Sexcord/ stromal ovarian tumors surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
'''Primary surgery:''' | |||
*Surgery is the mainstay of treatment for sexcord/ stromal ovarian tumors<ref name="pmid24753008">{{cite journal |vauthors=Gurumurthy M, Bryant A, Shanbhag S |title=Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent) |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD006912 |date=April 2014 |pmid=24753008 |doi=10.1002/14651858.CD006912.pub2 |url=}}</ref><ref name="pmid24315353">{{cite journal |vauthors=Gremeau AS, Bourdel N, Jardon K, Rabischong B, Mage G, Pouly JL, Canis M |title=Surgical management of non-epithelial ovarian malignancies: advantages and limitations of laparoscopy |journal=Eur. J. Obstet. Gynecol. Reprod. Biol. |volume=172 |issue= |pages=106–10 |date=January 2014 |pmid=24315353 |doi=10.1016/j.ejogrb.2013.10.023 |url=}}</ref><ref name="pmid22525408">{{cite journal |vauthors=Schultz KA, Schneider DT, Pashankar F, Ross J, Frazier L |title=Management of ovarian and testicular sex cord-stromal tumors in children and adolescents |journal=J. Pediatr. Hematol. Oncol. |volume=34 Suppl 2 |issue= |pages=S55–63 |date=May 2012 |pmid=22525408 |doi=10.1097/MPH.0b013e31824e3867 |url=}}</ref><ref name="pmid22426486">{{cite journal |vauthors=Gershenson DM |title=Current advances in the management of malignant germ cell and sex cord-stromal tumors of the ovary |journal=Gynecol. Oncol. |volume=125 |issue=3 |pages=515–7 |date=June 2012 |pmid=22426486 |doi=10.1016/j.ygyno.2012.03.019 |url=}}</ref><ref name="pmid28276867">{{cite journal |vauthors=Färkkilä A, Haltia UM, Tapper J, McConechy MK, Huntsman DG, Heikinheimo M |title=Pathogenesis and treatment of adult-type granulosa cell tumor of the ovary |journal=Ann. Med. |volume=49 |issue=5 |pages=435–447 |date=August 2017 |pmid=28276867 |doi=10.1080/07853890.2017.1294760 |url=}}</ref><ref name="pmid26411956">{{cite journal |vauthors=Uma Devi K, Purushotham N, Jayashree N |title=Management of Ovarian Cancer In Younger Women |journal=Rev Recent Clin Trials |volume=10 |issue=4 |pages=263–9 |date=2015 |pmid=26411956 |doi= |url=}}</ref><ref name="pmid25886261">{{cite journal |vauthors=Qian Q, You Y, Yang J, Cao D, Zhu Z, Wu M, Chen J, Lang J, Shen K |title=Management and prognosis of patients with ovarian sex cord tumor with annular tubules: a retrospective study |journal=BMC Cancer |volume=15 |issue= |pages=270 |date=April 2015 |pmid=25886261 |pmc=4408581 |doi=10.1186/s12885-015-1277-y |url=}}</ref><ref name="pmid25969483">{{cite journal |vauthors=Chatziioannidou K, Botsikas D, Tille JC, Dubuisson J |title=Preservation of fertility in non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=May 2015 |pmid=25969483 |pmc=4434316 |doi=10.1136/bcr-2014-207841 |url=}}</ref> | *Surgery is the mainstay of treatment for sexcord/ stromal ovarian tumors<ref name="pmid24753008">{{cite journal |vauthors=Gurumurthy M, Bryant A, Shanbhag S |title=Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent) |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD006912 |date=April 2014 |pmid=24753008 |doi=10.1002/14651858.CD006912.pub2 |url=}}</ref><ref name="pmid24315353">{{cite journal |vauthors=Gremeau AS, Bourdel N, Jardon K, Rabischong B, Mage G, Pouly JL, Canis M |title=Surgical management of non-epithelial ovarian malignancies: advantages and limitations of laparoscopy |journal=Eur. J. Obstet. Gynecol. Reprod. Biol. |volume=172 |issue= |pages=106–10 |date=January 2014 |pmid=24315353 |doi=10.1016/j.ejogrb.2013.10.023 |url=}}</ref><ref name="pmid22525408">{{cite journal |vauthors=Schultz KA, Schneider DT, Pashankar F, Ross J, Frazier L |title=Management of ovarian and testicular sex cord-stromal tumors in children and adolescents |journal=J. Pediatr. Hematol. Oncol. |volume=34 Suppl 2 |issue= |pages=S55–63 |date=May 2012 |pmid=22525408 |doi=10.1097/MPH.0b013e31824e3867 |url=}}</ref><ref name="pmid22426486">{{cite journal |vauthors=Gershenson DM |title=Current advances in the management