General Information About Ovarian Germ Cell Tumors
Stages of Ovarian Germ Cell Tumors
Recurrent Ovarian Germ Cell Tumors
Treatment Option Overview
Treatment Options By Stage

Stage I Ovarian Germ Cell Tumors Stage II Ovarian Germ Cell Tumors Stage III Ovarian Germ Cell Tumors Stage IV Ovarian Germ Cell Tumors

Treatment Options for Recurrent Ovarian Germ Cell Tumors
To Learn More About Ovarian Germ Cell Tumors
Get More Information From NCI
Changes to This Summary (09/12/2008)
About PDQ

General Information About Ovarian Germ Cell Tumors

Key Points for This Section

Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary. Possible signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause. Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor. Certain factors affect prognosis (chance of recovery and treatment options).

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 ¹ and Ovarian Low Malignant Potential Tumors Treatment ² 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 exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. 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 for biopsy.
• Lymphangiogram: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
• 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.
• 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 prognosis (chance of recovery and treatment options).

The prognosis (chance of recovery) 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 generally curable if found and treated early.

Stages of Ovarian Germ Cell Tumors

Key Points for This Section

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. The following stages are used for ovarian germ cell tumors: Stage I Stage II Stage III Stage IV

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 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.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for ovarian germ cell tumors:

Stage I

In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.

• Stage IA: Cancer is found in a single ovary.
• Stage IB: Cancer is found in both ovaries.
• Stage IC: Cancer is found in one or both ovaries and one of the following is true:
  • cancer is found on the outside surface of one or both ovaries; or
  • the capsule (outer covering) of the tumor has ruptured (broken open); 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 and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.

• Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
• Stage IIB: Cancer has spread to other tissue within the pelvis.
• Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and 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 III

Enlarge

Pea, peanut, walnut, and lime show tumor sizes.

In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:

• Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).
• Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.
• Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.

Cancer that has spread to the surface of the liver is also considered stage III disease.

Stage IV

In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body.

Cancer that has spread to tissues in the liver is also considered stage IV disease.

Recurrent Ovarian Germ Cell Tumors

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

Treatment Option Overview

Key Points for This Section

There are different types of treatment for patients with ovarian germ cell tumors. Three types of standard treatment are used: Surgery Chemotherapy Radiation therapy New types of treatment are being tested in clinical trials. High-dose chemotherapy with bone marrow transplant New treatment options 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.

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: 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 may not be able to be completely removed.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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 in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. 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. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

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.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site ³.

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 chemotherapy drug to fight cancer) is being tested in clinical trials.

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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

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. This is sometimes called re-staging.

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 Options By Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

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

Treatment of dysgerminoma may include the following:

• 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).
• Unilateral salpingo-oophorectomy followed by observation (closely monitoring a patient’s condition without giving any treatment until symptoms appear or change).
• Unilateral salpingo-oophorectomy followed by radiation therapy.
• Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may be either:

• unilateral salpingo-oophorectomy followed by careful observation; or
• unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I ovarian germ cell tumor ⁴.

Treatment depends on whether the tumor is dysgerminoma or another type of 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 germ cell tumors may include the following:

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

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II ovarian germ cell tumor ⁵.

Treatment depends on whether the tumor is dysgerminoma or another type of 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 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 surgery (surgery performed after primary treatment to determine whether tumor cells remain).
• A clinical trial of new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III ovarian germ cell tumor ⁶.

Treatment depends on whether the tumor is dysgerminoma or another type of 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 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 surgery (surgery performed after primary treatment to determine whether tumor cells remain).
• A clinical trial of new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV ovarian germ cell tumor ⁷.

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:

• Chemotherapy with or without radiation therapy.

Treatment of other 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 new treatment options.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent ovarian germ cell tumor ⁸.

To Learn More About Ovarian Germ Cell Tumors

For more information from the National Cancer Institute about ovarian germ cell tumors, see the Ovarian Cancer Home Page ⁹.

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer - An Overview ¹⁰
• Understanding Cancer Series: Cancer ¹¹
• Staging: Questions and Answers ¹²
• Chemotherapy and You: Support for People With Cancer ¹³
• Radiation Therapy and You: Support for People With Cancer ¹⁴
• Coping with Cancer ¹⁵
• Support and Resources ¹⁶
• Cancer Library ¹⁷
• Information For Survivors/Caregivers/Advocates ¹⁸

Get More Information From NCI

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The NCI Web site ²⁰ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ²¹. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (09/12/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ²⁰. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." 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.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ²². Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

AFP. A protein normally produced by a fetus. AFP levels are usually undetectable in the blood of healthy adult men or women (who are not pregnant). An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. Also called AFP.

Surgery to remove both ovaries and both fallopian tubes.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.

A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.

The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

Treatment using more than one anticancer drug.

Computed tomography scan. 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. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

The process of identifying a disease, such as cancer, from its signs and symptoms.

The length of a straight line that extends from one edge of a tumor or other object, through its center and to the opposite edge. It is usually used to measure the size of round or spherical shapes.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

A slender tube through which eggs pass from an ovary to the uterus. In the female reproductive tract, there is one ovary and one fallopian tube on each side of the uterus.

