Granulosa tumours are a type of sex cord stromal tumours. Less than 5 out of 100 women with ovarian cancer (5%) have this type.
What granulosa tumours are
Granulosa tumours are rare tumours of the ovary.
They are a type of sex cord stromal tumours. Sex cord stromal tumours start in the stroma or the sex cords. The stroma and the sex cords are tissues that support the ovary and from which different cells are developed. Out of 100 women with ovarian cancer, fewer than 5 will have a granulosa tumour (5%).
There are 2 main types of granulosa tumours:
- functioning tumours, which produce hormones and make the female hormone oestrogen
- non functioning tumours, which don’t produce hormones
Functioning tumours make the female hormone oestrogen.
We don’t know what causes this type of cancer, but we know most cancers are caused by a number of different factors working together.
The symptoms of functioning tumours are usually hormone related.
These symptoms include:
Menstrual changes (periods)
If you are still having periods they may become irregular, they may be very heavy and you may bleed between periods.
If you have had your menopause the most common symptom is vaginal bleeding. This happens because the hormones the tumour produces makes the lining of the womb thicker. This means that you may also need some tests to check your womb as well.
You may have breast tenderness and vaginal discharge due to the hormones.
Other symptoms of granulosa tumours can include:
- pain in the abdomen
- swelling of the abdomen
- passing urine more often than usual
The type of treatment you have will depend on:
- your age and whether you have been through the menopause
- whether you want to have children
- the stage of your cancer
There are different kinds of treatment for granulosa tumours.
Surgery is the main treatment for this type of ovarian cancer, and for many women it is the only treatment you need.
If you have had your menopause, you will have your ovaries, fallopian tubes and womb removed. Doctors call this operation a bilateral salpingo oophorectomy (pronounced sal-pin-go-oo-for-eck-tom-ee) and total abdominal hysterectomy.
If the tumour is only in one ovary, you are still having periods and haven't yet had all the children you want to, your surgeon may be able to remove just the ovary affected by the cancer and the fallopian tube on that side. This will leave your womb and the other ovary intact.
During surgery the doctors will also check the rest of your abdominal area for cancer.
If the cancer comes back in the same area you may have more surgery, and possibly other treatments too.
Doctors use chemotherapy to treat more advanced cancer, or cancer that has come back and can't be removed with surgery.
Generally, you have chemotherapy as a combination of 3 different drugs. Various different combinations are used but they all include a drug known as platinum.
One of the more common chemotherapy ‘regimens’ is called BEP.
This can also treat testicular cancer. All the drugs go into your bloodstream through a vein in your arm (intravenously) or through a central line.
You may have radiotherapy to treat the cancer if it comes back. It isn’t usually used as a first treatment.
Women with early stage granulosa tumour have a low risk of the cancer coming back. So, if all is well once you have recovered from your surgery, your surgeon (gynaecological oncologist) may discharge you. They will make sure you know how to contact them again if you develop any symptoms in the future.
Your doctor may want to see you regularly for a time, and this will be every few months at first. As time goes by it will become less often, if all is well. This follow up may continue for many years, as there is a chance the cancer can come back some years after treatment. Your doctor may discharge you after a time, with instructions on contacting them if you have any concerns.
Follow up may involve having a blood test. Doctors use these blood tests to look for a marker in your blood. A marker is a substance produced by cancer cells that can be picked up in blood. The level of the marker goes up as the cancer grows.
A number of different markers can be raised with granulosa tumours. It is important to remember that these markers may be raised for reasons other than cancer. But checking for these markers, alongside other tests, can sometimes help to show if the cancer has come back. The markers doctors may use to check for granulosa tumours are called inhibin, CA125 and Müllerian inhibiting substance or MIS (also called anti mullerian hormone - AMH).
Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.
Talking to other people who have the same thing can help. But it can be hard to find people who have had a rare type of cancer.
Cancer Research UK’s discussion forum, Cancer Chat, is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
Or contact the Rare Cancer Alliance who offer support and information to people who have rare cancers.
Research and clinical trials
There may be fewer clinical trials for rare types of cancer than for more common types.
It is hard to organise and run trials for rare cancers. Getting enough patients is critical to the success of a trial. The results won't be strong enough to prove that one type of treatment is better than another if the trial is too small.
The International Rare Cancers Initiative (IRCI) aims to develop more research into new treatments for rare cancers. They are designing trials that involve several countries so that more people will be available to enter trials.