What Is An Ovarian Germ Cell Tumor? How Do You Treat and Diagnosis This Cancer?

“Ovarian germ cell tumors account for up to 25% of ovarian tumors (benign or malignant) but only 5% are malignant ovarian neoplasms,” says Dr. Eleftheria Kalogera, a gynecologic oncologist at Miami Cancer Institute, part of Baptist Health South Florida.

“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: Women 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.

Types of Ovarian Germ Cell Tumors

Malignant ovarian germ cell tumors can be classified into the following types:

• Immature teratoma: A rare ovarian tumor that’s more common in younger patients. These tumors are associated with NMDA receptor encephalitis.
• Dysgerminoma: The most common type of ovarian germ cell tumor, these tumors usually grow rapidly.
• Yolk sac tumor: A rare type of ovarian germ cell tumor that tends to be more aggressive.
• Embryonal carcinoma: A rare type of ovarian germ cell tumor that's more common in children. This is one of the most aggressively growing ovarian tumors.
• Polyembryoma: A rare, aggressive ovarian germ cell tumor that is often part of a mixed germ cell tumor.
• Choriocarcinoma: Also rare, choriocarcinomas make up less than 1% of all ovarian tumors. They are aggressive and tend to metastasize.
• Mixed germ cell tumor: This is a combination of more than one type of ovarian germ cell tumor.

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 warning signs can be subtle

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.

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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