Granulosa cell tumors represent tumors of the ovary (ovary). They are usually slow-growing tumors with low malignancy. Although there is a juvenile and adult form of the disease, the average age of onset is about 52 years.
What is a granulosa cell tumor?
A granulosa cell tumor is a very rare tumor of the ovary. It belongs to the group of tumors called gonadal stromal tumors. Within the group of ovarian tumors, it accounts for only one to two percent. The granulosa cells within the ovary are affected by the growth. These are located there in the multilayer granule cell layer and are responsible for the formation of the egg mound. The egg cell then adheres to the egg mound. The name “granulosa cell” comes from Latin and means “granule cell”. Originally, granulosa cells develop during follicle maturation from the so-called follicular epithelial cells, which originate from the primary follicle. Follicle maturation takes place under the influence of the follicle-stimulating hormone FSH, which belongs to the gonatropins. Among the functions of the granulosa cells is the secretion of the fluid that fills the follicular cavity. After follicular rupture, the granulosa cells build up a layer that forms a sheath around the oocyte. Furthermore, some granulosa cells deposit lipids to form the so-called corpus luteum, which mainly produces the corpus luteum hormone progesterone. In addition, the granulosa cells also produce estrogens. In rare cases, the granulosa cells degenerate and a granulosa cell tumor develops. There are two forms of this disease. Every twentieth case of granulosa cell tumor begins in adolescence or even in childhood. This is called juvenile granulosa cell tumor. The adult form of this tumor, which is considerably more common, begins on average at the age of 52. Both forms are characterized by increased estrogen production and slow growth. The prognosis is usually good. However, it also depends on the stage at which the disease is detected and treated.
Causes
Little can be said about the cause of granulosa cell tumor. It is likely that, especially in the adult form, the usual risk factors lead to degeneration of the granulosa cells. Spontaneous mutations certainly play a role. How the juvenile form of granulosa cell tumor develops requires further investigation. Even today, this disease is poorly understood.
Symptoms, complaints, and signs
Granulosa cell tumor elicits two sets of symptoms, one related to increased estrogen production and the other to the progressive space-occupying nature of the tumor. The increased estrogen secretion can trigger a so-called pseudopubertas praecox in young girls before actual puberty. In this case, all the manifestations of female puberty occur too early with the premature maturation of the skeleton. The epiphyseal joints close too early, which may result in short stature. The uterus is constantly stimulated to grow, with the possible occurrence of intermenstrual bleeding. After menopause (menopause), bleeding often still occurs as well. The continuous stimulation of the uterus can also lead to uterine cancer in some cases. The other symptom complex relates to the spatial extent of the tumor. Thus, the tumor may press on the intestine and cause nonspecific abdominal discomfort. Many patients suffer from a feeling of fullness, constipation and enlargement of the abdominal circumference. In large tumors, there is a risk of stalk rotation, which can lead to acute abdominal discomfort. Granulosa cell tumor tends to metastasize, with swelling of the lymph nodes in the pelvic region and near the aorta.
Diagnosis
If unusual interstitial bleeding and enlargement of the abdominal circumference occur, imaging techniques such as sonography should be used to look for possible tumors in the abdominal area. Today, the disease is often not detected until the tumor has reached a significant size. Only after surgery can a biopsy determine what type of tumor it is. In many cases, the tumor is also found by manual palpation.
Complications
Granulosa cell tumor causes various symptoms and complications, which only affect women.In most cases, there is a premature onset of puberty. As a result, the female organs cannot develop fully and it is not uncommon for a short stature to occur. The uterus can also be affected by heavy and frequent bleeding. However, the symptoms also occur in adulthood, with women in the menopause being particularly affected. In this case, cervical cancer can also occur, which can continue to spread to other regions without treatment. The tumor can also press on the intestine, which can lead to various complaints. Life expectancy is limited and reduced by the granulosa cell tumor in most cases. The treatment of the tumor is surgical and there are no complications. However, it cannot be predicted whether the tumor may have spread to other parts of the body. In this case, further complications may occur. In most cases, radiation is performed after the removal. The earlier the granulosa cell tumor is detected and treated, the higher the patient’s chances of survival.
When should you see a doctor?
