- Signs & Symptoms
Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.
Germ cell tumors begin in the reproductive cells (egg or sperm) of the body. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary.
The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).
Ovarian germ cell tumor is a general name that is used to describe several different types of cancer. The most common ovarian germ cell tumor is called dysgerminoma. (Refer to the PDQ summaries on Ovarian Epithelial Cancer Treatment and Ovarian Low Malignant Potential Tumors Treatment for information about other types of ovarian cancers.)
Possible signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.
Ovarian germ cell tumors can be difficult to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic examinations (checkups). A woman who has swelling of the abdomen without weight gain in other places should see a doctor. A woman who no longer has menstrual periods (who has gone through menopause) should also see a doctor if she has bleeding from the vagina.
Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor.
The following tests and procedures may be used:
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.
- Lymphangiogram: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Blood tests: Tests to measure the levels of alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the blood. AFP and HCG are substances that may be signs of ovarian germ cell tumor when found at increased levels.
Certain factors affect prognosis (chance of recovery and treatment options).
The prognosis (chance of recovery) and treatment options depend on the following:
- The type of cancer.
- The size of the tumor.
- The stage of cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
- The way the cancer cells look under a microscope.
- The patient's general health.
Ovarian germ cell tumors are generally curable if found and treated early.
After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.
The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Certain tests are used in the staging process.
Many of the tests used to diagnose ovarian germ cell tumor are also used to determine the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, surgery is required to determine the stage of cancer in an operation called a laparotomy. The doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will cut out small pieces of tissue and look at them under a microscope to see whether they contain cancer. The doctor may also wash the abdominal cavity with fluid and then look at the fluid under a microscope to see if it contains cancer cells. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for ovarian germ cell tumors:
In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.
- Stage IA: Cancer is found in a single ovary.
- Stage IB: Cancer is found in both ovaries.
Stage IC: Cancer is found in one or both ovaries and one of the following is true:
- cancer is found on the outside surface of one or both ovaries; or
- the capsule (outer covering) of the tumor has ruptured (broken open); or
- cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
- Stage IIB: Cancer has spread to other tissue within the pelvis.
- Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:
- Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).
- Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.
- Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.
Cancer that has spread to the surface of the liver is also considered stage III disease.
In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body.
Cancer that has spread to tissues in the liver is also considered stage IV disease.
Recurrent Ovarian Germ Cell Tumors
Recurrent ovarian germ cell tumor is cancer that has recurred (come back) after it has been treated. The cancer may come back in the other ovary or in other parts of the body.