Granulosa cell tumor

Diagnosis

Granulosa cell tumors often are diagnosed when tests or surgery are done to look into symptoms caused by the tumor. Tests may include imaging, blood tests and examining tissue with a microscope.

Imaging tests

Imaging tests make pictures of the inside of the body. For granulosa cell tumor, imaging tests may include the following.

• Ultrasound is a common first imaging test for a possible tumor in the ovaries. An ultrasound can show how big the tumor is and whether it is solid, filled with fluid, or has some areas that are solid and some filled with fluid.
• CT and MRI also are sometimes done. These can give more information about a large tumor and may help look for signs that cancer has spread.

Imaging can help show whether a tumor in an ovary may be cancer, but it cannot show whether it is a granulosa cell tumor.

Blood tests

Blood tests used to help diagnose granulosa cell tumor cannot tell your healthcare team whether you have cancer. But they can offer clues about your diagnosis. Blood tests may be used to:

• Look for tumor markers made by granulosa cell tumors. These include inhibin A, inhibin B and antimullerian hormone (AMH). High levels may help suggest a diagnosis of granulosa cell tumor.
• Check hormone levels. Tests can look for increased hormone levels, if symptoms suggest that the tumor is making extra hormones. This may include estrogen and, sometimes, testosterone.

Examining the cancer cells

Your healthcare team usually cannot be sure of a diagnosis until you have surgery to remove the tumor. Then a doctor called a pathologist looks at the tumor tissue under a microscope. How the tumor cells look help your care team know whether it is a granulosa cell tumor and if it is adult-type or juvenile-type.

Sometimes, different types of cancer can look similar. So other lab tests may be needed to help with the diagnosis. Tests for proteins or gene changes can help the pathologist tell what type of tumor you have. The FOXL2 gene change found in most adult-type granulosa cell tumors may suggest a granulosa cell tumor, for example.

Some people also may have a small amount of tissue taken from the lining of the uterus. This is called a biopsy. Your care team may do a uterine biopsy if you have vaginal bleeding changes or if imaging shows that the uterine lining is thickened. The tissue is checked for changes caused by extra estrogen, such as endometrial cancer, because this can affect your treatment plan.

Treatment

Granulosa cell tumor treatment mainly includes:

• Surgery. This is the main treatment for all granulosa cell tumors.
• Chemotherapy. Chemotherapy may be used for granulosa cell tumors that are at a more advanced stage.

Surgery

Surgery is the main treatment for granulosa cell tumor and may be used to treat initial cancer and cancer that's come back, also called a recurrence. Surgery also helps the care team find out the cancer's stage. The type of surgery done depends on the cancer's stage. It also depends on whether you want to preserve fertility.

For an early-stage tumor limited to one ovary or fallopian tube, the surgeon may remove just that ovary and the nearby fallopian tube. This is called a salpingo-oophorectomy. The uterus and the other ovary are left in place. This means future pregnancy may be possible.

If preserving fertility is not a goal or if cancer has spread outside an ovary, the surgeon may remove the uterus and both ovaries and fallopian tubes.

Chemotherapy

Chemotherapy treats cancer with strong medicines. For granulosa cell tumor, chemotherapy may be used after surgery to treat:

• Cancer that has a higher risk of recurrence, including some stage 1C tumors. For stage 1C tumors, studies have not shown that chemotherapy clearly improves survival or delays the cancer's return. Because of this, your care team carefully considers details about your cancer and what you prefer before deciding whether to recommend chemotherapy for this stage.
• Cancer that's spread outside the ovary.
• Cancer that cannot be completely removed with surgery.
• A recurrence of cancer.

Chemotherapy may be given as a combination of medicines for granulosa cell tumors. One combination you may hear is called BEP. BEP stands for bleomycin, etoposide and cisplatin. But this is not the only chemotherapy option.

Chemotherapy can cause side effects such as nausea and vomiting. It also can affect the kidneys, nerves and lungs. Your care team checks for these side effects during treatment.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. It is rarely used for granulosa cell tumors. But radiation therapy may be used to ease symptoms. When it's used this way, it's called palliative care. It also is sometimes used to treat a cancer recurrence or for cancer that's spread to a small area.

Follow-up care and monitoring

Because granulosa cell tumors can recur, your care team may recommend follow-up care and monitoring after treatment. This may include:

• A physical exam 2 to 3 times a year.
• Blood tests to check for tumor markers such as inhibin or AMH 2 to 3 times a year.
• Imaging tests, but usually only if your tumor marker levels are high, you have symptoms or your care team sees signs of possible cancer during the exam.