Symptoms
The symptoms of granulosa cell tumors vary depending on the patient's age and the tumor's estrogen production. Common symptoms include:
Adult Granulosa Cell Tumors (AGCTs):
Abnormal vaginal bleeding (most common)
Postmenopausal bleeding
Enlarged ovaries or abdominal swelling
Uterine hyperplasia or endometrial cancer (due to prolonged estrogen exposure)
Breast tenderness
Juvenile Granulosa Cell Tumors (JGCTs):
Precocious puberty (early development of secondary sexual characteristics)
Vaginal bleeding
Breast development
Enlarged ovaries or abdominal swelling
Causes
The exact cause of granulosa cell tumors is not fully understood. However, genetic factors are known to play a role. Most adult granulosa cell tumors (AGCTs) have a somatic mutation in the FOXL2 gene. The cause of Juvenile Granulosa Cell Tumors are still not fully known.
Medicine Used
Treatment for granulosa cell tumors primarily involves surgery to remove the tumor. Additional treatments may include:
Surgery:
Unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) may be sufficient for women who wish to preserve fertility and have early-stage disease.
Total hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, both ovaries, and both fallopian tubes) may be recommended for women who have completed childbearing or have more advanced disease.
Chemotherapy:
Chemotherapy may be used for advanced-stage disease or recurrence. Common chemotherapy regimens include combinations of cisplatin, etoposide, and bleomycin (BEP) or carboplatin and paclitaxel.
Radiation Therapy:
Radiation therapy may be used in certain cases of recurrent or metastatic disease.
Hormonal Therapy:
Aromatase inhibitors may be used to reduce estrogen levels and slow tumor growth in some cases.
Is Communicable
Granulosa cell tumors are not communicable. They are not caused by infectious agents and cannot be spread from person to person.
Precautions
Since the exact cause is unknown, there are no specific precautions to prevent granulosa cell tumors. Women who experience abnormal vaginal bleeding, precocious puberty in young girls, or other unusual symptoms should seek prompt medical evaluation. Regular gynecological exams may help with early detection.
How long does an outbreak last?
Granulosa cell tumors do not have "outbreaks." They are tumors that develop over time. The time it takes for symptoms to become noticeable can vary. Some tumors are slow-growing and may take months or years to be detected, while others may present more rapidly.
How is it diagnosed?
Diagnosis of granulosa cell tumors typically involves:
Physical Examination: Including a pelvic exam.
Imaging Studies:
Ultrasound (transvaginal or abdominal)
CT scan or MRI of the pelvis and abdomen to assess the extent of the tumor and any spread to other organs
Blood Tests:
Hormone levels (estradiol, inhibin) may be elevated
Tumor markers (e.g., inhibin B)
Biopsy:
Surgical removal of the tumor with pathological examination of the tissue is the definitive method for diagnosis.
Timeline of Symptoms
The timeline of symptoms varies depending on the tumor subtype and growth rate:
Juvenile Granulosa Cell Tumors (JGCTs):
Precocious puberty symptoms (breast development, vaginal bleeding) may develop relatively quickly (weeks to months).
Abdominal swelling may occur later as the tumor grows.
Adult Granulosa Cell Tumors (AGCTs):
Abnormal vaginal bleeding may be intermittent and develop over months to years.
Postmenopausal bleeding may be the first noticeable symptom.
Abdominal swelling may occur later in the course of the disease.
Important Considerations
Fertility Preservation: For women who desire future fertility, unilateral salpingo-oophorectomy may be an option for early-stage disease.
Recurrence: Granulosa cell tumors can recur, even many years after initial treatment. Long-term follow-up is essential.
Endometrial Cancer Risk: Women with GCTs have an increased risk of endometrial cancer due to prolonged estrogen exposure. Regular endometrial biopsies may be recommended.
Psychological Support: A cancer diagnosis can be emotionally challenging. Support groups and counseling can be helpful.
Rare Disease: Due to the rarity of GCTs, treatment should ideally be managed by a multidisciplinary team with experience in treating gynecologic cancers.