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Ovarian germ cell tumor


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is ovarian germ cell tumor?
STAGE EXPLANATION
Stages of ovarian germ cell tumor
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How ovarian germ cell tumor is treated
Treatment by stage
STAGE I OVARIAN GERM CELL TUMOR
STAGE II OVARIAN GERM CELL TUMOR
STAGE III OVARIAN GERM CELL TUMOR
STAGE IV OVARIAN GERM CELL TUMOR
RECURRENT OVARIAN GERM CELL TUMOR
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is ovarian germ cell tumor?

Ovarian germ cell tumor, an uncommon cancer in women, is a disease in which cancer (malignant) cells are found in egg-making cells in the ovary. The ovary is the small sac that holds the eggs that can develop into a baby. There are two ovaries: one located on the left side of the uterus (the hollow, pear-shaped organ where a baby grows) and one located on the right. Ovarian germ cell tumors usually occur in teenage girls or young women. Ovarian germ cell tumor is different from cancer that occurs in the lining (epithelium) of the ovary (see the PDQ patient information summary on cancer of the ovary for treatment of cancer of the ovary).

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

A doctor may use several tests to see if there is cancer, usually beginning with an internal (pelvic) examination. During the examination, the doctor will feel for any lumps or changes in the shape of the pelvic organs. Blood and urine tests and an ultrasound examination may be done. During the ultrasound examination, sound waves are used to find tumors. A patient may also have a CT scan, which is a special type of x-ray.

The chance of recovery (prognosis) and choice of treatment depend on the type of tumor and stage of the cancer (whether it is just in one part of the ovary, the whole ovary, or has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of ovarian germ cell tumor

Once ovarian germ cell tumor has been found, more tests will be done to find out if the cancer has spread from the ovary to other parts of the body (staging). 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. During this operation, the doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. During the operation, the doctor will cut out small pieces of tissue (biopsy) and look at them under a microscope to see whether they contain cancer. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy (see section on How Ovarian Germ Cell Tumor is Treated).

A doctor needs to know the stage of the disease to plan further treatment. The doctor also needs to know what cell type the cancer is, based on how the cells look under the microscope. Germ cell tumors called dysgerminoma are often treated differently than other germ cell tumors (endodermal sinus tumors, embryonal carcinoma, teratoma, polyembryoma). The following stages are used for ovarian germ cell tumor:


Stage I

Cancer is found only in one or both of the ovaries.


Stage II

Cancer is found in one or both ovaries and/or has spread to the uterus, and/or the fallopian tubes (the pathway used by egg cells to get from the ovary to the uterus), and/or other body parts within the pelvis.


Stage III

Cancer is found in one or both ovaries and has spread to lymph nodes or to other body parts inside the abdomen, such as the surface of the liver or intestine. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).


Stage IV

Cancer is found in one or both ovaries and has spread outside the abdomen or has spread to the inside of the liver.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the ovary that is left or in another place.


TREATMENT OPTION OVERVIEW


How ovarian germ cell tumor is treated

There are treatments for all patients with ovarian germ cell tumor. Three kinds of treatment are used:

Surgery is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer (often during the staging laparotomy) using one of the following operations:

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for ovarian germ cell tumors usually comes from a machine outside the body (external radiation).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the ovary.

Following radiation or chemotherapy, sometimes an operation called a second-look laparotomy is 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.


Treatment by stage

Treatment of ovarian germ cell tumor depends on the stage and cell type of the disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for patients with ovarian germ cell tumor. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE I OVARIAN GERM CELL TUMOR

Treatment depends on how the cancer cells look under a microscope (cell type). If it is a tumor called a dysgerminoma, treatment may be one of the following:

1. Surgery to remove the ovary where the cancer is found and the fallopian tube on the same side as the involved ovary (unilateral salpingo-oophorectomy) followed by radiation therapy.

2. Unilateral salpingo-oophorectomy followed by chemotherapy if the patient wishes to have children in the future.

3. Unilateral salpingo-oophorectomy alone (in selected patients).

If it is another type of germ cell tumor, treatment may be one of the following:
1. Unilateral salpingo-oophorectomy followed by chemotherapy. Clinical trials are testing new combinations of chemotherapy drugs.

