Germ cell ovarian cancer is a rare type of ovarian cancer. Most germ cell tumors are benign. But germ cells in the ovaries can form malignant tumors, which can spread to other parts of the body without treatment.

In most cases, surgery and chemotherapy can treat germ cell ovarian cancer.

In this article, we look at the types of germ cell tumors, staging, diagnosis, treatment, and outlook.

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Germ cell tumors develop from the germ cells, which are the cells that form eggs.

According to the American Cancer Society (ACS), germ cell ovarian cancer is rare, accounting for 3% of ovarian cancer cases. They are most common in adolescents and young females between 15–19 years of age.

The ACS notes that most types of germ cell tumors are benign. But they can also be malignant, meaning they are cancerous. Approximately 1–2% of germ cell tumors are malignant.

In most cases, treatment is effective in curing germ cell ovarian cancer, especially when people receive an early diagnosis and treatment.

Different types of malignant germ cell ovarian tumors include:

  • dysgerminomas
  • immature teratoma
  • mixed germ cell tumors
  • choriocarcinoma
  • yolk sac tumors
  • embryonal carcinoma
  • polyembryoma

Dysgerminoma is the most common type of malignant ovarian germ cell tumor. It typically affects females in their teenage years or 20s.

The National Cancer Institute (NCI) states that there are usually no symptoms in the early stages. But a person should contact a doctor if they experience a swollen abdomen and bleeding from the vagina after menopause.

Other symptoms include:

  • pain or pressure in the pelvis or abdomen
  • irregular periods
  • fever or chills
  • nausea or vomiting
  • a feeling of fullness in the abdomen

Germ cell ovarian cancer may spread through the body via the blood, tissues, and lymphatic system.

Healthcare professionals use the following system to grade stages of ovarian germ cell tumors:

  • Stage 1: Cancer occurs in one or both ovaries or fallopian tubes.
    • 1A: The cancer is in one ovary.
    • 1B: The cancer is in both ovaries.
    • 1C: The cancer is in one or both ovaries, and:
      • it is on the outside surface of the ovaries
      • the outer covering of the ovary has ruptured during or before surgery
      • the cancer cells are in the peritoneal cavity, which is the cavity of the body that contains the majority of the organs
      • cancer cells are in the washings of the peritoneum, which is the tissue lining of the peritoneal cavity
  • Stage 2: Cancer occurs in one or both ovaries or fallopian tubes, and has spread to other areas of the pelvis.
    • 2A: The cancer has spread from where it first formed.
    • 2B: The cancer has spread to the organs in the peritoneal cavity.
  • Stage 3: Cancer occurs in one or both ovaries or fallopian tubes, and has spread beyond the pelvis to parts of the abdomen or surrounding lymph nodes.
    • 3A: The cancer has spread to the lymph nodes, or the cells have spread to the peritoneum.
    • 3B: The cancer has spread to the peritoneum and measures 2 centimeters (cm) or less.
    • 3C: The cancer has spread to the peritoneum outside the pelvis and is larger than 2 cm. It may have also spread to the lymph nodes located behind the peritoneum or the surface of the spleen or liver.
  • Stage 4: Cancer has spread beyond the abdomen to other areas of the body.
    • Cancer cells are in the fluid that builds up around the lungs.
    • The cancer has spread to organs outside the abdomen and lymph nodes in the groin.

Each stage is also split into sub-categories that detail more specifically where the cancer occurs.

Researchers are not sure what causes germ cell ovarian cancer. But Turner’s syndrome can increase a person’s risk for developing it.

Turner’s syndrome is a genetic condition that only affects females. A person with Turner’s syndrome has one X sex chromosome instead of two.

Risk factors of developing ovarian cancer can include:

  • being over the age of 65 years, except for some types of germ cell tumors, which are more common in younger females
  • increased ovulation, such as in people who have not been pregnant, started periods at a younger age, or start menopause late
  • existing conditions, such as breast cancer, endometriosis, or diabetes
  • family history of ovarian cancer
  • genetic conditions, such as lynch syndrome

To diagnose a germ cell tumor, a doctor will assess any symptoms and carry out a physical examination.

They may carry out a pelvic exam to check the pelvis, vagina, and abdominal area. They may also carry out certain tests, such as:

  • blood tests to find chemicals that some tumors release, known as tumor markers
  • ultrasound, CT scan, or MRI to examine the organs in the abdomen and pelvis
  • a biopsy, which takes a tissue sample to check for any abnormal or cancerous cells

Doctors will usually treat malignant germ cell cancers with surgery and chemotherapy.

