Ovarian Germ Cell Tumors


General Information

What is ovarian germ cell tumors?

Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary. Germ cell tumors begin in the reproductive cells (egg or sperm) of the body. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary.

The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).

Ovarian germ cell tumor is a general name that is used to describe several different types of cancer. The most common ovarian germ cell tumor is called dysgerminoma. (Refer to the PDQ summaries on Ovarian Epithelial Cancer Treatment and Ovarian Low Malignant Potential Tumors Treatment for information about other types of ovarian cancers.)

Possible signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause. Ovarian germ cell tumors can be difficult to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic examinations (checkups). A woman who has swelling of the abdomen without weight gain in other places should see a doctor. A woman who no longer has menstrual periods (who has gone through menopause) should also see a doctor if she has bleeding from the vagina.

Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor.

The following tests and procedures may be used:

Pelvic examination: An evaluation of the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size.

Laparotomy: A surgical incision made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope.

Lymphangiography: An x-ray study of the lymph system. A dye is injected into a lymph vessel and travels throughout the lymph system. The dye outlines the lymph vessels and organs on the x-ray. This test helps determine whether cancer has spread to the lymph nodes.

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Blood tests: Tests to measure the levels of alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the blood. AFP and HCG are substances that may be signs of ovarian germ cell tumor when found at increased levels.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the type of cancer, the size of the tumor, the stage of cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body), the way the cancer cells look under a microscope, and the patient's general health. Ovarian germ cell tumors are generally curable if found and treated early.

Stages of Ovarian Germ Cell Tumors

After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.
The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. Certain tests are used in the staging process.

Many of the tests used to diagnose ovarian germ cell tumor are also used to determine the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, surgery is required to determine the stage of cancer in an operation called a laparotomy. The doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will cut out small pieces of tissue and look at them under a microscope to see whether they contain cancer. The doctor may also wash the abdominal cavity with fluid and then look at the fluid under a microscope to see if it contains cancer cells. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy.

The following stages are used for ovarian germ cell tumor:

Stage I
Stage I is divided into stage IA, stage IB, and stage IC as follows:

Stage IA: Cancer is limited to one ovary.
Stage IB: Cancer is found in both ovaries.
Stage IC: Cancer is found in one or both ovaries and one of the following occurs:

-Cancer has spread to the outside surface of one or both ovaries; or
-The outer covering of the tumor has ruptured (broken open); or
-Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).

Stage II
Stage II is divided into stage IIA, stage IIB, and stage IIC as follows:

Stage IIA: Cancer is found in one or both ovaries and has spread into the pelvis and/or to the uterus and/or fallopian tubes.
Stage IIB: Cancer is found in one or both ovaries and has spread to other tissue within the pelvis.
Stage IIC: Cancer is found in one or both ovaries, has spread to the uterus, fallopian tubes, and/or to other tissues in the pelvis, and one of the following occurs:

-Cancer is on the surface of one or both ovaries; or
-The outer covering of the tumor has ruptured (broken open); or
-Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum.

Stage III
Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:

Stage IIIA: Cancer is found in one or both ovaries and the pelvis, and microscopic cancer cells are found in the peritoneum.
Stage IIIB: Cancer is found in one or both ovaries and has spread to the peritoneum. The peritoneal tumors are no larger than 2 centimeters (about 3/4 inch).
Stage IIIC: Cancer is found in one or both ovaries and has spread beyond the pelvis to the peritoneum. The peritoneal tumors are larger than 2 centimeters and/or cancer is found in lymph nodes in the pelvis.
Cancer that has spread to the surface of the liver or has spread to the small bowel or omentum (a fold of peritoneum that encloses the bowel) is also considered stage III disease.

Stage IV
In stage IV, cancer is found in one or both ovaries and has metastasized (spread) not only to the pelvis and abdomen but also to other parts of the body. Cancer is found in the tissues of the liver.

Recurrent Ovarian Germ Cell Tumors
Recurrent ovarian germ cell tumor is cancer that has recurred (come back) after it has been treated. Recurrent ovarian germ cell tumor may come back in the other ovary or in other parts of the body.

Treatment Option Overview

Different types of treatment are available for patients with ovarian germ cell tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery
Surgery is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer using one of the following types of surgery:

-Unilateral salpingo-oophorectomy: Surgery to remove one ovary and one fallopian tube.
-Hysterectomy and bilateral salpingo-oophorectomy: Surgery to remove the entire uterus, both ovaries, and both fallopian tubes.
-Tumor debulking: Taking out as much of the tumor as possible.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Ovarian germ cell cancer is treated with external radiation. Radiation may be used in addition to surgery, chemotherapy, or both.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy or radiation after surgery to kill any cancer cells that are left. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Following radiation or chemotherapy, an operation called a second-look laparotomy is sometimes done. This is similar to the laparotomy that is done to determine the stage of the cancer. During the second-look operation, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left.

Other types of treatment are being tested in clinical trials. These include the following:

-High-dose chemotherapy with bone marrow transplantation
-Chemotherapy can reduce the ability of bone marrow to make blood cells. Bone marrow transplantation has been tested as a way to help the blood recover so that higher than standard doses of chemotherapy can be given.

New treatment options
Combination chemotherapy (the use of more than one chemotherapy drug to fight cancer) is being tested in clinical trials.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

Stage I Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

1.Unilateral salpingo-oophorectomy with or without lymphangiography (an x-ray study of the lymph system, the tissues and organs that filter and destroy harmful substances and help fight infection and disease) or CT scan (a series of detailed pictures of areas inside the body, created by a computer linked to an x-ray machine).
2.Unilateral salpingo-oophorectomy followed by observation (closely monitoring a patient's condition but withholding treatment until symptoms appear or change).
3.Unilateral salpingo-oophorectomy followed by radiation therapy.
4.Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may be either:

1.Unilateral salpingo-oophorectomy followed by careful observation; or
2.Unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

Stage II Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may be either:

1.hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or
2.unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

1.Unilateral salpingo-oophorectomy followed by combination chemotherapy.
2.Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).
3.A clinical trial evaluating new treatment options.

Stage III Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

1.Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible.
2.Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

1.Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.
2.Unilateral salpingo-oophorectomy followed by chemotherapy.
3.Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).
4.A clinical trial evaluating new treatment options.

Stage IV Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

1.Hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy, with removal of as much of the cancer in the pelvis and abdomen as possible.
2.Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

1.Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.
2.Unilateral salpingo-oophorectomy followed by chemotherapy.
3.Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).
4.A clinical trial evaluating new treatment options.

Treatment Options for Recurrent Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may be:

1.Chemotherapy with or without radiation therapy.

Treatment of other germ cell tumors may include the following:

1.Chemotherapy.
2.Surgery with or without chemotherapy.
3.A clinical trial of high-dose chemotherapy followed by bone marrow transplantation.
4.A clinical trial evaluating new treatment options.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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