Sexcord/ stromal ovarian tumors surgery: Difference between revisions
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(i.e, 6-12 mo if early stage and low-risk disease,4-6 mo if high-risk disease) | |||
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|Serum tumor markers | |Serum tumor markers | ||
| | |Testing as clinically indicated, if applicable | ||
If done frequency based on stage(i.e, 6-12 mo if early stage and low-risk disease,4-6 mo if high-risk disease) | |||
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Revision as of 19:53, 12 April 2019
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Sexcord/ stromal ovarian tumors Microchapters |
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Differentiating Sexcord/ Stromal Ovarian Tumors from other Diseases |
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Treatment |
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Sexcord/ stromal ovarian tumors surgery On the Web |
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American Roentgen Ray Society Images of Sexcord/ stromal ovarian tumors surgery |
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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][9]
- 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
| 0-2 yrs | After 2 yrs | ||
|---|---|---|---|
| Physical exam | As clinically indicated based on stage
(i.e, 6-12 mo if early stage and low-risk disease,4-6 mo if high-risk disease) |
||
| Serum tumor markers | Testing as clinically indicated, if applicable
If done frequency based on stage(i.e, 6-12 mo if early stage and low-risk disease,4-6 mo if high-risk disease) |
||
| Radiological imaging |
Chemotherapy
- Adjuvant chemotherapy is usually considered for patients with poor prognosis factors such as: [9]
- Large tumour size
- High mitotic activity-index or
- Ruptured tumours
- BEP(bleomycin, etoposide, cisplatin) is the most accepted regimen even for recurrent disease that is refractory to hormone therapy
Hormonal therapy
- Hormone treatment is usually added for advanced granulosa cell tumors(GrCTs), given their frequent association with oestrogen dependence and usually indolent course
- Bone densitometry monitoring is indicated for patients receiving aromatase inhibitors
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.
- ↑ 9.0 9.1 Nasioudis D, Orfanelli T, Frey MK, Chapman-Davis E, Caputo TA, Witkin SS, Holcomb K (March 2019). "Role of adjuvant chemotherapy in the management of non-granulosa cell ovarian sex cord-stromal tumors". J Gynecol Oncol. 30 (2): e19. doi:10.3802/jgo.2019.30.e19. PMC 6393626. PMID 30740951.