Have you or someone close to you been recently diagnosed with a granulosa cell tumour? Whilst the name may sound daunting and scary, this article will aim to cover all the burning questions you have in your head about this relatively rare cancer.
Granulosa cell tumours arise in the ovarian reproductive tissue and can be benign or malignant. This article will aim to discuss all the different factors surrounding granulosa cell tumours such as risk factors, diagnosis, and treatment plans as well as cover frequently asked questions that many have been debating over this condition.
Granulosa cell tumours (GCTs) are rare ovarian neoplasms that arise from the granulosa cells, which are a part of the ovarian reproductive tissue. These tumours typically occur in women of reproductive age (15-49) and can be either benign (noncancerous) or malignant (cancerous). Granulosa cell tumours are low-grade malignancies, meaning that they tend to grow slowly and have a relatively good prognosis compared to other types of ovarian cancers.
Causes of granulosa cell tumour
The exact cause of granulosa cell tumours is still unknown. However, research has identified certain risk factors that may increase the risk of developing these tumours. These include:
- A history of certain genetic syndromes (such as Turner syndrome or multiple endocrine neoplasia type 1)
- Exposure to oestrogen therapy
- The presence of certain types of tumours in the contralateral ovary
Additionally, there may be a link between granulosa cell tumours and infertility, although the exact nature of this association is still under investigation1.
Signs and symptoms of granulosa cell tumour
Symptoms of granulosa cell tumours can vary depending on whether they are benign or malignant. In many cases, these tumours are discovered incidentally during routine gynaecological examinations or imaging studies.
However, some women may experience symptoms such as:
- Abdominal pain or discomfort
- Abnormal vaginal bleeding
- Pelvic mass or swelling
- Menstrual irregularities.
These symptoms are nonspecific and can be indicative of other gynaecological conditions as well, making the diagnosis of granulosa cell tumours slightly challenging2.
Management and treatment for granulosa cell tumour
The main treatment option for GCTs is surgery to remove the tumour and affected ovarian tissue. This is generally in two main scenarios:
- In cases where the tumour is localised and confined to one ovary, a unilateral oophorectomy (removal of the affected ovary) may be performed.
- In situations where the tumour has spread to both ovaries or beyond, a total hysterectomy (removal of the uterus and both ovaries) may be necessary.
In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended, particularly for women with malignant or recurrent tumours.
Chemotherapy drugs such as the ones listed below are the most common in treating granulosa cell tumours:
- BEP (bleomycin, etoposide, and cisplatin)
- EP (etoposide and cisplatin)
- Carboplatin and paclitaxel
Due to granulosa cell tumours being a relatively rare type of cancer, there is not much being done in terms of research and clinical trials as funding is limited.
However, the prognosis for granulosa cell tumours is generally favourable, particularly for those diagnosed with early-stage, low-grade tumours. The five-year survival rate for patients with granulosa cell tumours is relatively high, ranging from 80% to 95%. However, the long-term outlook can vary depending on several factors, including the tumour’s stage, grade, and whether it has spread to other parts of the body.
Regular follow-up care is essential for individuals who have been diagnosed with granulosa cell tumours. This typically involves:
- Periodic imaging studies
- Blood tests
- Clinical examinations to monitor for any signs of recurrence or progression.
Additionally, given the potential impact on fertility, women who wish to conceive after treatment may benefit from consulting with a fertility specialist to explore their options. This may include fertility treatments such as ovarian stimulation medications and IVF if necessary3.
Diagnosis of granulosa cell tumours is often complicated and unclear as signs and symptoms of this condition often overlap with other gynaecological issues and are often only picked up during a routine gynaecological visit. However, if a diagnosis of GTC is probable a variety of tests will be conducted to determine this.
- Transvaginal ultrasound, which allows for the visualisation of the ovaries and any abnormalities.
- Blood tests to measure levels of certain hormones, such as inhibin and anti-Mullerian hormone (AMH).
- A biopsy or surgical removal of the tumour is often necessary to obtain a definitive diagnosis and determine whether the tumour is benign or malignant4.
Although prognosis is generally favourable in those who have suffered from granulosa cell tumours there are some long-term effects because of cancer treatment.
The complications of oophorectomy and hysterectomy include:
- Menopause signs and symptoms, such as hot flashes and vaginal dryness.
- Bone mineral loss
- Depression or anxiety
- Heart disease
- Memory problems
- Decreased sex drive
These complications are caused due to a lack of hormones oestrogen and progesterone due to the removal of the ovaries.
