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Stage I

All stage I stromal tumors are treated with surgery to remove the ovary with the tumor. Most women with stage I tumors are watched closely after the operation and don’t require further treatment. However, some stage I tumors are more likely to come back after surgery, for example:

• Very large tumors
• Tumors where the cyst broke open (ruptured)
• Poorly-differentiated tumors (also called high grade ? the cancer cells don’t look like normal tissue when examined in the lab).

These cancers are said to be at high risk for recurrence. Women with high-risk stage I stromal cancers have 2 options after surgery: observation (being watched closely) or chemotherapy (chemo).

Stages II, III, and IV

These cancers are treated with surgery to remove the ovary with the tumor. Surgery is also used to stage and debulk the cancer, as needed. This may be followed by chemo or hormone therapy. Often, the chemo used is the same type used to treat germ cell tumors (PEB: cisplatin, etoposide, and bleomycin). The combination of carboplatin and paclitaxel (Taxol) may also be used. Hormone treatment is most often used to treat advanced stromal tumors in women who cannot tolerate chemo, but who want to try treatment. This may mean treatment with a drug such as leuprolide (Lupron) and goserelin (Zoladex), the drug tamoxifen, or an aromatase inhibitor. Rarely, radiation therapy may be an option.

Recurrent stromal tumors

Cancer that comes back after treatment is said to be recurrent. This can happen many years later for stromal tumors. Even so, the prognosis (outlook) might still be good because they grow so slowly. Surgery may be repeated. Any of the chemo regimens used initially can also be used to treat a relapse. Hormone therapy is also an option to treat recurrence. There really isn't a standard treatment for recurrent stromal cancer, so treatment as part of a clinical trial is also a good option. Radiation therapy might also sometimes be helpful.

For tumors that produce hormones, the hormone blood levels may be checked regularly after surgery to check for increased levels that could suggest the tumor has returned. The level of a hormone called inhibin can also go up with some stromal tumors and might be useful to check for recurrence.