Last knowledge on Ovarian germ cell tumors
Germ cells usually form the ova or eggs in
females and the sperm in males. Most ovarian germ cell tumors are benign, but
some are cancerous and may be life threatening. Less than 2% of ovarian cancers
are germ cell tumors. Overall, they have a good outlook, with more than 9 out
of 10 patients surviving at least 5 years after diagnosis. There are several
subtypes of germ cell tumors. The most common germ cell tumors are teratomas, dysgerminomas, endodermal sinus tumors, and choriocarcinomas. Germ cell tumors can also be a mix of more
than a single subtype.
Teratoma
Teratomas are germ cell tumors with areas
that, when seen under the microscope, look like each of the 3 layers of a
developing embryo: the endoderm (innermost
layer), mesoderm(middle
layer), and ectoderm (outer
layer). This germ cell tumor has a benign form called mature teratoma and a cancerous form called immature teratoma.
The mature teratoma is by far the most common
ovarian germ cell tumor. It is a benign tumor that usually affects women of
reproductive age (teens through forties). It is often called a dermoid cyst because its lining is made up of tissue
similar to skin (dermis). These tumors or cysts can contain different kinds of
benign tissues including, bone, hair, and teeth. The patient is cured by
surgical removal of the cyst, but sometimes a new cyst develops later in the
other ovary.
Immature teratomas are a type of cancer. They
occur in girls and young women, usually younger than 18. These are rare cancers
that contain cells that look like those from embryonic or fetal tissues such as
connective tissue, respiratory passages, and brain. Tumors that are relatively
more mature (called grade 1 immature teratoma) and haven’t spread beyond the ovary are treated by surgical
removal of the ovary. When they have spread beyond the ovary and/or much of the
tumor has a very immature appearance (grade 2 or 3 immature teratomas),
chemotherapy is recommended in addition to surgery.
Dysgerminoma
This type of cancer is rare, but it is the
most common ovarian germ cell cancer. It usually affects women in their teens and twenties.
Dysgerminomas are considered malignant (cancerous), but most don’t grow or
spread very rapidly. When they are limited to the ovary, more than 75% of
patients are cured by surgically removing the ovary, without any further
treatment. Even when the tumor has spread further (or if it comes back later),
surgery, radiation therapy, and/or chemotherapy are effective in controlling or
curing the disease in about 90% of patients.
Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma
These very rare tumors typically affect girls
and young women. They tend to grow and spread rapidly but are usually very
sensitive to chemotherapy. Choriocarcinoma that starts in the placenta (during
pregnancy) is more common than the kind that starts in the ovary. Placental
choriocarcinomas usually respond better to chemotherapy than ovarian
choriocarcinomas do.
Ovarian stromal tumors
About 1% of ovarian cancers are ovarian
stromal cell tumors. More than half of stromal tumors are found in women older
than 50, but about 5% of stromal tumors occur in young girls.
The most common symptom of these tumors is
abnormal vaginal bleeding. This happens because many of these tumors produce
female hormones (estrogen). These hormones can cause vaginal bleeding (like a
period) to start again after menopause. In young girls, these tumors can also
cause menstrual periods and breast development to occur before puberty.
Less often, stromal tumors make male hormones
(like testosterone). If male hormones are produced, the tumors can cause normal
menstrual periods to stop. They can also make facial and body hair grow. If the
stromal tumor starts to bleed, it can cause sudden, severe abdominal pain.
Types of malignant (cancerous) stromal tumors
include granulosa cell tumors (the most common type), granulosa-theca tumors, and Sertoli-Leydig cell tumors, which are usually considered
low-grade cancers. Thecomas and fibromas are
benign stromal tumors. Cancerous stromal tumors are often found at an early
stage and have a good outlook, with more than 75% of patients surviving
long-term.
Ovarian cysts
An ovarian cyst is a collection of fluid
inside an ovary. Most ovarian cysts occur as a normal part of the process of
ovulation (egg release) -- these are called functional cysts. These cysts usually go away within a few
months without any treatment. If you develop a cyst, your doctor may want to
check it again after your next menstrual cycle (period) to see if it has gotten
smaller.
An ovarian cyst can be more concerning in a
female who isn't ovulating (like a woman after menopause or a girl who hasn't
started her periods), and the doctor may want to do more tests. The doctor may
also order other tests if the cyst is large or if it does not go away in a few
months. Even though most of these cysts are benign (not cancer), a small number
of them could be cancer. Sometimes the only way to know for sure if the cyst is
cancer is to take it out with surgery. Cysts that appear to be benign (based on
how they look on imaging tests) can be observed (with repeated physical
exams and imaging tests), or removed with surgery.
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