of malignant germ cell and sex cord-stromal tumors of the ovary |journal=Gynecol. Oncol. |volume=125 |issue=3 |pages=515–7 |date=June 2012 |pmid=22426486 |doi=10.1016/j.ygyno.2012.03.019 |url=}}</ref><ref name="pmid28276867">{{cite journal |vauthors=Färkkilä A, Haltia UM, Tapper J, McConechy MK, Huntsman DG, Heikinheimo M |title=Pathogenesis and treatment of adult-type granulosa cell tumor of the ovary |journal=Ann. Med. |volume=49 |issue=5 |pages=435–447 |date=August 2017 |pmid=28276867 |doi=10.1080/07853890.2017.1294760 |url=}}</ref><ref name="pmid26411956">{{cite journal |vauthors=Uma Devi K, Purushotham N, Jayashree N |title=Management of Ovarian Cancer In Younger Women |journal=Rev Recent Clin Trials |volume=10 |issue=4 |pages=263–9 |date=2015 |pmid=26411956 |doi= |url=}}</ref><ref name="pmid25886261">{{cite journal |vauthors=Qian Q, You Y, Yang J, Cao D, Zhu Z, Wu M, Chen J, Lang J, Shen K |title=Management and prognosis of patients with ovarian sex cord tumor with annular tubules: a retrospective study |journal=BMC Cancer |volume=15 |issue= |pages=270 |date=April 2015 |pmid=25886261 |pmc=4408581 |doi=10.1186/s12885-015-1277-y |url=}}</ref><ref name="pmid25969483">{{cite journal |vauthors=Chatziioannidou K, Botsikas D, Tille JC, Dubuisson J |title=Preservation of fertility in non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=May 2015 |pmid=25969483 |pmc=4434316 |doi=10.1136/bcr-2014-207841 |url=}}</ref> | ||
*Both benign and malignant ovarian sex cord-stromal tumors are managed surgically | *Both benign and malignant ovarian sex cord-stromal tumors are managed surgically | ||
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{{Family tree| | | | | | | | | | | | | | | | | h03 |h03= If clinical relapse: Clinical trial, consider secondary cytoreductive surgery, or recurrence therapy}} | {{Family tree| | | | | | | | | | | | | | | | | h03 |h03= If clinical relapse: Clinical trial, consider secondary cytoreductive surgery, or recurrence therapy}} | ||
{{familytree/end}} | {{familytree/end}} | ||
1.'''Non-fertility-sparing surgery''': | |||
*Treatment in all postmenopausal and pre-menopausal women with bilateral involvement of ovaries includes total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) | *Treatment in all postmenopausal and pre-menopausal women with bilateral involvement of ovaries includes total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) | ||
*The main difference between sex cord-stromal versus other ovarian neoplasms is that lymph node metastasis is rare | *The main difference between sex cord-stromal versus other ovarian neoplasms is that lymph node metastasis is rare | ||
*Thus, most clinicians prefer not to perform pelvic and paraaortic lymphadenectomy in most women with malignant sex cord-stromal neoplasms | *Thus, most clinicians prefer not to perform pelvic and paraaortic lymphadenectomy in most women with malignant sex cord-stromal neoplasms | ||
*However, lymphadenectomy is required for women with palpable nodal enlargement | *However, lymphadenectomy is required for women with palpable nodal enlargement | ||
2.'''Fertility-sparing surgery''': | |||
Unilateral salpingo-oophorectomy (USO) with preservation of the contralateral ovary and the uterus is | *Unilateral salpingo-oophorectomy (USO) with preservation of the contralateral ovary and the uterus is considered to be adequate surgical treatment for the majority of pre-menopausal patients with granulosa cell tumors | ||
3.'''Comprehensive surgical staging''': | |||
==Contraindications== | ==Contraindications== |
Revision as of 18:54, 12 April 2019
Sexcord/ stromal ovarian tumors Microchapters |
Differentiating Sexcord/ Stromal Ovarian Tumors from other Diseases |
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Risk calculators and risk factors for Sexcord/ stromal ovarian tumors surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Indications
- Surgical intervention is not recommended for the management of [disease name].
