Treating Ovarian Teratomas and Germ Cell Tumors

Germ cell tumors, including teratomas and dysgerminomas, are rare ovarian tumors. They can be either benign or malignant. Treatment depends on the tumor type and stage, and may include surgery and chemotherapy. In some cases, there are treatment options that can preserve fertility.

Treating benign germ cell tumors

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

Treating most types and stages of malignant germ cell tumors

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

About 2-3% of all ovarian cancers are germ cell tumors. Because these tumors are so uncommon, it’s a good idea to consult with a gynecologic oncologist for treating malignant germ cell tumors.

Surgery

In general, all women with malignant germ cell tumors will have the same type of staging surgery 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.
• Sometimes, the doctor might consider removing only a part of one ovary to preserve ovarian function.
• Even when both ovaries are removed (for example, if the cancer is in both ovaries), leaving the uterus may allow future pregnancy through in-vitro fertilization.

If preserving fertility is not a concern, complete staging including removing both ovaries, both fallopian tubes, and the uterus is generally recommended.

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 chemotherapy, 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.

Treating 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.

Treating grade 1 immature teratoma

A grade 1 immature teratoma is made up mostly of non-cancerous tissue, with only a few cancerous areas visible. 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 affected ovary or ovaries and fallopian tube(s) 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.

If chemo is used, a combination of drugs is most common:

• PEB (cisplatin, etoposide, and bleomycin) may be used if this combination of drugs was not tried before.
• If PEB has already been tried, other drug combinations are used.

Clinical trials may offer access to newer treatment options for these cancers. Ask your cancer care team about clinical trials you might be eligible for.