Treatment for Germ Cell Tumors of the Ovary

Treating benign germ cell tumors

Women with benign (non-cancerous) germ cell tumors such as mature teratomas (dermoid cysts) are cured by removing the part of the ovary that has the tumor (ovarian cystectomy) or by removing the entire ovary.

Treating malignant germ cell tumors

As with epithelial ovarian cancers, it is a good idea to consult with a gynecologic oncologist for treating malignant germ cell tumors, especially because these are so uncommon. About 2-3% of all ovarian cancers are germ cell tumors.

For most types and stages of germ cell cancers

Most types and stages of germ cell cancers of the ovary are treated the same way, with surgery and chemotherapy (chemo).

Surgery: In general, all women with malignant germ cell tumors will have the same staging surgery that is done for epithelial ovarian cancer. For women who still want to be able to have children, the cancerous ovary and the fallopian tube on the same side are removed, but the uterus, the ovary, and the fallopian tube on the opposite side are left behind. This isn’t an option when the cancer is in both ovaries. If preserving fertility is not a concern, complete staging including removing both ovaries, both fallopian tubes, and the uterus is generally recommended.

Sometimes, the doctor might consider removing only a part of one ovary to allow a woman to keep her ovarian function. Even when both ovaries need to be removed, a woman may wish to keep her uterus to allow future pregnancy through the use of in-vitro fertilization.

If cancer has spread beyond the ovaries , debulking surgery may be done as a part of the initial surgery. This removes as much cancer as possible without damaging or removing essential organs.

Chemotherapy:Most women with germ cell cancer will need to be treated with combination chemo for at least 3 cycles. The combination used most often is PEB (or BEP), and includes the chemo drugs cisplatin, etoposide, and bleomycin. Dysgerminomas are usually very sensitive to chemo, and can sometimes be treated with the less toxic combination of carboplatin and etoposide. Other drug combinations may be used to treat cancer that has recurred (come back) or hasn't responded to treatment.

Germ cell cancers can raise blood levels of the tumor markers human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), and/or lactate dehydrogenase (LDH). If the blood levels of these are high before treatment starts, they are rechecked during chemo (usually before each cycle). If the chemo is working, the levels will go down. If the levels stay up, it might be a sign that a different treatment is needed.

Stage IA dysgerminoma

If dysgerminoma is limited to one ovary, surgery to remove that ovary and the fallopian tube on the same side might be the only treatment needed, without chemo after surgery. This approach requires close follow-up so that if the cancer comes back it can be found early and treated. Most women in this stage are cured with surgery and never need chemo.

Grade 1 immature teratoma

A grade 1 immature teratoma is made up mostly of non-cancerous tissue, and only a few cancerous areas are seen. These tumors rarely come back after being removed. If careful staging has determined that a grade 1 immature teratoma is limited to one or both ovaries, surgery to remove the ovary or ovaries containing the cancer and the fallopian tube or tubes might be the only treatment needed.

Treating recurrent or persistent germ cell tumors

Recurrent tumors are those that come back after initial treatment. Persistent tumors are those that never disappeared even after treatment. Sometimes increased blood levels of the tumor markers HCG and AFP will be the only sign that a germ cell cancer is still there (or has come back). Other times a definite tumor might be seen and removed by surgery.

Treatment for recurrent or persistent germ cell tumors might include surgery, chemo or, rarely, radiation therapy. For chemo, a combination of drugs is used most often. PEB (cisplatin, etoposide, and bleomycin) may be used if this combination of drugs was not used before. For women who have already been treated with PEB, other drug combinations are used.

For recurrent or persistent germ cell cancer, a clinical trial for new treatments may provide important advantages. Ask your cancer care team for information about clinical trials for your type of cancer.