Ovarian germ cell tumors (OGCTs) come from the ovary’s very first cells. They can be harmless (like a mature teratoma) or cancerous (e.g. immature teratoma, dysgerminoma, yolk sac tumor, mixed germ cell neoplasm). Most of the time, women under 20 get ovarian germ cell tumors, but older women can also get them. Tumors develop in only one ovary in the vast majority of cases.

Germ cell cancers vary. Most ovarian malignant germ cell tumors are dysgerminomas. Mature teratoma is the most frequent benign ovarian germ cell tumor. Teenage girls and young women get these noncancerous tumors. Immature ovarian teratoma might spread to other organs. Endodermal sinus tumors are a type of malignant tumor that doctors also call a yolk sac tumor. These fast-growing tumors affect children and young women.

Certain birth defects or genetic diseases (chromosomal abnormalities or gene mutations) may raise the risk of ovarian germ cell cancers. This tumor is most common in teenage girls, young women, and older women.

Patients may exhibit no symptoms at all, or they may show some combination of the following:

• Enlargement of the abdomen
• Abdominal pain which can be acute discomfort that is often misinterpreted as appendicitis.
• Early puberty which is probably caused by early human chorionic gonadotropin (hCG) production
• Signs and symptoms of pregnancy due to hCG production.
• Roughly 10% of patients experience fever or vaginal bleeding.

There are also symptoms unique to a particular OGCT type. For example when a mature teratoma bursts, it can release sebaceous material into the abdominal cavity, which can cause severe internal bleeding and shock. High-grade teratomas of the skin, or monodermal teratomas, typically manifest as hyperthyroidism or carcinoid symptoms. 

To find out if someone has an ovarian germ cell tumor, the pelvic area, blood, and ovarian tissue can be checked.

A doctor will perform a physical exam to check for any abdominal masses that can be felt.

During a pelvic exam, a doctor will check for problems in the vagina, cervix, fallopian tubes, ovaries, and rectum. A Pap test may also be done to look for signs of disease in the cervix.

During laparotomy or laparoscopy one or more cuts are made in the belly to look for signs of cancer in the ovary. Tissue samples can be taken out and looked at with a microscope.

Computed tomography (CT) scan is a test that takes a series of very clear pictures of the organs inside the pelvic area. Serum tumor marker is a blood test that looks for high levels of substances that have been linked to ovarian germ cell tumors. Human chorionic gonadotropin (hCG), lactate dehydrogenase (LDH), and alpha-fetoprotein (AFP) levels are linked to ovarian germ cell tumors.

After a diagnosis of an ovarian germ cell tumor, more tests may be done to see if the cancer has spread to other parts of the body. These tests include: PET scan, MRI, and transvaginal ultrasound exam.

Treatment

The type of treatment given depends on where the cancer is and how severe it is. Below are standard treatments currently used.

Surgery is the most common way to treat ovarian germ cell tumors. During surgery, the cancer is cut out. In a procedure called unilateral salpingo-oophorectomy, only one ovary and one fallopian tube are taken out. Sometimes, more biopsies and samples are taken from lymph nodes. In more serious cases, the whole uterus and cervix may need to be taken out (this is called a “total hysterectomy”). In a radical hysterectomy, along with the uterus and cervix, the ovaries, fallopian tubes, and nearby tissues are also taken out. In a procedure called “tumor debulking,” a surgeon takes out as much of the cancerous tumor as possible.

If the care team takes this approach, they may just watch and wait, paying close attention to any changes.

High-energy X-rays or other types of radiation are used to kill cancer cells or stop them from growing.

Chemotherapy is a treatment that stops cancer cells from growing. A combination of chemotherapy drugs may be used to treat ovarian germ cell tumors.

Unfortunately, it is impossible to prevent an ovarian germ cell tumor from growing. Visit a doctor regularly so he or she can keep tabs on your health and determine whether or not you are at an increased risk for ovarian germ cell cancer. 

References

Cleveland Clinic (2022). Ovarian Germ Cell Tumors. Retrieved November 18, 2022, from https://my.clevelandclinic.org/health/articles/6186-ovarian-germ-cell-tumors

Cancer Treatment Centers of America (2022). What are ovarian germ cell tumors? Retrieved November 18, 2022 from https://www.cancercenter.com/cancer-types/ovarian-cancer/types/ovarian-germ-cell-tumors

National Cancer Institute (2022). Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version. Retrieved November 18, 2022, from https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq#:~:text=and%20treatment%20options.-,Ovarian%20germ%20cell%20tumor%20is%20a%20disease%20in%20which%20malignant,often%20affect%20just%20one%20ovary.

Gershenson, DM. (2022). Ovarian germ cell tumors: Pathology, epidemiology, clinical manifestations, and diagnosis.  UpToDate. Retrieved February 18, 2022 from https://www.uptodate.com/contents/ovarian-germ-cell-tumors-pathology-epidemiology-clinical-manifestations-and-diagnosis#H5