General Information About Ovarian Germ Cell Tumors

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).

Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

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. (See 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, andrectum . 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. Aspeculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. APap test orPap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps orabnormalareas.
  
  Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
• Laparotomy : A surgical procedure in which anincision (cut) is made in the wall of theabdomen 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. Sometimesorgans are removed ortissue samples are taken forbiopsy.
• Lymphangiogram : A procedure used tox-ray thelymph system. Adye isinjected into thelymph vessels in the feet. The dye travels upward through thelymph nodesand 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.
• Serum tumor marker test : A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are calledtumor markers . An increased level ofalpha fetoprotein (AFP) orhuman chorionic gonadotropin(HCG) in the blood may be a sign of ovarian germ cell tumor.

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

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:

• Throughtissue . Cancerinvadesthe surrounding normal tissue.
• Through thelymph system . Cancer invades the lymph system and travels through thelymph vesselsto other places in the body.
• Through theblood . Cancer invades theveins andcapillariesand 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 thetumorhas ruptured (broken open); or
  • cancer cells are found in thefluid of theperitoneal cavity (the body cavity that contains most of theorgans in theabdomen ) or in washings of theperitoneum (tissue lining theperitoneal 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 theuterus and/or thefallopian tubes(the long slender tubes through which eggs pass from the ovaries to the uterus).
• Stage IIB : Cancer has spread to othertissuewithin the pelvis.
• Stage IIC : Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancercells are found in thefluid of theperitoneal cavity (the body cavity that contains most of theorgans in theabdomen ) or in washings of theperitoneum(tissue lining the peritoneal cavity).

Stage III

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 : Thetumor is found only in thepelvis , butcancer cells have spread to the surface of theperitoneum (tissue that lines theabdominal wall and covers most of the organs in theabdomen).
• Stage IIIB : Cancer has spread to the peritoneum but is 2centimeters or smaller indiameter.
• Stage IIIC : Cancer has spread to the peritoneum and is larger than 2centimeters in diameter and/or has spread tolymph nodesin 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

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 oneovary and onefallopian tube.
• Total hysterectomy : A surgical procedure to remove theuterus , including thecervix . If the uterus and cervix are taken out through thevagina , the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a largeincision (cut) in theabdomen , 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 alaparoscope, the operation is called a total laparoscopic hysterectomy.
  
  Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.
• Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
• Tumor debulking : A surgical procedure in which as much of thetumoras 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 cerebrospinal fluid , 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.

See Drugs Approved for Ovarian Cancer for more information.

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 lower the risk that the cancer will come back, 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 listing of clinical trials.

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.

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:

• Unilateral salpingo-oophorectomy with or withoutlymphangiography (anx-ray study of thelymph system , thetissues andorgans that filter and destroy harmful substances and help fightinfection and disease) orCT 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 byobservation (closely monitoring a patient's condition without giving any treatment untilsymptomsappear or change).
• Unilateral salpingo-oophorectomy followed byradiation therapy.
• Unilateral salpingo-oophorectomy followed bychemotherapy.

Treatment of other germ cell tumors may be either:

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

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

• totalabdominal hysterectomy andbilateral salpingo-oophorectomy followed byradiation therapy orcombination chemotherapy; or
• unilateral salpingo-oophorectomy followed bychemotherapy.

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 whethertumor cellsremain).
• Aclinical trialof new treatment options.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

• Totalabdominal hysterectomy andbilateral salpingo-oophorectomy , with removal of as much of thecancer in thepelvis andabdomenas possible.
• Unilateral salpingo-oophorectomy followed bychemotherapy.

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 aftersurgery.
• Unilateral salpingo-oophorectomy followed by chemotherapy.
• Second-look surgery (surgery performed after primary treatment to determine whether tumorcellsremain).
• Aclinical trialof new treatment options.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

• Totalabdominal hysterectomy andbilateral salpingo-oophorectomy followed bychemotherapy , with removal of as much of thecancer in thepelvis andabdomenas possible.
• Unilateral salpingo-oophorectomyfollowed 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 aftersurgery.
• Unilateral salpingo-oophorectomy followed by chemotherapy.
• Second-look surgery (surgery performed after primary treatment to determine whether tumorcellsremain).
• Aclinical trialof new treatment options.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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.

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 withoutradiation therapy.

Treatment of other germ cell tumors may include the following:

• Chemotherapy.
• Surgerywith or without chemotherapy.
• Aclinical trial ofhigh-dose chemotherapy followed bybone marrow transplant.
• A clinical trial of new treatment options.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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.

To Learn More About Ovarian Germ Cell Tumors

For more information from the National Cancer Institute about ovarian germ cell tumors, see the following:

• Ovarian Cancer Home Page
• Drugs Approved for Ovarian Cancer

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

• What You Need to Know About™ Cancer
• Understanding Cancer Series: Cancer
• Cancer Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer: Supportive and Palliative Care
• Questions to Ask Your Doctor About Cancer
• Cancer Library
• Information For Survivors/Caregivers/Advocates

Changes to This Summary (10 / 07 / 2011)

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.

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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.

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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.

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Last Revised: 2011-10-07

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