Ovarian Tumors in Children and Teens

Successfully treating your daughter's ovarian tumor depends on its size and whether it is benign or malignant. Doctors at Dana-Farber/Boston Children's will classify your daughter's ovarian tumor as one of the following types:

• Epithelial cell tumors: These are the most common type of ovarian tumor and develop from the ovaries’ surface.
• Germ cell tumors: These tumors develop in the egg producing cells. Most are benign but a few are cancerous.
• Stromal tumors: These growths develop in the female hormone producing cells.

Ovarian tumors sometimes don't produce symptoms, or their symptoms depend on the size and location of the growth. Keep in mind that the symptoms of an ovarian tumor may resemble other more common conditions or medical problems. It is important to consult your child's physician for a diagnosis.

Ovarian tumor symptoms may include:

• A feeling of pressure or fullness in the abdomen or pelvis
• A firm, painless swelling in the lower abdomen
• Frequent urination or retention of urine
• Persistent abdominal pain
• Nausea
• Vomiting

Among girls younger than 8, an ovarian tumor or cyst may cause secretions of estrogen, producing:

• Breast enlargement
• Pubic hair
• Vaginal discharge or bleeding
• Abnormal menstrual bleeding

As a parent, you undoubtedly want to know what may have caused your child’s tumor. Doctors do not completely understand the cause of most ovarian tumors. There’s nothing that you could have done or avoided doing that would have prevented the tumor from developing. It’s important to understand that these and other tumors most often occur with no known cause.

Scientists do know that there are some risk factors for developing ovarian cancer, including:

• inherited gene mutations
• breast cancer gene 1 (BRCA1)
• breast cancer gene 2 (BRCA2)
• family history of ovarian cancer
• previous cancer diagnosis

The first step in treating your child is forming an accurate and complete diagnosis. Your child’s physician may order a number of different tests including:

• A physical exam and complete medical history.
• Urine and blood tests.
• A pelvic ultrasound. This imaging procedure uses sound waves to make a picture of your child's ovaries, uterus and bladder. If the ultrasound shows a cyst filled with clear fluid it is unlikely a tumor; if it shows debris in the cyst fluid or solid parts, your child's doctor will likely recommend further testing.
• Computerized tomography scan (also called a CT or CAT scan), a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images, often called slices, of the body from horizontal and vertical perspectives. CT scans are more detailed than general x-rays.
• A gynecologist who specializes in pediatric and adolescent patients will perform a procedure to examine the interior of the abdomen, used to determine the size, grade and stage of a tumor.

There may be other diagnostic tests that your doctor will discuss with you depending on your child's individual situation. After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best possible treatment options.

Your child's physician will determine a specific course of treatment based on several factors, including your child's age, overall health and medical history as well as the size and malignancy of the tumor.

Your child's treatment will almost always include:

• Surgery: Pediatric gynecologic surgeons will remove as much of it as possible, while attempting to preserve your daughter's ability to have children. If an ovarian cyst growth is cancerous, and the cancer has spread far, the ovaries, uterus, fallopian tube, fatty tissue covering the intestines (omentum) and lymph nodes may be removed, in a process called debulking.

If your daughter's tumor is malignant, treatment may also include:

• Chemotherapy: Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce. Chemotherapy before surgery may help shrink the tumor, making it possible to remove; used after surgery it can help fight a cancer's recurrence. Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors. Your child may receive chemotherapy orally, as a pill to swallow; intramuscularly, as an injection into the muscle or fat tissue; intravenously, as a direct injection into the bloodstream, or IV; or intrathecally, as a direct injection into the spinal column through a needle.
• Radiation therapy: Our doctors use high-energy rays from a specialized machine to damage or kill cancer cells and shrink tumors.
• Supportive care: Throughout your child's treatment, our doctors use supportive care to prevent and treat infections, minimize side effects of treatment, respond to complications and keep your child comfortable. These include medications, acupuncture/acupressure, massage, herbs and dietary recommendations.

Many ovarian tumors are a type of germ cell tumor. Various germ cell tumor research studies are underway to help build our understanding of how treatment types and dosages can be modified according to the tumor sub-type, stage, location on the body and the age and gender of the child – to provide the best possible outcome.

Due to the rarity of germ cell tumors in children, however, statistically meaningful data with multivariate analysis is difficult to achieve. To address that, the Malignant Germ Cell International Collaborative (MaGIC) was formed. This consortium, led by A. Lindsay Frazier, MD, a pediatric oncologist at Dana-Farber/Boston Children’s, is a collaboration of the world’s experts in germ cell tumors, including pediatric, gynecologic and genito-urinary oncologists.

Clinical Trials
For many children with rare or hard-to-treat conditions, including testicular germ cell tumors, clinical trials – research studies evaluating new treatment approaches – provide new options.

Participation in any clinical trial is completely voluntary. We will take care to fully explain all elements of the treatment plan prior to the start of the trial, and you may remove your child from the medical study at any time.

• Search our solid tumor clinical trials
• Get answers to common questions about clinical trials
• Contact us: If you’re not sure which clinical trials might be right for your child, email us at clinicaltrials@danafarberbostonchildrens.org. We can help you navigate your options.

In children and adolescents, ovarian cancer has a much higher cure rate than adult forms of ovarian cancer. In girls younger than 8, one out of five ovarian tumors are cancerous.

At Dana-Farber/Boston Children’s, almost 100% of children’s ovaries are saved when removing benign cysts or tumors. In the rare case that an ovary has to be removed, your daughter can still have a child if one of her ovaries is removed.

Children treated for an ovarian tumor should visit a cancer survivorship clinic every year to manage disease complications, screen for recurrence and manage late treatment side effects. A typical follow-up visit is likely to include a physical exam, laboratory testing and imaging scans.

The David B. Perini, Jr. Quality of Life Clinic at Dana-Farber provides care and advocacy for survivors of childhood cancer, conducting research on the long-term effects of cancer treatments, and offering education and support for survivors of cancer. In addition to meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists. We also offer patient and family education, psychosocial assessment, genetic counseling, reproductive and fertility evaluation and counseling and opportunities to speak with other childhood cancer survivors.