Sexcord/ stromal ovarian tumors surgery
|
Sexcord/ stromal ovarian tumors Microchapters |
|
Differentiating Sexcord/ Stromal Ovarian Tumors from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Sexcord/ stromal ovarian tumors surgery On the Web |
|
American Roentgen Ray Society Images of Sexcord/ stromal ovarian tumors surgery |
|
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) |
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 |
|
|
| Radiological imaging | Reserved for patients with symptoms, elevated biomarkers, or suspicious findings on physical exam | Reserved for patients with symptoms, elevated biomarkers, or suspicious findings on physical exam |
Treatment of recurrence:
- There is no much data available on the optimal treatment of patients with recurrence of disease[10][11][12][13][14]
- For women who undergo complete resection and/or have no residual disease at the end of surgery, systemic therapy is often used
- However, if the recurrence seems to be resectable, then surgical treatment may offer a survival advantage
- Medical therapy is generally recommended for women who are:
- Not candidates for surgery
- Have residual disease after surgery
- Experience multiple recurrences
- Bleomycin, etoposide, and cisplatin (BEP) and paclitaxel plus carboplatin are the most commonly utilized platinum-based regimens for these patients.
Chemotherapy
- Adjuvant chemotherapy is usually considered for patients with poor prognosis factors such as: [9][12][13]
- 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.
- ↑ Sehouli J, Drescher FS, Mustea A, Elling D, Friedmann W, Kühn W, Nehmzow M, Opri F, Klare P, Dietel M, Lichtenegger W (2004). "Granulosa cell tumor of the ovary: 10 years follow-up data of 65 patients". Anticancer Res. 24 (2C): 1223–9. PMID 15154651.
- ↑ Mangili G, Sigismondi C, Frigerio L, Candiani M, Savarese A, Giorda G, Lauria R, Tamberi S, Greggi S, Lorusso D (July 2013). "Recurrent granulosa cell tumors (GCTs) of the ovary: a MITO-9 retrospective study". Gynecol. Oncol. 130 (1): 38–42. doi:10.1016/j.ygyno.2013.04.047. PMID 23623833.
- ↑ 12.0 12.1 Gershenson DM, Morris M, Burke TW, Levenback C, Matthews CM, Wharton JT (April 1996). "Treatment of poor-prognosis sex cord-stromal tumors of the ovary with the combination of bleomycin, etoposide, and cisplatin". Obstet Gynecol. 87 (4): 527–31. doi:10.1016/0029-7844(95)00491-2. PMID 8602303.
- ↑ 13.0 13.1 Homesley HD, Bundy BN, Hurteau JA, Roth LM (February 1999). "Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: A Gynecologic Oncology Group study". Gynecol. Oncol. 72 (2): 131–7. doi:10.1006/gyno.1998.5304. PMID 10021290.
- ↑ Brown J, Shvartsman HS, Deavers MT, Burke TW, Munsell MF, Gershenson DM (September 2004). "The activity of taxanes in the treatment of sex cord-stromal ovarian tumors". J. Clin. Oncol. 22 (17): 3517–23. doi:10.1200/JCO.2004.12.074. PMID 15337800.