 30s and 40s, younger on average than women with ovarian cancer, so many are still planning a family.
The two main types are serous and mucinous, named after how the cells look.
Most are found at an early stage, still within the ovary.
Symptoms, if any, are usually those of a cyst: a swollen tummy, pressure or pain. Many are found on a scan done for another reason.
The CA-125 blood test may be normal or only slightly raised, so a normal result does not rule one out.

The outlook is excellent for most women. The main issue is not spread, but the chance that a new borderline tumour may grow later in the remaining ovary.

How borderline tumours are treated

Treatment is surgery. The aims are to remove the tumour completely without bursting it, to check the inside of the tummy carefully (staging), and, where the woman wishes, to keep her fertility.

Fertility-sparing surgery: in a young woman, the affected ovary and its fallopian tube are usually removed, and the womb and the other ovary are kept. If both ovaries are involved, or only one ovary is left, removing only the tumour and keeping the rest of the ovary (cystectomy) may be possible, although the tumour is a little more likely to come back after this.
Staging: fluid samples from the tummy, a look at all surfaces, and biopsies, including of the fatty apron (omentum). For mucinous tumours the appendix is often checked as well. Lymph glands usually do not need to be removed.
Keyhole surgery: in selected cases the operation can be done by laparoscopy or robotic surgery, provided the tumour can be removed in a bag without bursting. Robotic surgery is available at Sterling Hospitals and KD Hospital in Ahmedabad.
Chemotherapy is usually not needed for borderline tumours.

For women who have completed their family, removing both ovaries and the womb may be offered. Whether the remaining ovary should be removed later in a woman who had fertility-sparing surgery is discussed individually; it is not always needed. You can read more about fertility-preserving cancer surgery and about life with one ovary.

Follow-up: regular check-ups with an ultrasound of the remaining ovary are usually advised for several years, sometimes with a CA-125 test. If a borderline tumour comes back, it is usually borderline again and can often be removed with another operation that still keeps fertility.

What are germ-cell tumours of the ovary?

Germ-cell tumours start in the cells that would normally develop into eggs. The most common germ-cell tumour by far is the dermoid cyst (mature teratoma), which is not cancer. The malignant (cancerous) types are rare and are found mostly in teenagers and women in their twenties. The main types are:

Dysgerminoma, the most common type, which sometimes affects both ovaries;
Immature teratoma;
Yolk sac tumour (also called endodermal sinus tumour);
rarer types such as embryonal carcinoma, choriocarcinoma and mixed germ-cell tumours.

These tumours can grow quickly. Common symptoms are a swelling or lump in the tummy, pain, and sometimes irregular bleeding. Sudden, severe pain can mean the ovary has twisted (torsion) or the tumour has bled, and needs same-day medical care.

Tumour markers: AFP, beta-hCG and LDH

Tumour markers are blood tests for substances that some tumours release. When a young woman has an ovarian lump with solid parts, these tests are usually done before surgery, together with CA-125:

AFP (alpha-fetoprotein): often raised in yolk sac tumours, and sometimes in immature teratomas and embryonal carcinomas.
Beta-hCG: the pregnancy hormone. It is raised in choriocarcinoma and embryonal carcinoma, and sometimes in dysgerminoma. A raised level can make a pregnancy test positive, so pregnancy is ruled out first.
LDH (lactate dehydrogenase): often raised in dysgerminoma.

There is no single “normal range” to remember: each lab prints its own range on the report. A raised marker does not confirm cancer on its own, and a normal marker does not rule it out; the final answer comes from the tumour itself under the microscope. If a marker was raised before treatment, it becomes a useful way to check that treatment has worked and to watch for any return.

How germ-cell tumours are treated

Surgery comes first. In most young women, the affected ovary and tube are removed and the womb and the other ovary are kept, together with staging biopsies. Because these tumours respond so well to chemotherapy, fertility can usually be kept even when the tumour has spread, as long as the womb and the other ovary look healthy.

Chemotherapy is advised for many germ-cell tumours, depending on the type and stage. The usual combination is called BEP (bleomycin, etoposide and cisplatin), typically given as 3 to 4 cycles, each lasting 3 weeks. Breathing tests may be checked, because bleomycin can affect the lungs. For some very early tumours, for example a stage 1A dysgerminoma or a low-grade immature teratoma that is limited to one ovary, careful follow-up alone may be enough, without chemotherapy.