Some complications may arise due to chemotherapy treatment. These include:
- Secondary cancers
- Cardiovascular disease
- Peripheral neuropathy
- Reduced bone density
- Hepatic dysfunction
- Visual changes
- Obesity and metabolic syndrome
- Infertility and hormonal disturbance5
How can I prevent granulosa cell tumour?
Since the cause of granulosa cell tumours remains unclear it is very difficult to determine any preventative measures. However as discussed earlier in the article if you fall into any of the risk categories for developing GTCs such as having a family history or any previous tumours in the ovaries, it may be wise to go for gynae screenings often and notify your doctor on the off chance that a tumour may develop, you have the best chance of catching it early6.
How common is granulosa cell tumour?
Granulosa cell tumours are relatively rare affecting around 5 in every 100 women who suffer from this type of cancer. These types of tumours are slow growing and difficult to diagnose therefore the data on this is rather minimal7.
Who is at risk of granulosa cell tumour?
Certain people have certain risk factors that may make them more likely to develop a granulosa cell tumour. These include:
- a history of certain genetic syndromes (such as Turner syndrome or multiple endocrine neoplasia type 1)
- exposure to oestrogen therapy
- the presence of certain types of tumours in the contralateral ovary8
When should I see a doctor?
If you exhibit any of the signs or symptoms of a granulosa cell tumour or fall into any of the risk groups, it would be recommended to speak to your healthcare provider about having some tests and scans conducted to assess whether you are suffering from GTC9.
In conclusion, granulosa cell tumours are rare ovarian neoplasms that can occur in women of reproductive age. While they can be benign or malignant, most of these tumours are low-grade malignancies. Early detection and appropriate management, including surgical removal of the tumour, can lead to favourable outcomes for most patients. As with any medical condition, timely diagnosis and a comprehensive treatment plan tailored to the individual's circumstances are crucial in optimising the chances of a successful recovery.
- Khosla D, Dimri K, Pandey AK, Mahajan R, Trehan R. Ovarian Granulosa Cell Tumor: Clinical Features, Treatment, Outcome, and Prognostic Factors. N Am J Med Sci [Internet]. 2014 [cited 2023 Jun 15]; 6(3):133–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978936/.
- Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care [Internet]. Washington, D.C.: National Academies Press; 2015 [cited 2023 Jun 15]. Available from: http://www.nap.edu/catalog/21794.
- Vani BR, Geethamala K, Geetha RL, Srinivasa MV. Granulosa cell tumor of ovary: A clinicopathological study of four cases with brief review of literature. J Midlife Health [Internet]. 2014 [cited 2023 Jun 15]; 5(3):135–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195186/.
- Brink GJ, Groeneweg JW, Hooft L, Zweemer RP, Witteveen PO. Response to Systemic Therapies in Ovarian Adult Granulosa Cell Tumors: A Literature Review. Cancers (Basel) [Internet]. 2022 [cited 2023 Jun 15]; 14(12):2998. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221362/.
- Kottarathil VD, Antony MA, Nair IR, Pavithran K. Recent Advances in Granulosa Cell Tumor Ovary: A Review. Indian J Surg Oncol [Internet]. 2013 [cited 2023 Jun 15]; 4(1):37–47. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578540/.
- Canbay E, Ishibashi H, Sako S, Miyata R, Nishino E, Yonemura Y. Management of peritoneal dissemination of recurrences granulosa cell tumor of the ovary. Gan To Kagaku Ryoho. 2012; 39(12):2435–7. Available from: https://pubmed.ncbi.nlm.nih.gov/23268102/
- Li J, Bao R, Peng S, Zhang C. The molecular mechanism of ovarian granulosa cell tumors. Journal of Ovarian Research [Internet]. 2018 [cited 2023 Jun 15]; 11(1):13. Available from: https://doi.org/10.1186/s13048-018-0384-1.
- Sex cord stromal tumours [Internet]. [cited 2023 Jun 15]. Available from: https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/types/sex-cord-stromal.
- Kulkarni RV, Nayak B, Parija J, Mohapatra J, Mohapatra M, Padhy A. Prognostic Factors of Granulosa Cell Tumors: A Retrospective Study in a Tertiary Care Cancer Centre of Eastern India. South Asian J Cancer [Internet]. 2022 [cited 2023 Jun 15]; 11(1):40–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273323/.
- Plett H, Ricciardi E, Vacaru V, Ramspott JP, Colombo N, Sehouli J, et al. Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence. International Journal of Gynecologic Cancer [Internet]. 2023 [cited 2023 Jun 15]; 33(5). Available from: https://ijgc.bmj.com/content/33/5/734.