Ovarian germ cell tumors contain malignant (cancerous) cells that grow in tissue covering the ovary(ies) and begin in the reproductive cells. It is a very aggressive tumor and are often difficult to diagnose early due to suttle symptoms.
A woman’s ovaries are located one on each side of the uterus where the fetus grows. The ovary produces eggs and female hormones.
Microscopic features are what determine whether or not the tumor is benign, borderline or malignant. (Borderline tumors contain uncertain malignant potential.) The term ovarian germ cell tumor represents various ovarian cancers as a whole. The most common ovarian germ cell tumor is called dysgerminoma.
Types of Ovarian germ cell tumors:
- Dysgerminoma
- Endodermal Sinus tumor
- Embryonal Carcinoma
- Polyembryoma
- Choriocarcinoma
- Teratoma: Immature
- Teratoma: Mature
- Solid Cystic: Dermoid Cyst
- Monodermal and highly specialized
- Mixed forms
Staging
- Stage 1: Cancerous cells are detected in one or both of the ovaries.
- Stage IA: Cancerous cells are found in only one of the ovaries.
- Stage IB: Cancerous cells are found in both ovaries.
- Stage IC: Cancerous cells are detected in one or both of the ovaries as well as on the ovary’s outside surface. In many cases, the tumor has broken the ovary wall and cancerous cells are detected in fluid from the peritoneal cavity which contains most of the organs in the abdomen.
- Stage II: Cancerous cells are found in one or both of the ovaries and has spread into various areas of the pelvis.
- Stage IIA: Cancerous cells have spread to the uterus and/or fallopian tubes (the long narrow tubes where eggs pass from the ovaries to the uterus).
- Stage IIB: Cancer has spread to other tissues within the pelvis.
- Stage IIC: Cancerous cells have spread and all of the above are true.
- Stage III: Cancerous cells are detected in one or both ovaries and has spread to various parts of the abdomen as well as the liver’s surface.
- Stage IIIA: The stromal tumor is only detected in the pelvis but cancerous cells have begun to spread to the peritoneum’s surface. (the tissue that lines the abdominal wall and protects several organs of the abdomen.)
- Stage IIIB: Cancerous cells have begun to spread or have already spread to the peritoneum, but appear to be less than 1 inch in diameter.
- Stage IIIC: Cancerous cells have begun to spread or have already spread to the peritoneum and appear to be more than 1 inch in diameter, and has spread to lymph nodes in the abdomen as well.
- Stage IV: Cancerous cells are found in one or both ovaries and has begun to spread or has already spread farther than the abdomen to the liver.
General Prognosis / Statistics
The prognosis of an Ovarian germ cell tumor depends on the stage of the tumor, as well as its DNA ploidy (amount of DNA in each cell). An individual’s prognosis also depends on the tumor’s location as well as its histiology (shape, function, structure of tumor cells), and their risk. There are three types of risks including: low, intermediate and high.
Low and intermediate risks contain a good prognosis, while a patient at high risk does not have as good of a prognosis. In any case, there is a possibility that the tumor will grow during treatment or reoccur after treatment is given. Ovarian germ cell tumors generally have a good prognosis and are curable if found and treated immediately.
Statistics:
Account for 30% of all ovarian cancers
Develop mainly in teenagers and young women.
90% are successfully treated, but in some cases, women become infertile
Risk Factors
Several risk factors for Ovarian germ cell tumors include:
History of breast cancer
Previously having estrogen replacement therapy
Family history (first degree relative having any type of ovarian cancer, usually the mother, daughter or sister)
Age (Occurring rarely in women younger than 40. Usually occur in women after menopause begins.)
Weight (Obesity)/ General health
Reproductive history ( Those with children have a lower risk)
Fertility drugs (Those who have taken Clomiphene Citrate, also known as Clomid for a year or more have a higher risk)
Symptoms
Because there are suttle symptoms of an Ovarian germ cell tumor, it is often hard to detect, especially in progressive-staged cases. Women who have early stage Ovarian germ cell tumors have mild symptoms such as:
No longer having menstrual periods but have abnormal vaginal bleeding
Pressure in pelvis
Pain/ swelling of the abdomen with no weight gain
Early Detection Tests
To find out if a woman has an Ovarian germ cell tumor, there are several tests that can be performed to confirm a diagnosis. Some of these tests include:
Pelvic exam
CA 125 assay ( a test that measures the amount of CA 125, a substance that is released by cells into the bloodstream. If high amounts of CA 125 are detected, this is a sign of cancer.)
Laparotomy (a surgical examination where an incision is made in the abdomen wall to look for signs of cancer)
Lymphangiogram (an examination where an x-ray is used to view the lymph system)
CT scan
Treatment
Women who are diagnosed to then be treated for germ cell tumors may be at a high risk for second ovarian cancers. Surgery is the primary option for those at low or intermediate risk in order to remove as much of the tumor as possible. (A patient’s risk is determined by location and stage of tumor) If the tumor cannot be surgically removed, a biopsy will be performed instead. Radiation therapy is an option for treatment as well. In this case, either external or internal radiation can be used. External radiation uses a machine outside the body to remove cancer cells, while internal radiation uses a radioactive substance contained within needles, seeds, wires or catheters that are placed directly towards the cancer. The type of radiation the patient receives depends on the type and stage of the cancer being treated. Chemotherapy is also used during treatment. Chemotherapy uses drugs to stop the growth of cancer cells by killing or stopping them from dividing. Another type of treatment containing no radiation, chemicals, or needles is watchful waiting. This option is usually for patients at low risk. For those who are given this treatment, the patient’s condition is monitored until symptoms appear or change. Other options include:
Tumor debulking (removing as much of the tumor as possible)
Unilateral salpingo-oophorectomy (the removal of one ovary and one fallopian tube)
Total abdominal hysterectomy and bilateral salpingo-oophorectomy (the removal of both ovaries and fallopian tubes and the uterus)
