Stromal tumors start from connective tissue cells, which hold the ovary together and produce hormones. Cells of stromal tumors often produce estrogen and progesterone (female hormones). 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 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 chemotherapy is often recommended since these tumors often do not respond to chemotherapy as well as epithelial ovarian cancers do. Stromal cell cancers can be treated with the same chemotherapy that is used for germ cell cancers. The combination of carboplatin and paclitaxel (Taxol) is also used.

Radiation therapy

This may be helpful in treating advanced 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. Hormone therapy is usually only used for stromal tumors that have come back after 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 do not 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 do not 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, or (rarely) radiation therapy

Stages II, III, and IV

After surgery for staging and debulking, treatment with chemotherapy is usually given. Rarely, radiation therapy is an option as well.

Relapse/recurrence

Stromal cell cancers may come back years later. Even so, their prognosis (outlook) may still be good because they grow so slowly. Repeat surgery may be performed. Any of the chemotherapy regimens for initial treatment can also be used for treatment of relapse. Hormone therapy is also an option to treat recurrence. Because there really isn't a standard treatment for recurrent stromal cancer, 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 levels may be watched after surgery to check for increased levels in the blood that could suggest a return of the tumor. Serum inhibin may also be followed in estrogen-secreting tumors.

Last Medical Review: 08/27/2009
Last Revised: 08/27/2009