granulosa cell cancer - inhibin b levels

[ll2510]

Hi there
I am 53 and  have had surgery in Jan 2011 for a recurrent GCT - the original was in Jan 2007 where I had total hysterectomy, omentectomy and appendectomy and lymph sampling. Stage 1c - no chemo. Following the original 2007 surgery I had 6 monthly inhibin checks for both inhibin a and b. I was always told they were off the bottom of the scale.

Last year my inhibin b level started to rise (June 112, Sept 190, Dec 344) CT scans originally showed asites, a small lesion in my left lung, but no visible tumour. Exploratory surgery in Jan 11 discovered a 7cm tumour attached to my intestine and several smaller tumours in the pelvic gutter (none of which had been spotted on the CT scan in Dec) - all were removed successfully and asites drained. I was advised not to have chemotherapy as there was no residual tumour. I had originally been prescribed HRT following the 2007 surgery, but testing of the recurrent tumour showed it to be oestrogen and progesterone receptive, so I am now off that. CT scan in April 11 showed no changes in the lung lesion and no further problems.

Post operative Feb 11 blood test showed the inhibin b level was down to 29, but in April it was 32. I know this is massively better than 344, but I thought that if all the cancer had been removed that the levels would drop close to 0 and would certainly have dropped further since the Feb levels. My oncologist said its ok as its stable, but I am worried that it is just making an immediate if gradual comeback. Understandably I am no longer confident in the doctors spotting future tumour growth until its quite big, so I tend to rely on the inhibin tests to provide me with the alarm bells.

How accurate is inhibin b is suggesting that GCT is hovering in the background, even if it isn't making an aggressive comeback? Should I be concerned that it rose slightly in April? I do know that once recurrent GCT gets a hold it can be relentless. Any further informatin on this would be gratefully received. Thanks

[ll2510]

Thanks for your comprehensive response. I have not been checked for MIS, only the inhibin and CA125 tests.
I have just heard back this morning that my July inhibin test is now up to 56, so it is starting to climb again steadily. I felt I knew in the back of my mind that because the April result was similar to the Feb one and had not reduced further, that this was on the cards.
I am based in the UK and there are basically no active forums that I could find on this cancer.
Oh well, it seems I back on the slippery slope. Wish me luck!

[kcd86]

My wife has GCT which was Dx back in Jan 2009, she had the ovary renoved intact and all nodes and pelvic washings were neg. Dr at Sloan Kettering in NYC said chemo will not be needed. Since then I have learned alot about the elusive GCT. Since it's a rare form of OVCA there are not a big population to do large drug trials on. Most OVCA's or most cancers for that matter are fast growing cancers to which most chemo's are designed for. GCT is a slow growing cancer and from what I understand chemo does not truely work on GCT as chemo would for most other cancers. I have her Inhibin A&B drawn every 6months ans so far it has been  alomost neg.
The hormonal activity of granulosa cell tumors permits the use of a variety of serum tumor markers in the diagnostic evaluation. Clinically, the most useful serum marker for granulosa cell tumors is inhibin, a peptide that is produced by the ovaries in response to follicle stimulating hormone and luteinizing hormone. Inhibin usually becomes undetectable after menopause, unless produced by certain ovarian tumors,ie; granulosa cell tumors.
An elevated inhibin level in a postmenopausal woman or a premenopausal woman presenting with amenorrhea and infertility is suggestive of the presence of a granulosa cell tumor, but not specific. Although most commercial laboratories only provide assays for inhibin A, serum levels of inhibin B seem to be more frequently elevated If available, it's suggested the use of assays that detect both isoforms.
Estradiol was one of the first markers identified in the serum of patients with granulosa cell tumors, however estradiol is not a sensitive marker for the presence of a granulosa cell tumor. Approximately 30 percent of tumors do not produce estradiol.
Mullerian inhibiting substance (MIS), which is produced by granulosa cells in the developing follicles, has emerged as a potential tumor marker for granulosa cell tumors. As with inhibin, MIS is typically undetectable in postmenopausal women>