OR
- Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
- [Indication 1]
- [Indication 2]
- [Indication 3]
- The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
- [Indication 1]
- [Indication 2]
- [Indication 3]
Surgery
Primary surgery:
- Surgery is the mainstay of treatment for sexcord/ stromal ovarian tumors[1][2][3][4][5][6][7][8]
- Both benign and malignant ovarian sex cord-stromal tumors are managed surgically
- The schematic approach to malignant sexcord/ stromal ovarian tumors is decribed below
Malignant sexcord-stromal tumors | |||||||||||||||||||||||||||||||||||||||
Stage IA/IC: fertility desired | All others | ||||||||||||||||||||||||||||||||||||||
Fertility sparing surgery with complete staging | Complete staging | ||||||||||||||||||||||||||||||||||||||
Stage I, low risk | Stage I high risk(eg, ruptured stage IC or poorly differentiated stage I) or Intermediate risk(eg, heterologous elements | Stage II-IV | |||||||||||||||||||||||||||||||||||||
Observe | Observe or consider platinum based chemotherapy | platinum based chemotherapy or radiotherapy for limited disease | |||||||||||||||||||||||||||||||||||||
Surveillance | Surveillance | Surveillance | |||||||||||||||||||||||||||||||||||||
If clinical relapse: Clinical trial, consider secondary cytoreductive surgery, or recurrence therapy | |||||||||||||||||||||||||||||||||||||||
1.Non-fertility-sparing surgery:
- Treatment in all postmenopausal and pre-menopausal women with bilateral involvement of ovaries includes total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
- The main difference between sex cord-stromal versus other ovarian neoplasms is that lymph node metastasis is rare
- Thus, most clinicians prefer not to perform pelvic and paraaortic lymphadenectomy in most women with malignant sex cord-stromal neoplasms
- However, lymphadenectomy is required for women with palpable nodal enlargement
2.Fertility-sparing surgery:
- Unilateral salpingo-oophorectomy (USO) with preservation of the contralateral ovary and the uterus is considered to be adequate surgical treatment for the majority of pre-menopausal patients with granulosa cell tumors
3.Comprehensive surgical staging:
Contraindications
References
- ↑ Gurumurthy M, Bryant A, Shanbhag S (April 2014). "Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent)". Cochrane Database Syst Rev (4): CD006912. doi:10.1002/14651858.CD006912.pub2. PMID 24753008.
- ↑ Gremeau AS, Bourdel N, Jardon K, Rabischong B, Mage G, Pouly JL, Canis M (January 2014). "Surgical management of non-epithelial ovarian malignancies: advantages and limitations of laparoscopy". Eur. J. Obstet. Gynecol. Reprod. Biol. 172: 106–10. doi:10.1016/j.ejogrb.2013.10.023. PMID 24315353.
- ↑ Schultz KA, Schneider DT, Pashankar F, Ross J, Frazier L (May 2012). "Management of ovarian and testicular sex cord-stromal tumors in children and adolescents". J. Pediatr. Hematol. Oncol. 34 Suppl 2: S55–63. doi:10.1097/MPH.0b013e31824e3867. PMID 22525408.
- ↑ Gershenson DM (June 2012). "Current advances in the management of malignant germ cell and sex cord-stromal tumors of the ovary". Gynecol. Oncol. 125 (3): 515–7. doi:10.1016/j.ygyno.2012.03.019. PMID 22426486.
- ↑ Färkkilä A, Haltia UM, Tapper J, McConechy MK, Huntsman DG, Heikinheimo M (August 2017). "Pathogenesis and treatment of adult-type granulosa cell tumor of the ovary". Ann. Med. 49 (5): 435–447. doi:10.1080/07853890.2017.1294760. PMID 28276867.
- ↑ Uma Devi K, Purushotham N, Jayashree N (2015). "Management of Ovarian Cancer In Younger Women". Rev Recent Clin Trials. 10 (4): 263–9. PMID 26411956.
- ↑ Qian Q, You Y, Yang J, Cao D, Zhu Z, Wu M, Chen J, Lang J, Shen K (April 2015). "Management and prognosis of patients with ovarian sex cord tumor with annular tubules: a retrospective study". BMC Cancer. 15: 270. doi:10.1186/s12885-015-1277-y. PMC 4408581. PMID 25886261.
- ↑ Chatziioannidou K, Botsikas D, Tille JC, Dubuisson J (May 2015). "Preservation of fertility in non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules". BMJ Case Rep. 2015. doi:10.1136/bcr-2014-207841. PMC 4434316. PMID 25969483.