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Under a Creative Commons license Open access AbstractObjectiveThe aim of this study is to evaluate the long-term outcome of ovarian recurrent granulosa cell tumors (GCTs) in a large series of patients treated in Taiwanese Gynecologic Oncology Group (TGOG) centers and to define the prognostic parameters for survival. Materials and methodsA retrospective multi-institutional review of patients with recurrent ovarian GCTs treated in TGOG centers was conducted. The clinical and pathological characteristics, treatment, and outcomes of patients with ovarian recurrent GCTs were analyzed using Kaplan-Meier and Cox proportional hazards analyses to determine the predictors for survival. ResultsA total of 44 patients from 16 medical centers were identified between January 1994 and December 2010. The median disease-free survival (DFS), postrecurrence survival, and overall survival (OS) were 61.5 months (range, 3.7–219.3 months), 55.8 months (range, 4.6–193.7 months), and 115.3 months (range, 17.2–390.6 months), respectively. In multivariate analysis, DFS (> 61.5 months versus ≤ 61.5 months, hazard ratio (HR) 0.15, 95% confidence interval (CI) 0.03–0.78, p = 0.024) at the initial operation after diagnosis of relapse was the only predictor that correlated with OS. ConclusionDFS after the initial operation was the only important predictor for overall survival in patients with recurrent GCTs, regardless of treatment, suggesting that the natural behavior of the tumor is a critical factor for patients with recurrent GCTs. Keywordsovarian granulosa cell tumor recurrent granulosa cell tumor recurrent ovarian neoplasm adult granulosa cell tumor survival outcome Taiwanese Gynecologic Oncology Group Cited by (0)Copyright © 2015 Published by Elsevier B.V. OverviewWhat is a granulosa cell tumor?A granulosa cell tumor (GCT) is a type of ovarian tumor. GCTs are the most common type of sex cord-stromal tumor. In people assigned female at birth, sex cord-stromal tumors are tumors that occur in tissues around their ovaries. These tumors cause high levels of estrogen, one of the female sex hormones. They can occur at any age ages, but the average age of diagnosis is 50 years old. Where do granulosa cell tumors form?GCTs form within the ovary. Ovaries are part of the female reproductive system. They produce eggs (ova) and estrogen and progesterone, two reproductive hormones. How common are granulosa cell tumors?Granulosa cell tumors are rare. They account for about 5% of primary ovarian tumors. Primary ovarian tumors are tumors that start in your ovary. Are granulosa cell tumors benign or malignant?Granulosa cell tumors are usually malignant (cancerous). But most GCTs grow slowly. Most of the time, healthcare providers diagnose them in early stages when they have good treatment outcomes. What is the difference between adult and juvenile granulosa cell tumors?GCTs are more common in adults. About 95% of GCT diagnoses are in mature adult women. When a GCT occurs in someone under 30, it’s usually juvenile type GCT. A juvenile GCT can be more likely than an adult GCT to recur (come back) within a few years and be more aggressive if diagnosed after it has already spread outside your ovary. Symptoms and CausesWhat causes a granulosa cell tumor?Experts don’t entirely understand what causes granulosa cell tumors. They often have a mutation (change) in the FOXL2 gene. FOXL2 typically functions to help granulosa cells develop normally. What are the symptoms of a granulosa cell tumor?The most common symptom of a GCT is high estrogen. In girls, high estrogen may cause early puberty. In adults, GCTs commonly cause:
GCTs may also cause abdominal pain. Usually, you only experience this symptom if the tumor ruptures (bursts). What are the complications of granulosa cell tumors?Without treatment, granulosa cell tumors can increase your risk of other health complications, including:
Diagnosis and TestsHow is a granulosa cell tumor diagnosed?Typically, healthcare providers use imaging techniques to diagnose granulosa cell tumors. You may have a:
Your provider may also use blood tests, such as tumor markers. Inhibin is a tumor marker produced by granulosa cell tumors. You may also need blood tests to rule out other conditions. Management and TreatmentHow are granulosa cell tumors treated?The first treatment for a granulosa cell tumor is surgery. Your surgeon will remove as much of the tumor as possible while keeping healthy tissue intact. If you don’t plan on having children or are past childbearing years, your doctor may recommend ovarian removal (oophorectomy) and possibly removal of the uterus (hysterectomy). You may need an oophorectomy to remove the entire GCT. Providers use a process called staging to determine the location of the granulosa cell tumor. Staging tells your provider whether cancer has spread.
