Ovarian Cancer

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Treating Ovarian Cancer TOPICS

Treatment for germ cell tumors of the ovary

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.

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. Less than 2% of all ovarian cancers are germ cell tumors.

Most types and stages of germ cell cancers of the ovary are treated the same way, with surgery and chemotherapy (chemo). The exceptions are stage I, grade 1, immature teratoma and stage IA dysgerminoma. Their treatment is discussed in detail later in this section.

Surgery: In general, all patients with malignant germ cell tumors will have the same staging surgery that is done for epithelial ovarian cancer. If the patient is still interested in having 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 can be left behind. This isn’t an option when the cancer is in both ovaries. If the patient has finished having children, 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 patient may wish to keep her uterus to allow future pregnancy through the use of in-vitro fertilization. Consulting a gynecologic oncologist is advised in these cases.

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

For stage IA dysgerminoma and stage I, grade 1, immature teratoma, surgery is usually the only treatment needed. Patients with these germ cell cancers are watched closely after surgery. If the cancer comes back later, the patient is usually given chemo.

Chemotherapy: Most patients 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 elevate 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 elevated before treatment starts, they are rechecked during chemo (usually before each cycle). If the chemo is working, the levels will go down to normal. If the levels stay up, it can be a sign that a different treatment is needed.

Stage IA dysgerminoma

If dysgerminoma is limited to one ovary, the patient may be treated by removing only that ovary and the fallopian tube on the same side, 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 patients 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 seen under the microscope look immature (look like fetal organs). 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, the patient may be treated by removing the ovary or ovaries containing the cancer and the fallopian tube or tubes. If implants (tumor deposits) are found outside the ovary but they appear mature under a microscope (look like adult tissues), no chemo is needed after surgery.

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).

Treatment for recurrent or persistent germ cell tumors may include chemo or, rarely, radiation therapy. For chemo, a combination of drugs is used most often. PEB (cisplatin, etoposide, and bleomycin) may be used if the patient did not receive this combination of drugs before. For patients who had already been treated with PEB, other combinations are used (see the section about chemotherapy).

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.

Last Medical Review: 08/05/2014
Last Revised: 08/11/2014