Ovarian germ cell tumours (OGCT) are a type of ovarian neoplasm principally affecting young women. They are derived from primitive germ cells of the embryonic gonad, and may undergo germinomatous or embryonic differentiation. They differ in clinical presentation, histology and biology, and include both benign (predominantly) and malignant subtypes. Germ cell tumours (GCT) account for 15-20% of all ovarian neoplasms, and constitute the second largest group of ovarian neoplasms. Less than 5% of ovarian cancers are of germ cell origin.
Classification of Ovarian Germ Cell TumorsThe following are the major types: -
- endodermal sinus tumor
- embryonal carcinoma
- teratoma: immature
- teratoma: mature
- solid cystic: dermoid cyst (mature cystic teratoma) or dermoid cyst with malignant transformation
- monodermal and highly specialized: struma ovarii carcinoid struma ovarii and carcinoid
- mixed forms
Stages of ovarian germ cell tumorOnce ovarian germ cell tumor has been found, surgery and staging is the first course of action. Staging determines if the cancer has spread from the ovaries to other parts of the body. The operation is called a laparotomy.
The cancerous tumor is removed and other organs are checked to see if they contain cancer. A biopsy is taken to determine the type of tumor.
The following stages are used for ovarian germ cell tumor: -
- Stage I: -Cancer is found only in one or both of the ovaries.
- Stage II: -Cancer is found in one or both ovaries and/or has spread to the uterus, and/or the fallopian tubes, and/or other body parts within the pelvis.
- Stage III: -Cancer is found in one or both ovaries and has spread to lymph nodes or to other body parts inside the abdomen, such as the surface of the liver or intestine.
- Stage IV: - Cancer is found in one or both ovaries and has spread outside the abdomen or has spread to the inside of the liver.
- Recurrent: - Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the ovary that is left or in another place.
TreatmentsSurgery is the most common treatment for ovarian germ cell tumor (most often during the staging laparotomy) using one of the following operations depending on the stage: -
- Unilateral salpingo-oophorectomy - taking out the ovary with the cancer and the fallopian tube on the same side.
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy - removing both ovaries and fallopian tubes and the uterus.
- Tumor debulking - taking out as much of the cancer as possible.
Chemotherapy combinations containing cisplatin, etoposide, and bleomycin (BEP) are now preferred because of a lower relapse rate and shorter treatment time. Other treatment plans may include VAC or PVB (cisplatin/vinblastine/bleomycin) chemotherapy. Treatment using BEP is in three or four cycles. Each cycle is over a five day period (in hospital) at three week intervals.
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