Granulosa cell tumours
This page provides information on Granulosa cell tumours, including information on symptoms, causes and treatments.
What are granulosa cell tumours (GCTs)?
Granulosa cell tumours are a type of sex cord stromal tumour. These tumours develop from cells in the ovary that produce hormones. Sex cord stromal tumours (SCSTs) can be cancers (malignant) or non-cancerous (benign).
Malignant forms of SCST are rare. Just five per cent (five in 100) of people diagnosed with ovarian cancer – around 375 people a year – will have a malignant sex cord stromal tumour.
Granulosa cell tumours (GCTs) are the most common form of these malignant tumours.
They can occur at any age, the average age at diagnosis is 50 years old.
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- Adult GCTs (AGCT) are most common and usually diagnosed in middle aged and older people
- Juvenile GCTs (JGCT) usually affect much younger people and are rare
What causes GCT?
The causes are thought to be genetic. Most cases arise when a change has occurred on a gene called FOXL2. This gene helps granulosa cells in the ovary to grow normally, so changes to the gene can allow abnormal cells to develop instead. We don’t know why this happens, but it is not thought to be a change that can be inherited. So, if you are diagnosed with GCT, your family members should not be at an increased risk of developing it too.
Symptoms of GCT
- Bloating in your abdomen (the area between the chest and the pelvis) that doesn’t go away
- Pelvic or abdominal pain
- Feeling full more quickly
- Changes in your bowels, such as diarrhoea, constipation
- Needing to urinate more often or more urgently
- Changes to your periods, they may be irregular, heavy or you have no bleeding
- Bleeding after your menopause
- Breast tenderness or changes
- Early puberty, in young girls
Tests and diagnosis
- Inhibin A and inhibin B. Inhibin is a chemical made by granulosa cells that is used as a tumour marker for GCT
- Anti-mullerian hormone (AMH)
- CA125, which is a tumour marker used to diagnose some other forms of ovarian cancer but is less helpful for GCT
Treatments for GCTs
Your treatment will depend on the stage and type of GCT you have, your age, whether you have been through the menopause, and whether you want to have children.
Most GCTs are diagnosed early, when they affect the ovaries only, and have not spread. This is stage 1.
Surgery
The first treatment is usually surgery which aims to remove as much of the tumour as possible. If your GCT is diagnosed at stage 1a and contained in one ovary, then usually only the affected ovary will be
removed. If it is at stage 1b and affecting both ovaries, then both will be removed. This may be the only treatment you need.
You may need chemotherapy if the GCT is stage 1c.This means it affects both ovaries and fallopian tubes, and the sac surrounding the tumour has burst; or the GCT is stage 1c 2, which means it has spread to the surface of the ovary or fallopian tube.
Younger people with juvenile granulosa cell tumour (JGCT) may be offered chemotherapy if their tumour is at stage 1c.
There is more information about staging here
Chemotherapy and other options
If you need chemotherapy, you may be offered bleomycin, etoposide and cisplatin. This is a combination called BEP. If you are aged over 40 you may be offered etoposide and cisplatin. There are other options that your multidisciplinary team can discuss with you. Your team may also recommend hormone therapy or radiation therapy.
After your treatment
When your treatment is complete you should be monitored regularly as an outpatient by a gynaecologist and/or oncologist. This should include blood tests looking at your levels of tumour markers such as inhibin A and B and AMH. You may also be offered ultrasound or MRI scans. You may have had your surgery before your menopause. This could result in you having a surgical menopause as your ovaries are likely to have been removed. This means after surgery you may develop menopausal symptoms.
As GCT is a hormone producing tumour, hormone replacement therapy (HRT) may not be a suitable treatment for you. Speak to the oncologist or gynaecologist who is monitoring you and ask what your options are, or to be referred to a specialist menopause clinic.
Your fertility
Will the GCT come back?
If it does come back, you may need further surgery followed by more chemotherapy or endocrine (hormone-controlling) therapy.
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