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Ovarian Cancer: Does Ovarian Cancer Occur in Young Women?

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Updated April 09, 2014

Although epithelial ovarian cancer is infrequent in women under 40 years of age, it can and does occur in young women. When found in a woman's 40s, or before she reaches them, it is more often related to hereditary factors and BRCA1 or BRCA2 (genes that greatly increase one's risk of both ovarian and breast cancer). Even at earlier ages, especially when there is a family history of these cancers, paying attention to persistent abdominal and pelvic symptoms is important.

Other Types of Ovarian Cancer

Ovarian cancer is actually a spectrum of diseases, and there are more than 30 known subtypes. Each type can behave differently and respond differently to treatment plans. There are two major categories of ovarian cancer that occur mainly in younger women: germ cell and sex-cord stromal tumors. Here, a brief overview of each:

Germ Cell Tumors

These cancers arise from the cells in the ovary that are meant to become eggs and are rare, representing only 3% of all ovarian cancers. The main sub-types in this category are dysgerminomas, yolk-sac or endodermal sinus tumors, embryonal carcinomas, immature teratomas, or a mixture of these. These long names can confuse just about anyone, so here are the key points you need to know:

  • Sixty to seventy percent of cases are diagnosed early.

  • Surgery is required to determine the exact subtype and determine if the cancer has spread.

  • These cancers often produce tumor markers -- LDH, AFP and hCG -- that are measurable in the blood. These are essentially clues that may help physicians determine, even before surgery, what the likely sub-type is.
  • They tend to be very sensitive to chemotherapy and therefore are often curable, especially when found in early stages.

  • Many women are concerned that choosing surgery as a treatment option will affect their fertility. In many cases, however, only one ovary needs to be removed, so fertility is often -- though not always -- able to be spared. In this case, the other ovary, fallopian tube and the uterus are left in place, and pregnancy can usually occur normally.

  • The treatment for immature teratoma is more complex than for the other germ cell tumors.
Sex Cord Stromal Tumors

These cancers begin in the connective tissue cells that essentially hold the ovaries together and produce hormones such as estrogen, progesterone and testosterone. They represent about 6% of all ovarian cancers and mainly occur in young women. The main subtypes are called granulosa stromal cell and Sertoli-Leydig tumors, although various mixtures, as well as other more rare forms, also occur.

The most common of these tumors is the granulosa stromal cell tumor. This type of tumor may produce a hormone called inhibin, which can be used as a tumor marker. Diagnosis is usually made in an early stage of the disease, and the “adult” form (usually found in patients over age 40) is usually not very aggressive. However, the so-called “juvenile” form (most but not all cases arise in the first 20 years of life) is more often found in advanced stages. Unfortunately, it is not very responsive to chemotherapy.

Malignant (cancerous) Sertoli and Sertoli-Leydig cell tumors are quite rare. Most are either benign or non-aggressive cancers. The vast majority are found in early stages and are very curable with surgery alone. Since they produce either estrogen or testosterone, early symptoms usually have something to do with hormonal changes. These symptoms may include facial hair growth, low voice, or early puberty and/or abnormal periods.

Source:

Kurman, Robert J. "Blaustein's Pathology of the Female Genital Tract." Springer, 2002.

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