The type and stage of an ovarian stromal tumor are the main factors influencing treatment. Ovarian cancers are categorized into subtypes based on the type or types of cells that have become cancerous. The subtypes include epithelial tumors, germ cell tumors, sex cord tumors, and stromal tumors. Stromal tumors may be benign (noncancerous) or malignant (cancerous). Cancerous stromal cell tumors make up about 1 percent of ovarian cancers.
The most common type of cancerous stromal tumor is called a granulosa cell tumor. Another type, called Sertoli-Leydig stromal cell tumors, develops less frequently and may be benign or malignant. Sertoli-Leydig cell tumors may cause complications by making extra male sex hormones such as testosterone. There are other more rare types of stromal tumors, such as steroid cell tumors, gynandroblastomas, granulosa cell-theca cell tumors, sex cord stromal tumors, and other unclassified tumors made up of multiple cell types.
If you have an ovarian stromal tumor, your doctor will consider several factors in recommending your treatment plan. These factors include the type of stromal tumor, the cancer’s stage and grade (how many abnormal cells are within the tumor), your age, whether you plan on having biological children, and whether the cancer has relapsed. Here’s what to know about the treatment options for ovarian stromal tumors.
For all people diagnosed with ovarian stromal tumors, surgery to remove the ovary with the tumor — a procedure known as an oophorectomy — is typically the initial treatment of choice.
For those with stromal cell tumors only affecting one ovary who wish to have children, fertility-sparing surgery is the recommended treatment. A surgery to remove only the cancerous tissue can be paired with a fertility-sparing treatment option. People who have undergone fertility-sparing treatment for ovarian cancer have reported successful pregnancies and healthy children after treatment.
People living with stage 1 tumors may be treated successfully by surgery alone. Most people diagnosed with an early-stage ovarian stromal tumor only need follow-up visits to watch for return of disease.
In advanced disease, surgery to remove the cancerous ovary also helps doctors stage the tumor and reduce the size of the cancer as much as possible (a process known as debulking). People diagnosed with stage 2, 3, or 4 stromal tumors often have additional treatment requirements, such as chemotherapy or hormone therapy.
People with advanced or relapsed disease usually require chemotherapy after surgery. Ovarian stromal tumors are rare, which makes researching and creating an optimal standard of care difficult. The current standard of care treatment is platinum-based combination chemotherapy, such as bleomycin, cisplatin, and etoposide (BEP) or carboplatin and paclitaxel.
In one study, platinum-based therapy achieved a partial or complete response rate — a partial or complete reduction of the cancer — in 63 percent to 80 percent of participants. However, platinum-based chemotherapy is difficult for many people to tolerate. In clinical trials, people undergoing these types of chemotherapies have experienced up to 40 different side effects.
Some people with advanced stages of disease cannot tolerate chemotherapy but want to pursue additional treatment after surgery. In these cases, health care professionals may recommend other therapy options, such as hormone therapy or radiation therapy.
Hormone therapy is often used to treat ovarian stromal tumors. It is most commonly used for people with advanced or recurrent disease who cannot tolerate standard chemotherapy regimens. Commonly experienced side effects of hormone therapy include menopause-like symptoms, such as hot flashes and vaginal dryness.
Examples of hormone therapies include luteinizing-hormone-releasing hormone (LHRH) agonists, tamoxifen, and aromatase inhibitors. Tamoxifen and aromatase inhibitors are usually used to treat breast cancer, but they have been effective in treating stromal tumors too.
LHRH agonists such as Zoladex (goserelin) and Eligard (leuprolide) can help lower estrogen levels in those who haven’t gone through menopause. LHRH agonists are given by injection every one to three months.
Tamoxifen works to keep the estrogen that is naturally present in the body from helping cancer cells to grow. Tamoxifen has been associated with increased risk of blood clots in the legs.
Aromatase inhibitors work to lower the overall estrogen levels in postmenopausal individuals. They are typically taken once per day by mouth. Aromatase inhibitors include Femara (letrozole), Arimidex (anastrozole), and Aromasin (exemestane).
In some situations, oncologists may recommend radiation therapy after surgery. Radiation therapy uses X-rays and other high-energy particles to target and kill cancer cells.
Radiation therapy is rarely used to treat ovarian stromal tumors because platinum-based chemotherapy is often more effective. However, radiation therapy may help kill cancer cells that have metastasized (spread to other areas of the body).
People with tumors that are large or high-grade (containing many abnormal cells) or that have broken apart are at a higher risk for recurrence of the disease. Recurrent stromal tumors are often treated similarly to first-time tumors, with options including surgery, chemotherapy, hormone therapy, or radiation therapy.
Relapsed stromal tumors are rare, however, so there is not a standard treatment for recurrent disease. The lack of a standard of care makes treatment in a clinical trial an attractive option for many individuals with recurrent disease. Clinical trials provide the opportunity to use newer therapies or new combinations of therapies.
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