Stromal tumors start from the structural cells that hold the ovary together and produce the female hormones estrogen. Stromal tumors often produce estrogen as well as inhibin A and B. Less often, they produce androgens (male hormones). Epithelial and germ cell tumors are more common than stromal tumors.
Surgery
Most stromal tumors are confined to the ovary and are cured with surgery to remove the ovary containing the tumor. The other ovary can be biopsied if the doctor strongly suspects cancer is there, too. Stromal tumors rarely spread beyond the ovary. If they do, the surgical treatment includes removing the involved ovary and as much tumor as possible (debulking).
Chemotherapy
Chemotherapy (chemo) is a treatment option for stromal cell cancers that have spread outside the ovary (stages II, III, and IV). It may also be offered to patients with high-risk stage I tumors -- this includes very large tumors (at least 10 cm to 15 cm), tumors that have ruptured (split open), and high-grade tumors. However, observation without chemo is often recommended since these tumors often don’t respond as well to chemo as epithelial ovarian cancers do. Stromal cell cancers can be treated with the same chemo that is used for germ cell cancers. The combination of carboplatin and paclitaxel (Taxol) is also used.
Radiation therapy
Radiation therapy may help treat disease when it is limited to a specific area. However, it is rarely used.
Hormone therapy
Leuprolide (Lupron) is a drug that turns-off the natural signal that tells the ovaries to make estrogen. Sometimes this signal encourages stromal tumors to grow, and stopping the signal can inhibit growth of the tumor. The drug tamoxifen, which acts like an anti-estrogen, has also helped some women with stromal cell cancers, as have aromatase inhibitors. Hormone therapy is usually only used for stromal tumors that have come back after treatment or in women who cannot tolerate chemo, but who want to try a treatment.
Treatment of stromal tumors by stage
Stage I
All stage I tumors are treated with surgery. Most patients with stage I tumors are watched closely after the operation and don’t require further treatment. Some stage I tumors are more likely to come back after surgery. These cancers are said to be at high-risk for recurrence. Features that make a stage I tumor high-risk include very large tumors, tumors where the cyst broke open (ruptured), and poorly-differentiated tumors (also called high grade -- the cancer cells don’t look very much like normal tissue when examined under the microscope). Patients with high-risk stage I stromal cancers have 3 options after surgery: observation (being watched closely), chemo, or (rarely) radiation therapy
Stages II, III, and IV
After surgery for staging and debulking, treatment with chemo is usually given. Rarely, radiation therapy is an option as well.
Relapse/recurrence
Stromal cell cancers may come back years later. Even so, the prognosis (outlook) may still be good because they grow so slowly. Repeat surgery may be performed. Any of the chemo regimens for initial treatment can also be used for treatment of relapse. Hormone therapy is also an option to treat recurrence. There really isn't a standard treatment for recurrent stromal cancer, so treatment as part of a clinical trial is also a good option. Radiation therapy may sometimes be helpful for recurrent cancer.
For tumors that produce hormones, the hormone blood levels may be checked at regular intervals after surgery to check for increased levels that could suggest a return of the tumor. Serum inhibin may also be followed in select stromal tumors.
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