What Is Ovarian Germ Cell Tumour?

Did you know the human female body has a pair of ovaries in its reproductive system? A human ovary is just the size and shape of an almond. These small ovaries produce hormones (estrogen and progesterone) and also contain the germ cells (reproductive cells), which grow into eggs and either become fertilized with sperm and proceed to pregnancy or stay unfertilized and are passed out through menstruation. .

Introduction

Ovarian germ cell tumour is a disease in which cancer cells form in the germ cells of the ovary.¹ Ovarian germ cell tumour primarily develops in one of the ovaries.

Ovarian germ cell tumour usually occurs in teenage girls and young girls under 20, but they can also rarely develop in older women. 

Types of ovarian germ cell carcinoma:

Ovarian germ cell tumour is a broad term describing various cancer forms. The most common of which is dysgerminoma. 

Most germ cell tumours are not cancerous (benign), but sometimes they may be malignant (cancerous). Malignant tumours are rare. 

Benign germ cell tumours

Benign ovarian germ cell tumours are non-cancerous and common. These tumours are removed with surgery. Mature teratomas are the most prevalent and are usually called dermoid cysts. They are primarily seen in the reproductive years of women, i.e., 20 to 40's.²

Malignant germ cell tumours

Malignant germ cell tumours are cancerous and are rare. This type of tumour requires chemotherapy for treatment. Some of these are:

Immature teratomas

In the case of immature ovarian teratoma, the tumour can metastasize, meaning it can spread beyond the ovary to various organs in the body.

Dysgerminomas

Dysgerminomas are the most common form of ovarian germ cell tumour. This tumour develops in the female germ cells and causes the dysregulation of beta-hCG hormone , which is produced more in pregnancy.³

Yolk sac tumours

Yolk cell tumours are usually identified by the presence of a mass composed of solid and cystic components.

Choriocarcinomas

This fast-growing tumour spreads through blood. It primarily affects the lungs. Choriocarcinoma is rare and forms in the uterus.

Embryonal carcinomas

It's another rare form of cancer and usually develops in adolescence.

Risk Factors

The risk factors are the factors that may increase the chances of developing cancer. It's important to note, however, that having one or more risk factors does not necessarily mean that ovarian cancer will develop. Some of the risk factors are stated below:

• Aging: The chances increase as you advance in age. Women aged between 75 and 79 are at the greatest risk⁴
• Genes: Inheriting mutated genes may put you at a higher risk of ovarian germ cell tumour⁴
• Previous cancer: Women with breast cancer are at a higher risk of developing ovarian germ cell tumours⁴
• Using Hormone replacement therapy (HRT): Using HRT after menopause increases the risk⁴
• Smoking: There is a correlation between smoking and an elevated risk of developing specific categories of cancer. The increase in risk depends on how long you have been smoking⁴
• Asbestos: Asbestos comprises tiny fibers, and you can quickly inhale it. The International Agency For Research categorizes asbestos as a causative agent for ovarian cancer⁴
• Other medical conditions: Other medical conditions, such as diabetes and endometriosis, may elevate the risks of developing ovarian germ cell tumours⁴ 
• Being overweight or obese: Obesity and too much weight also increase the chances of ovarian germ cell tumours^4,5

Symptoms of ovarian germ cell tumour

Ovarian germ cell syndrome is challenging to be recognized early on. The symptoms of malignant tumours do not appear until the cancer has progressed to an advanced stage.⁶ Some of the common symptoms are:

• Pain in the pelvic area
• Swollen abdomen
• Nausea and difficulty in eating
• Changes in bowel habits like persistent constipation
• Vaginal bleeding after menopause
• Unexplained weight loss
• Tiredness

Diagnosis of ovarian germ cell tumour:

After carefully evaluating the symptoms, the healthcare professional would suggest several tests and examinations. These may be

• Physical examination

A thorough physical examination of the body is done to assess the overall health condition, including a thorough investigation for any signs of disease, such as the identification of lumps or any other unusual mass. A complete history of previous treatments and habits of the patients, such as smoking, is also noted.¹

• Pelvic Exam

A pelvic examination is carried out to estimate the size, shape, and position of the ovaries and uterus. The vagina, cervix, fallopian tubes, and rectum are also examined.¹

• Laparotomy

Laparotomy is a surgical procedure that involves making incisions in the abdominal wall to examine the body cavity for any indications of illness. Sometimes, samples are also taken for biopsy. ¹

• CT scan

CT scan is a procedure in which detailed images of the affected area are taken from different angles and evaluated for tumours. It is also called computerized tomography.¹

• Serum tumour marker test

In this test, blood samples are taken and checked for certain substances released by tumour cells in the body. AFP (Alpha-Fetoprotein) or HCG (Human Chorionic gonadotropin) in the blood may be a sign of ovarian germ cell tumour.¹

Grades of ovarian germ cell tumour

The ovarian germ cell tumour grade helps the practitioners decide upon the best treatment options. The grade tells how much the cancer cells look like normal cells.

Less developed cells have higher grades. Higher-grade cancer proliferates as compared to low-grade cells.

