An ovarian germ cell tumor is an abnormal mass of tissue that forms in germ (egg) cells in the ovary (female reproductive gland in which the eggs are formed). 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.
An ovarian cancer as seen on CT
Image by James Heilman, MD
What Is
Ovarian Germ Cell Tumors - General Information
Image by Jpogi at English Wikipedia
Ovarian Germ Cell Tumors - General Information
Digital camera shot though a microscope; human primary follicle.
Image by Jpogi at English Wikipedia
What Are 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 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 make eggs and female hormones.
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.
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Symptoms
Sensitive content
This media may include sensitive content
Withdrawal bleeding on sanitary napkin
Image by Anne Jea.
Sensitive content
This media may include sensitive content
Withdrawal bleeding on sanitary napkin
Withdrawal bleeding (or "fake periods") are different of periods because withdrawal bleeding happens when an hormonal contraception is temporarily stopped while periods are part of the menstrual cycle.
Image by Anne Jea.
What Are the Signs and Symptoms of Ovarian Germ Cell Tumors?
Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.
Ovarian germ cell tumors can be hard to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic exams (checkups). Check with your doctor if you have either of the following:
Swollen abdomen without weight gain in other parts of the body.
Bleeding from the vagina after menopause (when you are no longer having menstrual periods).
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Diagnosis
Tumor cell clusters from ascites fluid: nuclei colored in blue, tumor-specific markers colored in red and green
Image by Matthias Bojar
Tumor cell clusters from ascites fluid: nuclei colored in blue, tumor-specific markers colored in red and green
Tumor cell clusters from ascites fluid: nuclei colored in blue, tumor-specific markers colored in red and green
Image by Matthias Bojar
How Are Ovarian Germ Cell Tumors Diagnosed?
Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to diagnose ovarian germ cell tumor.
The following tests and procedures may be used:
Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Serum tumor marker test: A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG) in the blood may be a sign of ovarian germ cell tumor.
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Staging
Cancer staging
Image by TheVisualMD
Cancer staging
Staging Cancer : Staging is the process of finding out the amount of cancer in the body and if it has spread. Most tumorous cancers are staged using the TNM system. In the TNM system, T = extent of the primary tumor, N = extent of spread to lymph nodes, M = presence of metastasis. After the TNM description has been decided, the cancer can be designated as Stage 0-IV. Stage 0 =carcinoma in situ. In Stage I, Stage II, and Stage III, higher numbers indicate more extensive disease, ie, greater tumor size, and/or spread of the cancer to nearby lymph nodes, and/or organs adjacent to the primary tumor. In Stage IV, the cancer has spread to another organ.
Image by TheVisualMD
What Are the Stages of Ovarian Germ Cell Tumors?
KEY POINTS
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.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
The following stages are used for ovarian germ cell tumors:
Stage I
Stage II
Stage III
Stage IV
Ovarian germ cell tumor can recur (come back) after it as been treated.
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. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, an operation called a laparotomy is done to see if the cancer has spread. The doctor must cut into the abdomen and carefully look at all the organs to see if they have cancer in them. The doctor will cut out small pieces of tissue so they can be checked under a microscope for signs of cancer. The doctor may also wash the abdominal cavity with fluid, which is also checked under a microscope to see if it has cancer cells in it. Usually the doctor will remove the cancer and other organs that have cancer in them during the laparotomy. It is important to know the stage in order to plan treatment.
Many of the tests used to diagnose ovarian germ cell tumor are also used for staging. The following tests and procedures may also be used for staging:
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of tumor as the primary tumor. For example, if an ovarian germ cell tumor spreads to the liver, the tumor cells in the liver are actually cancerous ovarian germ cells. The disease is metastatic ovarian germ cell tumor, not liver cancer.
The following stages are used for ovarian germ cell tumors:
Stage I
In stage I, cancer is found in one or both ovaries or fallopian tubes. Stage I is divided into stage IA, stage IB, and stage IC.
Stage IA: Cancer is found inside a single ovary or fallopian tube.
Stage IB: Cancer is found inside both ovaries or fallopian tubes.
Stage IC: Cancer is found inside one or both ovaries or fallopian tubes and one of the following is true:
the tumor ruptured (broke open) during surgery; or
the capsule (outer covering) of the ovary ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube; or
cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
Stage II
In stage II, cancer is found in one or both ovaries or fallopian tubes and has spread into other areas of the pelvis, or primary peritoneal cancer is found within the pelvis. Stage II is divided into stage IIA and stage IIB.
Stage IIA: Cancer has spread from where it first formed to the uterus and/or the fallopian tubes and/or the ovaries.
Stage IIB: Cancer has spread from the ovary or fallopian tube to organs in the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).
Stage III
In stage III, cancer is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.
In stage IIIA, one of the following is true:
Cancer has spread to lymph nodes behind the peritoneum only; or
Cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the omentum (a fold of the peritoneum that surrounds the stomach and other organs in the abdomen). Cancer may have spread to nearby lymph nodes.