Germ-cell tumours are among the most treatable cancers in young women, and most are cured. Follow-up is closest in the first two years, with examinations, tumour marker tests and scans as needed.

Periods, fertility and pregnancy afterwards

After fertility-sparing surgery for a borderline tumour, many women conceive naturally. After treatment for a germ-cell tumour, most young women get their periods back and many have children, even after chemotherapy. Chemotherapy can lower the egg reserve in some women, so it is reasonable to ask about egg freezing before treatment if time allows; it often takes about 2 weeks and should never delay urgent treatment. Your specialist will also tell you how long to wait after treatment before trying for a pregnancy.

Why the first operation matters: specialist care and frozen section

Because these tumours are uncommon, the first operation sets up everything that follows. A gynaecological oncologist (a women’s cancer specialist) plans it to remove the tumour in one piece, stage it properly and keep fertility wherever it is safe. Removing both ovaries or the womb in a young woman is rarely needed for these tumours.

During the operation, a sample can be sent for a quick microscope check called a frozen section, while the patient is still asleep. It helps the surgeon decide how much to do. For borderline tumours, though, a frozen section is not always certain: the final report a few days later occasionally shows a different result, and a second, planned operation is sometimes needed. Because the pathology of rare tumours can be difficult, having the slides reviewed by an experienced pathologist can be helpful. If you have already had surgery elsewhere and are unsure about the next step, you can ask for a second opinion; our page on cyst removal versus removal of an ovary also explains the difference between the two operations.

FAQs

Is a borderline ovarian tumour cancer?

Not in the usual sense. It has some features of cancer under the microscope, but it does not grow into nearby tissue the way an ovarian cancer does. Most are found early, are treated with surgery alone, and the outlook is excellent. Doctors still treat it carefully and follow it up, because it can come back.

Can a borderline tumour turn into cancer?

Rarely. Most borderline tumours that come back are borderline again and can be removed with another operation. A small number come back as a slow-growing (low-grade) cancer, which is one reason regular follow-up scans are advised.

Can a teenager get ovarian cancer?

It is uncommon, and most ovarian lumps in teenagers are harmless cysts or dermoid cysts. When a cancer does occur at this age, it is most often a germ-cell tumour, which usually responds very well to treatment. A lump that is large, solid or growing, or that comes with raised tumour markers, should be seen by a specialist.

Is a germ-cell tumour of the ovary curable?

In most cases, yes. Germ-cell tumours are among the most treatable cancers in young women. Surgery cures many early tumours on its own, and these tumours usually respond very well to chemotherapy, so many women are cured even when the tumour has spread. Each person’s outlook depends on the type and stage, so ask your specialist about your own situation.

Will chemotherapy for a germ-cell tumour make me infertile?

Usually not. Most young women get their periods back after treatment, and many go on to have children naturally. Chemotherapy can lower the egg reserve in some women, so it is reasonable to ask about egg freezing before treatment if time allows; it often takes about 2 weeks and should not delay urgent treatment.

Are germ-cell tumours hereditary?

Most are not. Ovarian germ-cell tumours are not usually linked to BRCA genes and do not usually mean other family members are at higher risk. In rare cases, a dysgerminoma in a young girl who has not started her periods is linked to a difference in the sex chromosomes, and the doctor may suggest a chromosome blood test.

How often will I need check-ups after treatment?

Follow-up is closest in the first two years, because that is when a return is most likely, and then becomes less frequent. Visits usually include an examination, tumour marker blood tests (for germ-cell tumours) or a scan of the remaining ovary (for borderline tumours). Your specialist will give you a schedule.

If you or your daughter has been told about an ovarian lump, a borderline tumour or a germ-cell tumour, Dr. Nishtha Tripathi Patel, an ESGO-certified gynaecological oncologist, can review the scans, marker results and pathology, and explain the options, including keeping fertility. She sees patients at Sterling Hospitals, KD Hospital and Welcare Speciality Hospital in Ahmedabad, and video consultations are also available. Please book an appointment and bring all your reports.

Ovarian Tumours in Young Women: Borderline and Germ-Cell Tumours Explained

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