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Table of Contents 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
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
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Ovarian germ cell tumor is a disease in which malignant
(cancer) cells form in the germ (egg) cells of the ovary.
Germ cell tumors begin
in the reproductive cells (egg or
sperm) of the body. Ovarian germ
cell tumors usually occur in teenage girls or young women and most often affect
just one ovary.
The ovaries are a pair of organs in the female reproductive system. They are
located in the pelvis, one on each
side of the uterus (the hollow,
pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries
produce eggs and female hormones (chemicals that control the way certain cells or organs function).
Ovarian germ cell tumor is a general name that is used to describe
several different types of cancer. The
most common ovarian germ cell tumor is called dysgerminoma. (Refer to the PDQ
summaries on Ovarian Epithelial Cancer
Treatment and Ovarian
Low Malignant Potential Tumors Treatment for information
about other types of ovarian cancers.)
Possible signs of ovarian germ cell tumor are swelling of the
abdomen or vaginal bleeding after menopause.
Ovarian germ cell tumors can be difficult to diagnose (find) early.
Often there are no symptoms in the
early stages, but tumors may be found during regular gynecologic examinations (checkups). A woman who has swelling of the abdomen without weight gain in other
places should see a doctor. A woman who no longer has menstrual periods (who has gone
through menopause) should also see a
doctor if she has bleeding from the vagina.
Tests that examine the ovaries, pelvic area, blood, and ovarian
tissue are used to detect (find) and diagnose ovarian germ cell tumor.
The following tests and procedures may be used:
- Pelvic 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.
Back to Top Stages of Ovarian Germ Cell Tumors
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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:
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
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| 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:
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.
Back to Top 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.
Back to Top Treatment Option Overview
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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.
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.
Back to Top 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.
Stage I Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.
Treatment of dysgerminoma may include the following:
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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another
type of germ cell tumor.
Treatment of dysgerminoma may be either:
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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another
type of germ cell tumor.
Treatment of dysgerminoma may include the following:
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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Ovarian Germ Cell Tumors
Treatment depends on whether the tumor is dysgerminoma or another
type of germ cell tumor.
Treatment of dysgerminoma may include the following:
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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top 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:
Treatment of other germ cell tumors may include the following:
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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top 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.
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
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- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site 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. 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.
Back to Top 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.
Back to Top 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. 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. 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.
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