Granulosa Cell Tumor

What is a granulosa cell tumor?

A granulosa cell tumor (GCT) is a type of ovarian tumor. GCTs are the most common type of sex cord-stromal tumor. In people assigned female at birth, sex cord-stromal tumors are tumors that occur in tissues around their ovaries. These tumors cause high levels of estrogen, one of the female sex hormones. They can occur at any age ages, but the average age of diagnosis is 50 years old.

Where do granulosa cell tumors form?

GCTs form within the ovary. Ovaries are part of the female reproductive system. They produce eggs (ova) and estrogen and progesterone, two reproductive hormones.

How common are granulosa cell tumors?

Granulosa cell tumors are rare. They account for about 5% of primary ovarian tumors. Primary ovarian tumors are tumors that start in your ovary.

Are granulosa cell tumors benign or malignant?

Granulosa cell tumors are usually malignant (cancerous). But most GCTs grow slowly. Most of the time, healthcare providers diagnose them in early stages when they have good treatment outcomes.

What is the difference between adult and juvenile granulosa cell tumors?

GCTs are more common in adults. About 95% of GCT diagnoses are in mature adult women. When a GCT occurs in someone under 30, it’s usually juvenile type GCT. A juvenile GCT can be more likely than an adult GCT to recur (come back) within a few years and be more aggressive if diagnosed after it has already spread outside your ovary.

What causes a granulosa cell tumor?

Experts don’t entirely understand what causes granulosa cell tumors. They often have a mutation (change) in the FOXL2 gene. FOXL2 typically functions to help granulosa cells develop normally.

What are the symptoms of a granulosa cell tumor?

The most common symptom of a GCT is high estrogen. In girls, high estrogen may cause early puberty. In adults, GCTs commonly cause:

• Abnormal uterine bleeding (AUB) or postmenopausal bleeding.
• Increased abdomen size (a swollen belly).
• Irregular menstrual cycles or absence of menses.
• Tender or sore breasts.

GCTs may also cause abdominal pain. Usually, you only experience this symptom if the tumor ruptures (bursts).

What are the complications of granulosa cell tumors?

Without treatment, granulosa cell tumors can increase your risk of other health complications, including:

• Endometrial hyperplasia, an unusually thick uterine lining.
• Uterine cancer.
• Breast cancer.
• Infertility.

How is a granulosa cell tumor diagnosed?

Typically, healthcare providers use imaging techniques to diagnose granulosa cell tumors. You may have a:

• CT scan.
• MRI.
• Transvaginal ultrasound.

Your provider may also use blood tests, such as tumor markers. Inhibin is a tumor marker produced by granulosa cell tumors. You may also need blood tests to rule out other conditions.

How are granulosa cell tumors treated?

The first treatment for a granulosa cell tumor is surgery. Your surgeon will remove as much of the tumor as possible while keeping healthy tissue intact. If you don’t plan on having children or are past childbearing years, your doctor may recommend ovarian removal (oophorectomy) and possibly removal of the uterus (hysterectomy). You may need an oophorectomy to remove the entire GCT.

Providers use a process called staging to determine the location of the granulosa cell tumor. Staging tells your provider whether cancer has spread.

• Stage 1 GCTs haven’t spread outside your ovaries.
• Stage 2 to 4 GCTs have spread (metastasized) to other parts of your body.

As many as 9 in 10 GCTs are diagnosed while they are only in your ovary. For these tumors, surgery is generally recommended, and may be the only treatment needed.

Depending on the tumor size and risk factors for recurrence, you may also have treatment designed to keep the tumor from coming back (recurring). Your provider may also recommend:

• Chemotherapy.
• Hormone therapy.
• Radiation therapy.

How can I prevent a granulosa cell tumor?

There’s no guaranteed way to prevent a granulosa cell tumor. You can live an overall healthier life and decrease your risk of chronic disease by:

• Achieving and maintaining a weight that’s healthy for your body type, sex and age.
• Avoiding smoking.
• Eating a nutritious diet.
• Exercising regularly for cardiovascular and bone health.
• Limiting alcohol and caffeine.
• Managing stress with healthy coping strategies, such as mindfulness or meditation.
• Sleeping seven to eight hours per night.

How can I reduce my risk of granulosa cell tumor complications?

If you have any symptoms that could point to a GCT, see a healthcare provider right away. If you have irregular bleeding, breast tenderness or bleeding after menopause, see your healthcare provider. Early treatment for GCTs typically leads to excellent outcomes.

Are granulosa cell tumors curable?

Yes. Surgery can cure GCTs, especially when surgeons remove them early.

Curing a GCT is less likely if a healthcare provider finds it after it has already spread to other parts of your body. If you have symptoms of a GCT, see your healthcare provider right away.

What can I expect after GCT treatment?

After tumor removal, you need regular follow-up with your healthcare provider for many years because these tumors can come back many years later. Your provider examines you to ensure the tumor hasn’t returned. You may have:

• Pelvic exams.
• Blood tests to look for markers of possible cancer recurrence.
• Imaging tests.

What is the outlook for granulosa cell tumors?

The outlook for a GCT depends on how advanced the tumor was (stage) when you received a diagnosis. If your provider diagnoses GCT before it spreads to other parts of your body (metastasizes), the outlook is good.

What else should I ask my doctor?

You may also want to ask your healthcare provider:

• What is the most likely cause of symptoms?
• What tests do I need to diagnose a granulosa cell tumor?
• What are the treatment options?
• What is the likelihood a GCT will return after treatment?
• What is the outlook after removing a granulosa cell tumor?

A note from Cleveland Clinic

Granulosa cell tumors are rare, usually slow-growing ovarian tumors. They grow in the tissues around your ovaries. Often, they produce hormones, leading to high estrogen. High estrogen may cause abnormal bleeding, irregular periods or a larger abdomen. The first treatment is usually surgery to remove the tumor. If you have an increased risk of a GCT coming back, your doctor may recommend chemotherapy, hormone therapy or radiation therapy. When you find a GCT in its early stages, the outlook is usually good.