Ovarian germ cell tumor
Overview
Development of cancer in the tissue of the eggs (germ cells) in the ovaries.
Symptoms
* Asymptomatic * Abdominal swelling * Unusual vaginal bleeding
Causes
Exactly what causes ovarian cancer isn't known, but the greatest number of cases occurs in the fifth decade of life. However, it can occur during childhood. Other contributing factors include infertility; nulliparity; familial tendency; ovarian dysfunction; irregular menses; and possible exposure to asbestos, talc, and industrial pollutants. Primary epithelial tumors arise in the ovarian surface epithelium; germ cell tumors, in the ovum itself; and sex cord tumors, in the ovarian stroma. Ovarian tumors spread rapidly intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics and the bloodstream. Generally, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other metastasis is rare.
Diagnosis
Ovarian germ cell tumors can be difficult to diagnose early. Often there are no symptoms in the early stages. Because young girls have yet to have a gynecologic examination, the only symptoms may be a swelling or hard distended abdomen without weight gain (with or with out pain). Tests which may be used to indicate this type of tumor are an ultrasound or CT scan. (Also for older patients the first step would be an internal (pelvic) exam). Prognosis and choice of treatment depend on the type of tumor and stage of the tumor (whether it affects one ovary, both, or has spread to other places).
Treatment
Surgery 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. Depending on the type and stage of the tumor one or both ovaries may be removed along with fallopian tubes and sometimes the uterus. All efforts are made to preserve fertility whenever possible. Some stage one tumors can be treated with surgery alone. Depending on the stage and type of tumor, radiation or chemotherapy are also used. 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.