Treatment of malignant germ cell tumors of the ovary
- David M Gershenson, MD
David M Gershenson, MD
- J Taylor Wharton MD Distinguished Chair in Gynecologic Oncology
- Professor of Gynecologic Oncology
- The University of Texas MD Anderson Cancer Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Alberto S Pappo, MD
Alberto S Pappo, MD
- Section Editor — Pediatric Oncology
- Head of Solid Malignancies Program
- St. Jude Children's Research Hospital
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
Ovarian germ cell tumors (OGCTs) are derived from primordial germ cells of the ovary (figure 1). They may be benign or malignant. Malignant germ cell cancers of the ovary include dysgerminomas and nondysgerminomas, which include immature teratomas, embryonal cell carcinoma, yolk sac tumors, primary ovarian (nongestational) choriocarcinomas, polyembryoma, and mixed germ cell tumors . In contrast to epithelial ovarian cancer (EOC), they constitute a rare form of ovarian malignancy. (See "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum".)
Dysgerminomas differ from other malignant OGCTs in several ways: they are more likely to be localized to the ovary at diagnosis (approximately two-thirds of cases are stage IA, (table 1)), bilateral ovarian involvement is more common (10 to 15 percent), they are more likely to spread in a predictable fashion, and they are more sensitive to radiation therapy (RT).
The management of malignant OGCTs will be reviewed here. Pathology and clinical manifestations of these neoplasms, as well as the treatment of benign OGCTs, are reviewed separately. (See "Ovarian germ cell tumors: Pathology, clinical manifestations, and diagnosis".)
In general, the treatment principles for all types of malignant ovarian germ cell tumors (OGCTs) are similar to those that guide the management of the more common epithelial ovarian cancer (EOC), with some exceptions:
●Many OGCTs produce tumor products (alpha fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH]) that can be measured in the serum. The presence of these markers provides a highly sensitive and specific indicator of the presence of certain histologic components (table 2). Testing for serum tumor markers prior to definitive treatment can provide a diagnostic clue to the presence of an OGCT. In a child, teen, or young woman, the tumor marker results may help with surgical planning, resulting in the preservation of fertility potential. Furthermore, serial assay of these tumor markers is useful for monitoring the response to chemotherapy and for subsequent posttreatment follow-up. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)
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- SURGICAL STAGING AND PRIMARY CYTOREDUCTION
- Staging system
- Staging procedure
- - Lymphadenectomy
- Initial cytoreduction for advanced disease
- ADJUVANT TREATMENT
- Platinum-based therapy
- - Bleomycin, etoposide, and cisplatin
- Dose and schedule
- - Nondysgerminomas
- - Dysgerminomas
- Substitution of cisplatin with carboplatin
- Surveillance as an alternative option
- Radiation therapy
- TREATMENT OF DE NOVO STAGE IV DISEASE
- FERTILITY PRESERVATION
- Fertility-sparing surgery
- Oocyte cryopreservation
- POSTTREATMENT SURVEILLANCE
- POSTTREATMENT ISSUES
- Premature menopause
- Secondary malignancies
- Other issues
- RELAPSED DISEASE
- Role of surgery
- SPECIAL POPULATIONS
- Children and adolescents
- - Primary treatment
- - Treatment after surgery
- Pregnant women
- SUMMARY AND RECOMMENDATIONS