Surgery

In most cases, surgery will remove the ovary and fallopian tube where the germ cell tumor is present. This is called a unilateral salpingo-oophorectomy. This is the typical treatment if the tumor has not spread.

A person may only require surgery for stage 1A dysgerminoma or stage 1A immature teratoma.

People will need to attend regular checkups involving blood tests and scans to make sure that the cancer has not returned.

In some cases, people may need surgery to remove both ovaries and fallopian tubes, which is called a bilateral salpingo-oophorectomy. The surgeon may also remove the uterus.

Chemotherapy

If the tumor has spread outside of the ovaries, people may need to undergo chemotherapy.

People may receive chemotherapy to shrink and kill cancer cells.

People may receive chemotherapy:

  • before having surgery, to reduce the cancer and make surgery easier
  • after surgery, to lower the risk of cancer recurring
  • to treat recurrent cancer or cancer that has spread

To treat germ cell ovarian cancer, people may have a type of chemotherapy called PEB, which consists of the following drugs:

  • bleomycin
  • etoposide
  • cisplatin

After treatment for germ cell ovarian cancer, people may still require regular checkups for several years to check that the cancer has not returned.

The frequency of tests may reduce over time if doctors do not find anything abnormal.

Some people may experience side effects of treatment months to years afterward. Doctors refer to these as long-term or late effects.

Treatment with bleomycin can affect the lungs if people have any treatments that involve high doses of oxygen.

Some treatments may affect fertility, although this uncommon.

If people require surgery to remove both ovaries, both fallopian tubes, and the uterus, they will not be able to conceive. The removal of both ovaries will cause a person to enter surgical menopause. This means that they will go through menopause immediately.

Chemotherapy may help to reduce the amount of surgery people require, which may help to maintain fertility.

But the NCI notes that chemotherapy can also cause primary ovarian insufficiency (POI). This is when the ovaries stop releasing eggs and estrogen. POI can be temporary, with a person’s menstrual periods and fertility returning after completing treatment. In other cases, it can also permanently damage the ovaries.

Chemotherapy can also reduce the number of healthy eggs in the ovaries.

People can discuss fertility when making a decision with their healthcare team about treatment options. If people have had surgery to remove an affected ovary and fallopian tube, it is still likely they will be able to have children.

There is no clear strategy for preventing germ cell ovarian cancer.

A person can take combined hormonal birth control pills (ones with estrogen and progestin) to help reduce the risk of ovarian cancer by 20% for every 5 years of taking the pill.

Removing the fallopian tubes with a procedure called salpingectomy may help to reduce the risk of ovarian cancer.

Dysgerminomas are usually slow to grow or spread. If dysgerminomas are only present in the ovary, surgical removal of the ovary can cure over 75% of cases without need for any further treatment.

If the tumor has spread farther than the ovary, or is recurrent, cancer treatments including surgery, radiation therapy, and chemotherapy can effectively control or cure the cancer in around 90% of cases.

According to the ACS, germ cell ovarian cancer has a good outlook overall, with over 90% of people surviving a minimum of 5 years after their diagnosis.

In most cases, treatment is successful in curing germ cell ovarian cancer, especially if people have early diagnosis and treatment.

Outlook for germ cell ovarian cancer can depend on:

  • the type and size of germ cell tumor
  • if the cancer has spread to other parts of the body
  • how cancer cells appear under a microscope
  • the overall health of the individual

If people have any symptoms of ovarian cancer or germ cell ovarian cancer, they will need to contact a doctor. Other conditions can cause similar symptoms, but it is important to have a checkup to find out the underlying cause.

People can also contact a doctor if they have any unusual or new symptoms between checkups or after receiving treatment for germ cell tumors.

Questions to ask

People may want to make a list of questions to ask their doctor during diagnosis or treatment of germ cell ovarian cancer, such as:

  • What type of germ cell ovarian cancer is it?
  • Where is the cancer located? Has it spread?
  • What tests will they require?
  • How can they access financial help?
  • What are the treatment options, and what are the goals of treatment?
  • What are the risks and side effects of treatment?
  • Will treatment affect fertility?
  • What is the likely outlook of treatment?
  • What are the diet and lifestyle recommendations during treatment?
  • What symptoms do they need to look out for?
  • How can they access additional support, such as emotional or mental health support?

Germ cell ovarian cancer is a rare type of ovarian cancer where germ cells in the ovaries form malignant tumors.

Most people will have either surgery or chemotherapy to treat germ cell ovarian cancer. Treatment can successfully cure germ cell ovarian cancer in most cases, especially in the early stages.