As many as 9 in 10 GCTs are diagnosed while they are only in your ovary. For these tumors, surgery is generally recommended, and may be the only treatment needed. Depending on the tumor size and risk factors for recurrence, you may also have treatment designed to keep the tumor from coming back (recurring). Your provider may also recommend:
PreventionHow can I prevent a granulosa cell tumor?There’s no guaranteed way to prevent a granulosa cell tumor. You can live an overall healthier life and decrease your risk of chronic disease by:
How can I reduce my risk of granulosa cell tumor complications?If you have any symptoms that could point to a GCT, see a healthcare provider right away. If you have irregular bleeding, breast tenderness or bleeding after menopause, see your healthcare provider. Early treatment for GCTs typically leads to excellent outcomes. Outlook / PrognosisAre granulosa cell tumors curable?Yes. Surgery can cure GCTs, especially when surgeons remove them early. Curing a GCT is less likely if a healthcare provider finds it after it has already spread to other parts of your body. If you have symptoms of a GCT, see your healthcare provider right away. What can I expect after GCT treatment?After tumor removal, you need regular follow-up with your healthcare provider for many years because these tumors can come back many years later. Your provider examines you to ensure the tumor hasn’t returned. You may have:
What is the outlook for granulosa cell tumors?The outlook for a GCT depends on how advanced the tumor was (stage) when you received a diagnosis. If your provider diagnoses GCT before it spreads to other parts of your body (metastasizes), the outlook is good. Living WithWhat else should I ask my doctor?You may also want to ask your healthcare provider:
A note from Cleveland Clinic Granulosa cell tumors are rare, usually slow-growing ovarian tumors. They grow in the tissues around your ovaries. Often, they produce hormones, leading to high estrogen. High estrogen may cause abnormal bleeding, irregular periods or a larger abdomen. The first treatment is usually surgery to remove the tumor. If you have an increased risk of a GCT coming back, your doctor may recommend chemotherapy, hormone therapy or radiation therapy. When you find a GCT in its early stages, the outlook is usually good. How often do granulosa cell tumors recur?GCTs are rare and may recur 5–30 years after the initial diagnosis [6]. Several factors, such as tumor size, stage, and mitotic index, are associated with recurrence [3]. Recurrence sites vary, and the pelvis, ovary, mesentery, appendix, liver, and omentum have been reported [7].
Can ovarian cancer come back after total hysterectomy?Yes. You still have a risk of ovarian cancer or a type of cancer that acts just like it (peritoneal cancer) if you've had a hysterectomy. Your risk depends on the type of hysterectomy you had: Partial hysterectomy or total hysterectomy.
Where does granulosa cell tumor spread to?Spread is largely within the pelvis and the lower abdomen. Distant metastases are rare with few reported cases of lung, liver, brain, bone, diaphragm, abdominal wall, adrenal gland and supraclavicular lymph node metastasis from ovarian tumors.
What are the symptoms of ovarian cancer after hysterectomy?In many cases, one or both ovaries are left in place after a hysterectomy.. abdominal bloating and discomfort.. trouble eating or feeling overly full.. frequent urination or the need to urinate often.. fatigue.. heartburn or upset stomach.. back pain.. painful intercourse.. constipation.. |
Granulosa cell tumor recurrence symptoms after hysterectomy
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