SAN DIEGO – Young women and girls with gynecologic malignancies more often present with pain and masses greater than 5 cm in size, compared with their counterparts who have benign disease. Additionally, gynecologic oncologists are inconsistently involved in the management of this patient population.
Those are key findings from a study that set out to compare the clinical presentation and surgical outcomes of women and girls younger than 21 years old who had a pelvic mass.
Doug Brunk/Frontline Medical News
Dr. Teuta Shemshedini
“If something is suspicious, it’s not a bad idea to get your colleagues who specialize in gynecologic cancer involved sooner rather than later,” Dr. Teuta Shemshedini, the lead study author, said in an interview at the annual meeting of the Society of Gynecologic Oncology. Clinicians who specialize in gynecologic oncology “were often talked to either intraoperatively or postoperatively, so we were kind of working backwards when we could have sat with patients and the families before the surgery and worked forward.”
Dr. Shemshedini, who is a fourth-year resident in the department of obstetrics and gynecology at Westchester Medical Center, Valhalla, N.Y., and her associates reviewed medical records of all women and girls younger than 21 years old who underwent primary surgery for a pelvic mass at the medical center from 2010 to 2015.
Of the 138 patients evaluated, 77 were included in the final analysis: 57 who had benign disease and 20 who had malignant disease. The mean age of the patients was 13.5 years and the mean adnexal mass size was 9.8 cm in the benign group, compared with 15.5 cm in the malignant group (P = .005). The most common presentation was pain, which occurred in 75% of all cases.
Gynecologic oncologists were consulted on 10 cases (13%), with six of the 10 consults (60%) requested by pediatric gynecologists. However, only two of eight (25%) were preoperative consults in malignant cases.
The researchers also observed that tumors greater than 10 cm in size were found in 75% of malignancies, and all tumors 5 cm or smaller were benign (14%). Clinicians did not use tumor markers in 29% of the entire study group, even though tumor markers were elevated in 70% of the malignant cases.
Laparoscopic surgery was performed in 35 patients (45%), with a majority of cases being benign. The most common benign tumors were mature teratomas (70%). The most common malignant tumors were borderline ovarian tumors (35%), followed by immature teratomas (20%), and mixed germ cell tumors (20%). More than half of malignant tumors (55%) were stage I.
“The most surprising part was that we weren’t getting gynecologic oncology involved soon enough,” Dr. Shemshedini said. “I think most people are very surprised when a mass comes back as cancer in kids, especially ovarian cancer. In adults we see epithelial cancer most commonly, while in kids it’s more of the germ cell tumors. Those are rare.”
Dr. Shemshedini reported having no financial disclosures.