Ovarian tumors can form in infants, young girls, and
adolescents on one or both ovaries, the organs that store and release
eggs and produce female hormones. Ovarian
masses may be cysts or tumors, and if they’re tumors, they may be cancerous
or benign. Tumors and cysts can appear individually or in clusters.
Ovarian tumors account for one percent of all malignant
tumors found in children between birth and age 17. In girls younger than 8,
four out of five ovarian tumors are benign (non-cancerous).
Ovarian tumors are distinguished from ovarian cysts because
they are a more solid mass of tissue, while cysts are filled with fluid,
tissues, or other materials. Some ovarian cysts can develop into cancer.
Non-functional cysts, which do not go away on their own and are not associated
with a woman producing an egg each month, can develop to be malignant.
Girls with malignant ovarian tumors are treated at Dana-Farber/Boston Children's
through our Solid
Tumor Center. Our treatment
team includes medical oncologists, surgical oncologists, radiation oncologists,
and pediatric subspecialists, including gynecologists, who have specialized
expertise in treating ovarian tumors.
In children and adolescents, ovarian tumors have a much
higher cure rate than adult forms of ovarian cancer. At Dana-Farber/Boston
Children's, almost 100% of girls' ovaries are saved when removing ovarian
tumors, helping to preserve your daughter's future fertility.
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.
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.