In the worst case, a granulosa cell tumor can lead to the death of the affected person, which is why treatment is absolutely necessary. Short stature may indicate a granulosa cell tumor. If this is detectable in a person, he or she will need regular examinations later in life to avoid further complications and discomfort. Persistent constipation or a severe feeling of fullness may also indicate granulosa cell tumor and should be investigated if these symptoms occur over a long period of time. There is generally severe discomfort in the abdomen and also severely swollen lymph nodes. In women, this tumor can also cause a tumor in the cervix, so a medical professional should also be consulted if symptoms occur in this region. In the first instance, a general practitioner can be contacted if a granulosa cell tumor is suspected. This doctor will then refer the affected person to the relevant specialist, who will be able to make a precise diagnosis. With an early diagnosis, the chances of a complete cure increase enormously.
Treatment and therapy
After the tumor is discovered, the treatment of choice is its complete removal. In the early stages of the disease, a unilateral adnectomy (removal of the fallopian tubes and ovary) and scraping of the uterus can be performed. In later stages, complete adnectomy is appropriate. In addition, the uterus may also be removed, as there is a risk of developing uterine cancer. If metastases have already formed in the lymph nodes, the affected lymph nodes should also be removed. In some cases, recurrences form years later even after the tumor is supposedly completely removed. Since recurrences also grow slowly and with little infiltration, surgery is still a successful treatment method in this case as well. In advanced stages of a granulosa cell tumor, supportive chemotherapy or radiotherapy is still performed after surgery. Radiotherapy is used when there are still tumor remnants that could not be removed during surgery. Adjuvant (supportive) chemotherapy is given when recurrences occur. Overall, the ten-year survival rate is approximately 70 to 95 percent. However, it also depends on the stage at which the disease is first treated.
Outlook and prognosis
The prospect of a cure is linked to various conditions in granulosa cell tumor. Basically, the disease occurs exclusively in the female sex and may spread to such an extent that it is no longer treatable or treatable. This results in the premature death of the patient. The mortality rate is on average less than twenty percent. With timely diagnosis and initiation of treatment, there is a good chance of cure. Nevertheless, secondary complications are to be expected due to the possible therapies. Some patients undergo surgical removal of the uterus because no other therapy is possible. The operation is associated with the usual risks and at the same time it is accompanied by infertility of the woman. This can cause emotional as well as psychological problems and result in secondary diseases. At the same time, the hormonal balance must be changed and supported.If cancer therapy occurs, numerous side effects are to be expected. Chemotherapy represents a considerable interference in the patient’s lifestyle and triggers various complications. Nevertheless, the probability of survival increases with this form of treatment. At an early stage of the disease, complete freedom from symptoms and recovery can take place by means of a curettage. If this is successful, the patient can be discharged from treatment within a short time.
Prevention
Since the causes of granulosa cell tumor are not sufficiently known, no specific preventive measures against this disease can be mentioned. Certainly, a healthy lifestyle with a balanced diet, plenty of exercise and little stress to strengthen the immune system generally lowers the risk of developing this tumor.
Follow-up
In the case of a granulosa cell tumor, there are usually no follow-up care options available to the patient. In this case, the patient is primarily dependent on early detection and treatment of the tumor to prevent further complications. No self-healing occurs with this disease. Even after successful treatment of the granulosa cell tumor, regular examinations of the body should be performed in order to identify and treat new tumors in time. Possibly, the granulosa cell tumor also reduces the life expectancy of the affected person. Treatment for this type of cancer is done by surgery or chemotherapy. The patient should always rest and take care of the body after such an operation. Here, all strenuous and stressful activities or activities should be avoided in order not to put unnecessary strain on the body. Unnecessary stress should also be avoided in the case of chemotherapy. Those affected by a granulosa cell tumor also need the support of friends and family. This can prevent psychological upsets that could have a negative effect on the further course of the disease. Since granulosa cell tumor can also recur after treatment, the body should be examined regularly for this tumor.
This is what you can do yourself
Granulosa cell tumor is a form of ovarian cancer and can only affect female patients. It is a serious and life-threatening disease that absolutely must be treated under medical supervision. Therapies usually take place surgically followed by chemotherapy or radiation and are performed by medically trained personnel. Therefore, the patient has no possibility to treat her disease herself. Nevertheless, the patient can contribute significantly to the success of the treatment. First and foremost, by following the instructions of her doctors and carrying out the therapies consistently and without interruption as planned. Regular check-ups and discussions of the further course of therapy should be attended. Parallel to medical therapy, there are a number of factors through which the patient can promote her own recovery. A positive attitude towards life can help to better accept and cope with the side effects of the treatment. Since the body is severely weakened by the therapies and by possible operations, it should be strengthened and supported as much as possible from other sides. A healthy and balanced diet that relieves the body helps here. Alcohol and too much caffeine should be avoided completely, and smoking should also be stopped. All these so-called stimulant poisons consume forces that are otherwise no longer available to the body for healing and regeneration.
