Ovarian Cancer: Getting an Early Diagnosis
- At 19 years old, beauty therapist Storm Reveley started experiencing stomach pains and feelings of fullness that she chalked up to generalized anxiety due to a break-up, but as her symptoms progressed, she eventually found out she had an ovarian germ cell tumor, a type of ovarian cancer.
- Ovarian germ cell tumors (OGCTs) are tumors that develop from immature female germ cells (the cells that develop into eggs) in one or both ovaries. They can be either non-cancerous (benign) or cancerous (malignant).
- Diagnosing ovarian germ cell tumors can be complicated. Your doctor may order a combination of imaging studies and blood work to diagnose and stage ovarian germ cell tumors.
- Germ cell tumors of the ovary may have symptoms that overlap with other types of ovarian cancer. Pain or swelling in the abdomen, fever, fullness, a change in bowel habits and/or irregular vaginal bleeding should always be investigated by a doctor. Diagnosing ovarian cancer early greatly increases your chance of successful treatment.
They found a mass in her stomach, and thinking it was a twisted ovarian cyst (since the ultrasound didn’t provide good enough visibility on the area), Storm underwent an emergency surgery to remove it. That’s when her cancerous tumor was discovered.
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“I was in so much pain I was so glad about having the surgery and the pain to be gone,” Storm said. “I felt relieved. I probably didn’t understand the full extent.”
Namely, the way her medical team phrased her diagnosis. “At the time they didn’t say it was cancer. They said it was a germ cell tumor and I had to say ‘is that cancer’?”
[Cancer] has an impact on you when you finish treatment. It doesn’t end when you ring the bell.”
But in a few months, after undergoing chemotherapy, the skincare expert was lucky enough to find out she was cancer-free.
Having stayed positive during treatment, Storm said she didn’t quite “feel any of the anger, frustration or sadness. It has an impact on you when you finish treatment. It doesn’t end when you ring the bell.”
Grieving the “old me,” she now worries about her fertility, not yet knowing what the future will bring.
“They don’t know for definite. My egg count is lower than the average person my age but I’m still fertile to an extent — how am I going to feel when my friends are having babies and I can’t?”
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Ovarian Germ Cell Tumors
Ovarian germ cell tumors (OGCTs) are tumors that develop from immature female germ cells (the cells that develop into eggs) in one or both ovaries. They can be either non-cancerous (benign) or cancerous (malignant).
RELATED: What Is An Ovarian Germ Cell Tumor? How Do You Treat and Diagnose This Cancer?
“Ovarian germ cell tumors account for up to 25% of ovarian tumors (benign or malignant) but only 5% are malignant ovarian neoplasms,” Dr. Eleftheria Kalogera, a gynecologic oncologist at Miami Cancer Institute, part of Baptist Health South Florida, previously told SurvivorNet.
“They tend to affect young women in the 2nd and 3rd decade of life with a mean age at presentation of 19 to 20 years old. While they account for two-thirds of the ovarian tumors in this age group, only one-third is malignant.”
Risk Factors for Ovarian Germ Cell Tumors
There are few known risk factors for developing germ cell ovarian cancers:
- Family history: Your mother, sister or daughter have developed an ovarian germ cell tumor
- Age: Females between 10 and 30 years of age are at an increased risk
- Race: Hispanic Americans and Asian/Pacific Islanders are more likely to have malignant germ cell tumors than other races
- History of cancers: Women with a history of breast, ovarian, or uterine cancer have an increased risk
Symptoms of Ovarian Germ Cell Tumors
Ovarian germ cell tumors can cause:
- Abdominal and/or pelvic pain
- Increase in abdominal girth
- Signs of early puberty in young girls
- Loss of appetite
- Nausea and/or vomiting
- Pain during intercourse
- Urinary urgency
- Abnormal vaginal bleeding, especially after menopause
- False-positive pregnancy test
Ovarian Cancer: ‘The cancer that whispers’
Diagnosis
Diagnosing ovarian germ cell tumors can be complicated. Your doctor may order a combination of imaging studies and blood work to diagnose and stage ovarian germ cell tumors.