2. Unilateral salpingo-oophorectomy alone (in selected patients).


STAGE II OVARIAN GERM CELL TUMOR

Treatment depends on how the cancer cells look under a microscope (cell type). If it is a tumor called a dysgerminoma, treatment may be one of the following:

1. Surgery to remove the uterus and both ovaries and fallopian tubes (total abdominal hysterectomy and bilateral salpingo-oophorectomy) followed by radiation therapy.

2. If the cancer is found only in the ovary and the fallopian tube on the same side and the patient wants to have children in the future, surgery to remove the ovary where cancer is found and the fallopian tube on the same side as the involved ovary (unilateral salpingo-oophorectomy) can be done. Chemotherapy is given following surgery.

If it is another type of germ cell tumor, treatment may be one of the following:
1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy. If the cancer cannot be totally removed, as much of the cancer as possible will be taken out (tumor debulking). Surgery is followed by chemotherapy.

2. If the cancer is found only in the ovary and the fallopian tube on the same side and the patient wants to have children in the future, a unilateral salpingo-oophorectomy can be done. Chemotherapy is given following surgery.

3. Total abdominal hysterectomy and bilateral salpingo-oophorectomy, and removal of as much of the cancer as possible (tumor debulking), followed by chemotherapy. If the cancer remains following chemotherapy, another operation may be done to remove as much remaining tumor as possible.


STAGE III OVARIAN GERM CELL TUMOR

Treatment depends on how the cancer cells look under a microscope (cell type). If it is a tumor called a dysgerminoma, treatment may be one of the following:

1. Surgery to remove the uterus and both ovaries and fallopian tubes (total abdominal hysterectomy and bilateral salpingo-oophorectomy) and removal of as much of the cancer as possible (tumor debulking). If the cancer left after surgery is very small, external radiation therapy is given to the abdomen following surgery.

2. Total abdominal hysterectomy and bilateral salpingo-oophorectomy and tumor debulking. If the cancer left after surgery is large, systemic chemotherapy is given following surgery.

3. If a patient wants to have children in the future, surgery can be done to remove only the ovary where cancer is found and the fallopian tube on the same side (unilateral salpingo-oophorectomy). Chemotherapy is given following surgery.

If it is another type of germ cell tumor, treatment may be one of the following:
1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy and tumor debulking, followed by systemic chemotherapy. If the cancer remains following chemotherapy, another operation may be done in some cases.

2. Systemic chemotherapy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy and tumor debulking. Following this operation, a patient may receive more chemotherapy.

3. If cancer is found only in the ovary and the fallopian tube on the same side and the patient wants to have children in the future, a unilateral salpingo-oophorectomy can be done. Chemotherapy is given following surgery.


STAGE IV OVARIAN GERM CELL TUMOR

Treatment depends on how the cancer cells look under the microscope (cell type). If it is a tumor called a dysgerminoma, treatment may be one of the following:

1. Surgery to remove the uterus, both ovaries, and the fallopian tubes (total abdominal hysterectomy and bilateral salpingo-oophorectomy) and removal of as much of the cancer as possible (tumor debulking). Chemotherapy is given after surgery. If cancer remains following chemotherapy, additional chemotherapy with different drugs may be needed.

2. If cancer is found only in one ovary and the fallopian tube on the same side and the patient wants to have children in the future, surgery can be done to remove only the ovary where cancer is found and the fallopian tube on the same side (unilateral salpingo-oophorectomy). Chemotherapy is given following surgery.

If it is another type of germ cell tumor, treatment may be one of the following:
1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy and tumor debulking. Chemotherapy is given after surgery. If the cancer remains following chemotherapy, another operation may be done to remove as much remaining tumor as possible. Following this operation, the patient may receive more chemotherapy if there is still active disease.

2. Systemic chemotherapy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy and tumor debulking. Depending on the results of this operation, the patient may need more chemotherapy.

3. If cancer is found only in the ovary and the fallopian tube on the same side and the patient wants to have children in the future, unilateral salpingo-oophorectomy can be done. Chemotherapy is given following surgery.


RECURRENT OVARIAN GERM CELL TUMOR

Treatment depends on how the cancer cells look under a microscope (cell type). If it is a tumor called dysgerminoma, treatment will probably be systemic chemotherapy with or without radiation therapy. If it is another type of germ cell tumor, treatment will probably be systemic chemotherapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about ovarian germ cell tumor, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about ovarian cancer may be helpful:

The following general booklets on questions related to cancer may also be helpful:

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 04/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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