There are three grades of malignant ovarian cell tumours. Grade 1, Grade 2, Grade 3. Grade 1 cancers grow slowly and are least likely to spread.⁷

Stages of ovarian germ cell tumour

Germ cell tumours are removed after surgery. The surgery done to remove ovarian germ cell tumours is called oophorectomy. 

Following the diagnosis of germ cell tumours, the healthcare providers classify them by a process called staging. The size and look of the tumour is monitored. The primary purpose is determining if the tumour has spread to the surrounding tissues or other body parts. A CT-scan is done to gather all this information.⁸

• Stage 1 denotes that the cancer is restricted to the ovary without any spread to other areas
• Stage 2 means the cancer has spread to the fallopian tubes, womb, or area within the hip bone
• Stage 3 means the cancer has progressed either to the lymph nodes or the peritoneum, which is the tissue lining the abdomen
• Stage 4 means that the cancer has advanced and migrated to other organs like the lungs or the liver

Treatment

The treatment of ovarian germ cell tumours depends on some factors, like

• Type of germ cell tumour
• Grade of the tumour
• Stage of the tumour

Usually, the primary treatment is surgery. But if the tumour is cancerous, chemotherapy is also done.

Benign germ cell ovarian tumours

Most of the time, healthcare providers remove benign tumours through surgery. Sometimes, only a part of the ovary or, in some cases, only one ovary is removed. These tumours rarely relapse after surgery.

Malignant ovarian germ cell tumour

Treatment of malignant germ cell tumours includes surgery and chemotherapy.

Surgery

Malignant germ cell tumours are also removed through surgery called oophorectomy. In this surgery, one or both ovaries are removed.

After surgery, doctors keep regular records of checkups and monitor the patient regularly through follow-ups. It is called active surveillance.

Chemotherapy

Chemotherapy uses medications to kill cancer cells and stop them from multiplying. The chemotherapy drugs are taken orally or injected into the body through infusion. Chemotherapy may continue for several weeks or months. Ity is not required if the tumour is benign.

Radiation

High-energy X-rays are used to treat cancer by shrinking the size of the cancer cell. This is called palliative radiotherapy. Radiotherapy is usually done in relapse cases of cancer. It treats the whole abdomen area.

Prognosis of treatment of ovarian germ cell tumour

The prognosis of the treatment depends on the following factors:

• The type of cancer
• Size of the tumour
• Cancer stage
• Cancer grade
• General health of the patient

If diagnosed early, ovarian germ cell tumours can be cured and treated correctly.

Pregnancy after an ovarian germ cell tumour

Pregnancy after an ovarian germ cell tumour depends upon the type of surgery you have had. If only one ovary and fallopian tube have been removed, then the patient can still get pregnant and have kids.

If both the ovaries and fallopian tubes have been removed, then there is an option to freeze eggs before surgery and later try an IVF.

But one cannot get pregnant if both the ovaries and uterus are removed.

The patient should talk to the healthcare practitioner about the treatment and the surgery to discuss the options if she wants to get pregnant in the future.

Coping with ovarian germ cell tumour

Coping with the diagnosis of the tumour can be very difficult, both practically and emotionally, especially if you don't know that it's benign or malignant.

So, staying well informed about your condition and advancing in diagnosis can help you make better decisions about your treatment.

Taking emotional help from your friends and family and talking to others with the same health condition can help you cope. 

Summary

Ovarian Germ cell tumour primarily affects teenage and young girls, originating in the ovaries' germ cells. While most cases are benign, malignant forms like dysgerminomas and yolk sac tumours may require chemotherapy. 

Risk factors include age, genetic predisposition, previous cancers, hormone replacement therapy, smoking, asbestos exposure, and medical conditions. Symptoms are often elusive, and diagnosis involves physical exams, pelvic exams, laparotomy, CT scans, and serum tumour marker tests. 

The grading and staging of OGCT guide treatment decisions, usually involving surgery (oophorectomy) and, if malignant, chemotherapy. The prognosis hinges on factors like cancer type, stage, and overall health. Fertility options vary based on surgical interventions. Coping strategies involve staying informed and seeking emotional support.

FAQs

What is the most common ovarian cell tumour?

Among all types of ovarian cancer, epithelial ovarian cancer is the most prevalent. Primary peritoneal cancer and fallopian tube cancer are similar to epithelial ovarian cancer and are treated in the same way.⁹

What is the most common germ cell tumour?

Teratomas are among the most common types of germ cell tumours. These tumours are initially benign in nature; however, they have the potential to progress into a malignant state.Teratomas are the most common type of germ cell tumour to develop in extragonadal (not in the ovary or testes) areas.¹⁰

What size is a germ cell tumour in the ovary?

The size of tumours varies from 7 cm to 40 cm, with a median of 15-16 cm. The tumour is rarely bilateral (12-19%) and never so in cases of endodermal sinus tumours. Diagnosis depends mainly on age, abdominal symptoms, size and consistency of the tumour, and tumour markers, i.e. AFP and hCG.¹¹

Mariam Atique

RPh. , Pharm D, University of Sargodha, Pakistan

Mariam is a registered pharmacist passionate about pursuing a career in medical writing. With a solid scientific background and experience in both hospital and community pharmacy, she loves to share her medical knowledge. She is currently interning as a medical writer at Klarity.

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