The developing offspring from 7 to 8 weeks after conception until birth.

Liquid.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

A type of tumor that begins in the cells that give rise to sperm or eggs. Germ cell tumors can occur almost anywhere in the body and can be either benign or malignant.

Having to do with the female reproductive tract (including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina).

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

A cut made in the body to perform surgery.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, radiation brachytherapy, and implant radiation therapy.

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.

A thin, tube-like instrument used to look at tissues and organs inside the abdomen. A laparoscope has a light and a lens for viewing and may have a tool to remove tissue.

A surgical incision made in the wall of the abdomen.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

An x-ray study of the lymphatic system. A dye is injected into a lymphatic vessel and travels throughout the lymphatic system. The dye outlines the lymphatic vessels and organs on the x-ray.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

The time of life when a woman's menstrual periods stop. A woman is in menopause when she hasn't had a period for 12 months in a row. Also called change of life.

Periodic discharge of blood and tissue from the uterus. From puberty until menopause, menstruation occurs about every 28 days when a woman is not pregnant.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called watchful waiting, active surveillance, and expectant management.

A part of the body that performs a specific function. For example, the heart is an organ.

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

One of a pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap smear can also show noncancerous conditions, such as infection or inflammation. Also called a Pap test.

A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap test can also show noncancerous conditions, such as infection or inflammation. Also called a Pap smear.

A physical examination in which the health care professional will feel for lumps or changes in the shape of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The health care professional will also use a speculum to open the vagina to look at the cervix and take samples for a Pap test. Also called an internal examination.

The lower part of the abdomen, located between the hip bones.

The space within the abdomen that contains the intestines, the stomach, and the liver. It is bound by thin membranes.

The tissue that lines the abdominal wall and covers most of the organs in the abdomen.

The original tumor.

The likely outcome or course of a disease; the chance of recovery or recurrence.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

The last several inches of the large intestine closest to the anus.

To come back or to return.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.

An egg or sperm cell. Each mature reproductive cell carries a single set of 23 chromosomes.

The organs involved in producing offspring. In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). In men, it includes the prostate, the testes, and the penis.

Surgery performed after primary treatment to determine whether tumor cells remain.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

An instrument used to widen an opening of the body to make it easier to look inside.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Cancer that began in tissue covering the ovary and is found in one or both of the ovaries. Stage I is divided into stages IA, IB, and IC. In stage IA, cancer is found in a single ovary. In stage IB, cancer is found in both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: (1) cancer is found on the outside surface of one or both ovaries; or (2) the capsule (outer covering) of the tumor has ruptured (broken open); or (3) cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

The tumor is found in one or both ovaries. Stage I ovarian germ cell tumor is divided into stages IA, IB, and IC. In stage IA, cancer is found in a single ovary. In stage IB, cancer is found in both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: cancer is found on the outside surface of one or both ovaries; or the capsule (outer covering) of the tumor has ruptured (broken open); or cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

Cancer that began in tissue covering the ovary and has spread from one or both ovaries into other areas of the pelvis. Stage II is divided into stages IIA, IIB, and IIC. In stage IIA, cancer has spread to the uterus and/or the fallopian tubes. In stage IIB, cancer has spread to other tissues within the pelvis. In stage IIC, cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

The tumor is found in one or both ovaries and has spread into other areas of the pelvis. Stage II ovarian germ cell tumor is divided into stages IIA, IIB, and IIC. In stage IIA, cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus). In stage IIB, cancer has spread to other tissue within the pelvis. In stage IIC, cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

Cancer that began in tissue covering the ovary and has spread from one or both ovaries to other parts of the abdomen. Stage III is divided into stages IIIA, IIIB, and IIIC. In stage IIIA, the tumor is found in the pelvis only, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen). In stage IIIB, cancer has spread to the peritoneum and is 2 centimeters or smaller in diameter. In stage IIIC, cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen. Cancer that has spread to the surface of the liver is stage III disease.

The tumor is found in one or both ovaries and has spread to other parts of the abdomen. Stage III ovarian germ cell tumor is divided into stages IIIA, IIIB, and IIIC. In stage IIIA, the tumor is found in the pelvis only, but cancer cells have spread to the surface of the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). In stage IIIB, cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter. In stage IIIC, cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen. Cancer that has spread to the surface of the liver is considered stage III disease.

Cancer that began in tissue covering the ovary is found in one or both ovaries and has spread beyond the abdomen to distant parts of the body. Ovarian cancer that is found in tissues of the liver is stage IV disease.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice.

A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment with anticancer drugs that travel through the blood to cells all over the body.

A group or layer of cells that work together to perform a specific function.

Surgery to remove the entire uterus, including the cervix. Also called complete hysterectomy.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Surgical removal of as much of a tumor as possible. Tumor debulking may increase the chance that chemotherapy or radiation therapy will kill all the tumor cells. It may also be done to relieve symptoms or help the patient live longer. Also called debulking.

Surgery to remove the ovary and fallopian tube on one side of the body.

The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called the womb.

The muscular canal extending from the uterus to the exterior of the body. Also called birth canal.

A blood vessel that carries blood to the heart from tissues and organs in the body.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.