Granulosa cell tumours

Granulosa cell tumours are a type of ovarian tumour arising from the cells that normally surround developing eggs and produce hormones, particularly oestrogen. They are usually slow-growing and often diagnosed at an early stage. They can occur at any age but have two typical peaks, in childhood and around or after menopause.

The exact cause is not fully understood, though specific gene mutations, such as in the FOXL2 gene, are found in most adult-type granulosa cell tumours. They are not generally linked to a strong inherited family pattern in most cases. Ongoing research continues to clarify the underlying biology.

Because these tumours often produce oestrogen, symptoms can include abnormal vaginal bleeding, particularly after menopause or irregular periods before it, abdominal swelling or pain, and in children, early puberty. Some are found incidentally on imaging done for other reasons. The hormone-related symptoms are often what first prompts investigation.

Most granulosa cell tumours are low-grade and slow-growing, with a generally good outlook, especially when diagnosed and treated early. However, they can recur many years after initial treatment, sometimes a decade or more later, so long-term follow-up is important. A small proportion behave more aggressively, which is assessed based on tumour features at diagnosis.

Surgery to remove the tumour, and often the affected ovary, is the main treatment, with the extent of surgery depending on the woman’s age, fertility wishes, and whether the tumour appears confined to the ovary. Additional treatment such as chemotherapy may be recommended for higher-risk or advanced cases. A gynaecological oncology specialist tailors the treatment plan to individual circumstances.

Many granulosa cell tumours are cured with surgery alone, particularly when caught at an early stage, since they tend to be slow-growing and often confined to one ovary. Because of the possibility of late recurrence, long-term follow-up continues even after apparently successful treatment. Regular monitoring, including hormone blood tests, helps detect any recurrence early.

Granulosa cell tumours are a specific type of sex-cord stromal tumour that often produces hormones, unlike the more common epithelial ovarian cancers which usually do not. This hormone production means they can cause distinctive symptoms, such as abnormal bleeding, that are less typical of other ovarian cancer types. They also tend to have a better overall outlook than many epithelial ovarian cancers, though long-term surveillance remains important.

Because recurrence can occur many years after initial treatment, follow-up is typically recommended for at least ten years, and sometimes longer, with regular clinical review and tumour marker blood tests such as inhibin. This differs from many other cancers where follow-up is often concentrated in the first five years. Your specialist will set an individualised long-term monitoring schedule.

See a doctor for any unexplained abnormal vaginal bleeding, especially after menopause, or new abdominal swelling or pain, so it can be properly investigated. A private gynaecology assessment with pelvic ultrasound can typically be arranged within about one to two weeks. Early assessment supports the best chance of catching these tumours while still confined to the ovary.