Part 2 Sex cell stromal tumor

[kr2010]

Questions:

1.  My last follow up appointment, my gyn/onc told me I can go back to regular np.  My regular np was not comfortable due to lack of experience with gct.  I have read that those that are followed by gyn/onc live longer.  What are your thoughts?

2.  Since my fate gct stage 1c I believe.  Mass was large, significantly >15cm and there were cells on diaphram found in pelvic wash which puts me in higher risk group, plus, I have had many issues in the last 18 months-  those being thyroid, gi bleed, bowel obstruction.  My gyn/onc said chances better than not that it would not be back, oncologist i was referred to said it would be back.  At last hostpitalization I was told the longer I go without recurrence the better, so I assume this thing will be back.  Is there anything I should be doing to prevent it from coming back, other than the vitamin regimin i am  on and healthy diet.  I don't want this thing to come back, it was big and painful and i don't want more parts removed.

3.  now that most of my parts are gone, am i at an increased risk of this thing attacking a major organ, and if so is that it for me?  does a pelvic wash get rid of those cells that were floating around?

4.  I have read on the internet that stress/anxiety help cells grow elsewhere, what are your thoughts on that.  i have stress and anxiety by the way which i am working on.

5.  due to my surgery i am now at increased risk of heart disease, osteopoerois sp?.   does this mean, aside from everything else, im looking at heaving heart failure and broken bones in near future.  note:  i am taking vit d, calcium and have cut out saturated fats.  my last hospitlization 9/2011 i still had malnutrition issues, met with a nutritionist and have been working on diet and maintaining weight.  as long as i stay out of the hospital i maintain my weight, but the last 3 -4 stays i lost weight due to nfbm.

6.  what are the physical signs of a recurrence that I should watch for?

[Annekathryn Goodman, M.D.]

Hi There
thank you
so you have a stage Ic adult granulosa cell tumor.This is a sex cord stromal tumor

You have had complete staging.  The question of how much surgery to do is hard to evaluate in retrospect. You had a large tumor. These tumors can be very hemorrhagic, they can be stuck to the surrounding tissues - so sometimes it is necessary to remove the uterus to complete remove the tumor.

your risk factors for recurrence include:
large primary tumor - risk of recurrence increases with size greater than 10 cm
the malignant washings by the right diaphragm

having said that, it is not standard to give chemotherapy or radiation after primary surgery

the standard followup includes
pelvic exam and tumor marker labs at least every 6 months
after five years, we usually just do yearly checks but as granulosa cell tumor is a slow grower, one can see recurrences even 20 years later

the lab tests - tumor markers include
estrogen level
inhibin A and B levels
CA 125

CA 125 is really a tumor marker for epithelial ovarian cancers but it will become elevated if there is a tumor growth in the abdomen

as far as estrogen- the data suggests that estrogen replacement by itself does not increase the risk of breast cancer. It is the combination of estrogen with progresterone that increases the risk

here are some resources for you:
http://www.gctf.org.nz/

http://women.webmd.com/womens-health-initiative-whi-risks-and-benefits-of-hormone-replacement-therapy-hrt-and-estrogen

[kr2010]

This report is pretty long
Final Pathologic Diagnosis:
A.  Left ovary and fallopian tube, salpingo-oophorectomy.  1. 29 cm adult grandulosa cell tumor: see note. 2. unremarkable segment of falopian tube.
b.  omentum, biopsy. 1. benign fibroadipose tissue, consisten w/omentum 2. foci of reactive mesothelial hyperplasia 3. one reactive lymph node, no tumor seen
c.  abdominal-peritoneum adhesion biposy, benign dense firboconnective tissue no tumor seen
d. serosa, biopsy dense fibroconnective tissue, no tumor seen
e. small bowel serosa #1 biopsy: dense fibro-connective tissue, no tumor seen
f. small bowel serosa #2 biopsy: 1. benign fibroconnective tissue, and fibroadipose tissue w/extensive cautery changes, no tumor identified
g uterus, right ovary & fallopian tube, suprcervical hysterectomy (was this really necessary...i now have no parts) 1. benign supracervial hyst specimen w/disordered proliferative endometrium, benign leiomyoma, & unremarkable lower uterine segment 2. benign right ovary w/copora albicantia, & unremarkable segment of fallopian tube
h. upper endocervix, biopsy: 1. segment of benign endocervial mucosa w/nabothian cysts, and lower uterine segment 2. no evidence of malignancy
i. left pelvic lymph node, biopsy, two reactive lymph nodes w/sinus histocytosis, no tumor seen
j. posterior cul-de-sac biopsy: dense fibroconnective, and firboadipose tissue, no tumor seen
k left pelvic sidewall, biopsy dense fibor-connective tissue, and fibroadipose tissue, no tumor seen
l. right pelvic wall biopsy, benign fibroconnective, and fibroadipose tissue, no tumor seen
m. anteriro cul-de-sac, biopsy, dense fibroconnective tissue, no tumor seen
n. left common iliac lymph node, biopsy; one reactive lymph node, no tumor seen
o. left aortic lymph node, biopsy two reactive lyph nodes w/sinus histiocytosis, no tumor seen
p left pericolic space, biopsy 1.  benign firboadipose, & firbo-connective tissue, no tumor seen
q. right pericolic space, biopsy benign fibroadipose, and fibroconnective tissue. no tumor seen
r. appendix, appendectomy 1. unremarkable appendix, 2. no evidence of malignancy
s right diaphram biopsy benign dense fibroconnective tissue w/chronic inflammation, no tumor seen
t umbilical peritoneum biopsy, dense fibro-connective, and fibroadipose tissue w/chronic inflamattion no tumor seen
on the result flag/legend it has A=abnormal *
final pathologic diagnosis A: diaphram washing-right diaphram washing malignant...caution this section does not function reliably for beacon (chemotherary) treatment plan orders..there are a total
Was it really necessary to take my parts?    with my anemia/gi bleed of ukn origin issues, i am not to take any nsaids, and was told that yes i could take hrt but they prefer not due to increase risk of breast cancer.  i know i don't want breast cancer, so i am afraid of any hrt.  so with regard to my fate, i am hopeful to be around to hit the 5 year mark, at this point i am 1.5 years out with no signs of recurrence but very concerned about when this thing comes back.   isn't there anything i could take to prevent it from returning?

[Annekathryn Goodman, M.D.]

Hi there
lots of good questions
could you please paste in here the exact pathology report so I can understand exactly what your diagnosis is.

I am just going to address your last question
which I will simplify to what are the consequences of not having natural estrogen porduction. (I am making an asuumption that you have the surgical removal of yourutrus and both your right and left oavries and fallopian tubes)

In the absence of estrogen
there are shot term issues like hot flashes
long term issues include vaginal dryness, bone loss that could result in osteporosis, and possibly an increase risk of heart disease

the solutions are:
30 minutes of sustained exercise a day
a baby aspirin a day
calcium and vitamin d replacement
also estrogen replacement is definitely an option

best wishes