All stage I tumors are treated with surgery to remove the ovary with the tumor. 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), chemotherapy (chemo), or (rarely) radiation therapy
Stages II, III, and IV
These cancers are treated with surgery to remove the ovary with the tumor. Surgery is also used to stage and debulk the cancer, as needed (this is discussed in the section about surgery). This may be followed by chemo or hormone therapy. Often, the chemo used is what’s used in the treatment of germ cell tumors (PEB: cisplatin, etoposide, and bleomycin). The combination of carboplatin and paclitaxel (Taxol) may also be used. Hormone treatment is most often used to treat advanced stromal tumors in women who cannot tolerate chemo, but who want to try treatment. This can mean treatment with a drug such as leuprolide (Lupron) and goserelin (Zoladex), the drug tamoxifen, or an aromatase inhibitor. Rarely, radiation therapy is an option as well.
Cancer that comes back after treatment is said to be recurrent. This can happen years later for stromal tumors. Even so, the prognosis (outlook) may still be good because they grow so slowly. Surgery may be repeated. Any of the chemo regimens used initially can also be used to treat a 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 the tumor has returned. The level of inhibin can also go up with some stromal tumors and may be useful to in finding a recurrence
Last Revised: 02/04/2016