Ovarian Masses and Ovarian Tumors in Adolescents

Ovarian tumors can form in infants and adolescents born female on one or both ovaries, the organs that store and release eggs and produce female hormones. Ovarian masses may be cysts or tumors. Tumors can be cancerous or benign; both tumors and cysts may appear individually or in clusters.

Ovarian tumors account for 1 percent of all malignant tumors found in children between birth and age 17. In females younger than 8, four out of five ovarian tumors are benign.

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.

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:

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

Among children 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

Doctors do not completely understand the cause of most ovarian tumors. There’s nothing that could have been 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.

The first step in treating your child is forming an accurate and complete diagnosis. After a complete medical history and physical exam, your child’s physician may recommend:

• Urine and blood tests
• Pelvic ultrasound
• Computerized tomography (CT) scan
• 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 child'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 the tumor is malignant, treatment may also include chemotherapy and/or radiation therapy

Chemotherapy and radiation therapy

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. Our doctors also use high-energy rays from a specialized machine to damage or kill cancer cells and shrink tumors.

Malignant ovarian tumors are treated at Dana-Farber/Boston Children's Cancer and Blood Disorders Center 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 all ovaries are saved when removing ovarian tumors, helping to preserve your future fertility.

If the ovarian tumor is benign, it will be treated through the Division of Gynecology at Boston Children’s Hospital.

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, 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 ovarian tumors

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.