Ovarian tumors are rare in children, adolescents, and young adults. As a result, relatively little information exists about incidence rates, treatment, and outcomes for specific ovarian tumors for these age groups. This chapter is designed as a guide for the evaluation and treatment of ovarian tumors in adolescents and young adults, with the goal of engendering interest in studies aimed specifically at this patient population.
Ovarian neoplasms represent a diagnostic and therapeutic dilemma because of the desire to maintain fertility in this young age group. Thankfully, the majority of neoplasms present at an early stage with generally good long-term survival. Further work is necessary to delineate appropriate screening for young women at risk for ovarian cancers. Advances in assisted reproductive medicine will probably impact the management of this group of patients in the future.
Although the vast majority of ovarian cancers in adult women are epithelial in origin, 60-70% of ovarian malignancies in children and adolescents are non-epithelial, consisting primarily of germ-cell and sex cord-stromal tumors . Hence, the adolescent and young adult years are a time of transition in tumor type, as the incidence of non-epithelial tumors gradually decreases and epithelial tumors become more common. Surgery, chemotherapy, radiation, and hormonal therapy are all components of treatment, but specific management recommendations are dependent on many factors, including patient age, tumor histology, karyotype, and extent of disease. Conservative surgery to maintain reproductive potential is an important consideration in the treatment of all adolescents and young adults with ovarian tumors.
Appropriate surgical staging and assessment are necessary components in determining the extent of surgery required and the need for post-operative chemotherapy. With the advent of modern surgical and post-surgical techniques, response rates and survival have improved dramatically and are excellent for most tumor types.
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