Stage IIIB: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is 2 centimeters or smaller. Cancer may have spread to lymph nodes behind the peritoneum.
Stage IIIC: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is larger than 2 centimeters. Cancer may have spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen.
Stage IV
In stage IV, cancer has spread beyond the abdomen to other parts of the body. Stage IV is divided into stage IVA and stage IVB.
Stage IVA: Cancer cells are found in extra fluid that builds up around the lungs.
Stage IVB: Cancer has spread to organs and tissues outside the abdomen, including lymph nodes in the groin.
Ovarian germ cell tumor can recur (come back) after it as been treated.
The cancer may come back in the other ovary or in other parts of the body.
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Treatment
Treating Cancer
Image by TheVisualMD
Treating Cancer
Because cancers differ from one another in many ways, and because each patient is unique, there isn`t just one approach to treatment. Cancer treatment aims to eliminate the primary tumor, prevent the recurrence or spread of the cancer, and relieve symptoms. Types of cancer treatment include surgery; radiation therapy, which targets specific cancer cells; chemotherapy, which targets cancer cells throughout the body; and biological therapy, which works with the body`s own immune system. If you have cancer, it`s important to educate yourself about the type of cancer you have and the options for its treatment so that you can make informed decisions.
Image by TheVisualMD
How Are Ovarian Germ Cell Tumors Treated?
Treatment Option Overview
KEY POINTS
There are different types of treatment for patients with ovarian germ cell tumors.
Four types of standard treatment are used:
Surgery
Observation
Chemotherapy
Radiation therapy
New types of treatment are being tested in clinical trials.
High-dose chemotherapy with bone marrow transplant
New treatment options
Treatment for ovarian germ cell tumors may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for patients with ovarian germ cell tumors.
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. 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. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four 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: A surgical procedure to remove one ovary and one fallopian tube.
Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
After chemotherapy for an ovarian germ cell tumor, a second-look laparotomy may be done. This is similar to the laparotomy that is done to find out the stage of the cancer. Second-look laparotomy is a surgical procedure to find out if tumor cells are left after primary treatment. During this procedure, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left. This procedure is not done for dysgerminomas.
Observation
Observation is closely watching a patient’s condition without giving any treatment unless signs or symptoms appear or change.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
High-dose chemotherapy with bone marrow transplant
High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
New treatment options
Combination chemotherapy (the use of more than one anticancer drug) is being tested in clinical trials.
Treatment for ovarian germ cell tumors may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment of Stage I Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.
Treatment of dysgerminoma may include the following:
Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan.
Unilateral salpingo-oophorectomy followed by observation.
Unilateral salpingo-oophorectomy followed by radiation therapy.
Unilateral salpingo-oophorectomy followed by chemotherapy.
Treatment of other ovarian germ cell tumors may be either:
unilateral salpingo-oophorectomy followed by careful observation; or
unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.
Treatment of Stage II Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.
Treatment of dysgerminoma may be either:
total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or
unilateral salpingo-oophorectomy followed by chemotherapy.
Treatment of other ovarian germ cell tumors may include the following:
Unilateral salpingo-oophorectomy followed by combination chemotherapy.
Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).
A clinical trial of a new treatment.
Treatment of Stage III Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.
Treatment of dysgerminoma may include the following:
Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible.
Unilateral salpingo-oophorectomy followed by chemotherapy.
Treatment of other ovarian germ cell tumors may include the following:
Total abdominal 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.
Unilateral salpingo-oophorectomy followed by chemotherapy.
Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).
A clinical trial of a new treatment.
Treatment of Stage IV Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.
Treatment of dysgerminoma may include the following:
Total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy, with removal of as much of the cancer in the pelvis and abdomen as possible.
Unilateral salpingo-oophorectomy followed by chemotherapy.
Treatment of other ovarian germ cell tumors may include the following:
Total abdominal 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.
Unilateral salpingo-oophorectomy followed by chemotherapy.
Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).
A clinical trial of a new treatment.
Treatment of Recurrent Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.
Treatment of dysgerminoma may be:
Chemotherapy with or without radiation therapy.
Treatment of other ovarian germ cell tumors may include the following:
Chemotherapy.
Surgery with or without chemotherapy.
A clinical trial of high-dose chemotherapy followed by bone marrow transplant.
A clinical trial of a new treatment.
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Prognosis
Ovarian Germ Cell Tumors - Treatment
Image by Nephron
Ovarian Germ Cell Tumors - Treatment
Micrograph of a seminoma. H&E stain.Features:
Image by Nephron
What Factors Affect the Prognosis of Ovarian Germ Cell Tumors?
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on the following:
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.
The patient’s general health.
Ovarian germ cell tumors are usually cured if found and treated early.
Source: PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute.
Send this HealthJournal to your friends or across your social medias.
Ovarian Germ Cell Tumors
An ovarian germ cell tumor is an abnormal mass of tissue that forms in germ (egg) cells in the ovary (female reproductive gland in which the eggs are formed). 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.