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Information from PDQ for Patients
Ovarian germ cell tumor
208/03125
** GENERAL INFORMATION ABOUT OVARIAN GERM CELL TUMOR **
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 Tumor 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 help detect (find) and diagnose ovarian germ cell tumor. The following
tests or procedures can help detect cancer:
- Pelvic examination: An evaluation of the uterus, vagina, ovaries, fallopian
tubes, bladder, and rectum to find any abnormality in their shape or size.
- Laparotomy: A surgical incision made in the wall of the abdomen to check the
inside of the abdomen for signs of disease and to remove tissue and fluid for
examination under a microscope.
- Lymphangiography: An x-ray study of the lymph system. A dye is injected into
a lymph vessel and travels throughout the lymph system. The dye outlines the
lymph vessels and organs on the x-ray. This test helps determine whether
cancer has spread to the lymph nodes.
- CT scan (CAT scan): A CT scan creates 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. This test 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 treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on 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, and the patient's
general health. Ovarian germ cell tumors are generally curable if found and
treated early.
** STAGES OF OVARIAN GERM CELL TUMOR **
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 the best treatment. Certain tests are used to determine
stage.
Many of the tests used to diagnose ovarian germ cell cancer 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.
The following stages are used for ovarian germ cell tumor:
-- Stage I --
Stage I is divided into stage IA, stage IB, and stage IC as follows:
- Stage IA: Cancer is limited to one ovary.
- Stage IB: Cancer is found in both ovaries.
- Stage IC: Cancer is found in one or both ovaries and one of the following
occurs:
- Cancer has spread to the outside surface of one or both ovaries; or
- The outer covering of the tumor has ruptured (broken open); or
- Cancer cells are found in the fluid of the peritoneal cavity or in washings
of the peritoneum (tissue that lines the abdominal wall and covers most of
the organs of the abdomen).
-- Stage II --
Stage II is divided into stage IIA, stage IIB, and stage IIC as follows:
- Stage IIA: Cancer is found in one or both ovaries and has spread into the
pelvis and/or to the uterus and/or fallopian tubes.
- Stage IIB: Cancer is found in one or both ovaries and has spread to other
tissue within the pelvis.
- Stage IIC: Cancer is found in one or both ovaries, has spread to the uterus,
fallopian tubes, and/or tissues in the pelvis, and one of the following
occurs:
- Cancer is on the surface of one or both ovaries; or
- The outer covering of the tumor has ruptured (broken open); or
- Cancer cells are found in the fluid in the peritoneal cavity or in washings
of the peritoneum.
-- Stage III --
Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:
- Stage IIIA: Cancer is found in one or both ovaries and the pelvis, and
microscopic cancer cells are found in the peritoneum.
- Stage IIIB: Cancer is found in one or both ovaries and has spread to the
peritoneum. The peritoneal tumors are no larger than 2 centimeters (about
3/4 inch).
- Stage IIIC: Cancer is found in one or both ovaries and has spread beyond the
pelvis to the peritoneum. The peritoneal tumors are larger than 2
centimeters and/or cancer is found in lymph nodes in the pelvis.
Cancer that has spread to the surface of the liver or has spread to the small
bowel or omentum (a fold of peritoneum that encloses the bowel) is also
considered stage III disease.
-- Stage IV --
In stage IV, cancer is found in one or both ovaries and has metastasized
(spread) not only to the pelvis and abdomen but also to other parts of the
body. Cancer is found in the tissues of the liver.
** Recurrent Ovarian Germ Cell Tumor **
Recurrent ovarian germ cell tumor is cancer that has recurred (come back) after
it has been treated. Recurrent ovarian germ cell tumor may come back in the
other ovary or in other parts of the body.
** TREATMENT OPTION OVERVIEW **
There are different types of treatment for all patients with ovarian germ cell
tumor. Some treatments are standard (the currently used treatment), and some
are being tested in clinical trials. Before starting treatment, patients may
want to think about taking part in a clinical trial. 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 treatment currently used as
"standard" treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov). Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care team.
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: Surgery to remove one ovary and one
fallopian tube.
- Hysterectomy and bilateral salpingo-oophorectomy: Surgery to remove the
entire uterus, both ovaries, and both fallopian tubes.
- Tumor debulking: Taking out as much of the tumor as possible.
-- Chemotherapy --
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be
taken by mouth, or it may be put into the body by inserting a needle into a
vein or muscle. Either type of chemotherapy is called systemic treatment
because the drugs enter the bloodstream, travel through the body, and can kill
cancer cells throughout the body.
-- Radiation therapy --
Radiation therapy is the use of x-rays or other types of radiation to kill
cancer cells and shrink tumors. Radiation therapy may use external radiation
(using a machine outside the body) or internal radiation. Internal radiation
involves putting radioisotopes (materials that produce radiation) through thin
plastic tubes into the area where cancer cells are found. Ovarian germ cell
cancer is treated with external radiation. Radiation may be used in addition
to surgery, chemotherapy, or both.
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.
Other types of treatment are being tested in clinical trials. These include
the following:
- High-dose chemotherapy with bone marrow transplantation
- Chemotherapy can reduce the ability of bone marrow to make blood cells. Bone
marrow transplantation has been tested as a way to help the blood recover so
that higher than standard doses of chemotherapy can be given.
-- New treatment options --
- Combination chemotherapy (the use of more than one chemotherapy drug to fight
cancer) is being tested in clinical trials.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE I OVARIAN GERM CELL TUMOR **
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 but withholding 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.
** TREATMENT OPTIONS FOR STAGE II OVARIAN GERM CELL TUMOR **
Treatment depends on whether the tumor is dysgerminoma or another type of germ
cell tumor.
Treatment of dysgerminoma may be either:
- 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 evaluating new treatment options.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE III OVARIAN GERM CELL TUMOR **
Treatment depends on whether the tumor is dysgerminoma or another type of germ
cell tumor.
Treatment of dysgerminoma may include the following:
- 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:
- 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 evaluating new treatment options.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE IV OVARIAN GERM CELL TUMOR **
Treatment depends on whether the tumor is dysgerminoma or another type of germ
cell tumor.
Treatment of dysgerminoma may include the following:
- 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:
- 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 evaluating new treatment options.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR RECURRENT OVARIAN GERM CELL TUMOR **
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
transplantation.
- A clinical trial evaluating new treatment options.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov).
** TO LEARN MORE **
Call
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.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) 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. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
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 (https://cissecure.nci.nih.gov/ncipubs). 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.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 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
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the 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
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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.
Before starting treatment, patients may want to think about taking part in a
clinical trial. 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 new treatments, the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better than one currently
being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). 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.
Date Last Modified: 09/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* 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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