Physical and Pelvic Exam
A physical exam may reveal an enlarged abdomen, cysts in the ovaries, or a mass that can be felt through the uterus.
If your doctor suspects an ovarian tumor, they may perform a pelvic exam. This involves inserting a speculum into the vagina and pressing on your abdomen to check for abnormalities and growths. A pap smear may be done during this exam to check for abnormal cells.
Imaging studies
Common imaging studies used to help diagnose ovarian germ cell tumors include:
- Transvaginal ultrasound (sonography): Uses high-frequency sound waves to create an image of your internal organs. A transvaginal ultrasound is commonly used to evaluate pelvic masses or abnormal growths in the ovaries.
- CT scans: Uses radiation to create detailed images of the ovaries, which may reveal a solid or fluid-filled mass.
- MRI: Uses powerful magnets and radio waves to make detailed images of your internal organs. An MRI may be recommended if you have a contrast allergy or wish to avoid radiation exposure.
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Blood tests
Common blood tests used to help diagnose ovarian germ cell tumors include:
- Complete Blood Count: Measures the levels of red blood cells, white blood cells, and platelets. If an elevated number of leukocytes (white blood cells) are found in your bloodstream, this may indicate inflammation or infection.
- CA-125: Measures the levels of cancer antigen 125 in your blood. This test may indicate ovarian cancer, although noncancerous conditions may also cause it to be elevated.
- Alpha-Fetoprotein (AFP): Elevated AFP may indicate there is a germ cell tumor in your ovaries.
- Human Chorionic Gonadotropin (HCG): While HCG is usually elevated during pregnancy, a high level of HCG in non-pregnant women may point to a germ cell tumor.
- Lactate Dehydrogenase (LDH): In some cases, elevated LDH may signify a dysgerminoma.
Treatment
Treatment depends on whether the tumor is benign or malignant (cancerous). If benign, your doctor may remove the tumor through a laparoscopy procedure.
Treatment for malignant tumors may include:
- Surgery: Your doctor may remove part or all of the ovary. If the tumor is cancerous, a hysterectomy (surgical removal of the uterus and cervix) may be recommended. Early-stage patients may be safely treated with fertility-preserving surgery.
- Chemotherapy: Cancer-killing medications are used to shrink the size of a large cancerous tumor so it can be surgically removed. Chemotherapy may also be given after surgery to help kill any remaining cancer cells.
- Radiation: Radiation therapy is used to destroy cancer cells that may have spread beyond the ovaries. Radiation may be given after surgery to ensure there are no cancer cells left.
- Clinical trials: Patients diagnosed with ovarian germ cell tumors sometimes qualify for clinical trials. Clinical trials use new drugs or treatments that aren’t yet available to the public. Your doctor can help find a clinical trial that may be right for you and your type of cancer.
Fertility Management for Women With Germ Cell Tumors
A common concern for many women with ovarian germ cell tumors is the preservation of fertility. The good news is that there are options to help preserve fertility in women with this type of tumor.
The most common option is unilateral (one-sided) removal of the ovary and fallopian tube, which often allows for normal ovulation and fertility. Even after chemotherapy, at least 80% of these women will resume normal menstrual function. Studies show that those who achieve pregnancy after treatment do not have an increase in pregnancy complications.
If cancer has spread beyond one ovary or both ovaries are involved, it can be more difficult to achieve pregnancy without some form of fertility assistance. If preserving fertility is a concern, you should talk to your oncologist about fertility management options.
Can Ovarian Germ Cell Tumors be Prevented?
“Unfortunately, there is no known strategy at the current time to prevent OGCTs,” says Dr. Kalogera. Having regular pelvic exams are important for early detection.
When to See Your Doctor
“It’s important for women to be educated on the most common symptoms associated with ovarian cancer so you can seek medical attention as soon as possible,” adds Dr. Kalogera. “I find that oftentimes women tend to tolerate their symptoms for a long time before seeking medical attention and this can be key.”
Germ cell tumors of the ovary may have symptoms that overlap with other types of ovarian cancer. New abdominopelvic pain or swelling, fevers, or irregular vaginal bleeding should always be investigated by a doctor. Diagnosing ovarian cancer early greatly increases your chance of successful treatment.
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