Doctors from Memorial Sloan Kettering Explain Ovarian Germ Cell Cancers

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An ovarian germ cell tumor is a cancer that arises in the germ (egg or oocyte) cells of the ovary. It is equivalent to testicular cancer in the male.

How does an ovarian germ cell tumor differ from other types of ovarian cancer?

There are three types of ovarian cancer: epithelial tumors, stromal tumors, and germ cell tumors.

  • Epithelial tumors are the most common and can be ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. This is what people mean when they say “ovarian cancer.”
  • Stromal tumors are granulosa cell tumors and Sertoli-Leydig cell tumors. These cancers arise in the stroma, or supporting tissues around the germ cell.
  • Germ cell tumors differ in their cell of origin (the germ cell or egg). Germ cell tumors are extremely chemotherapy sensitive and are almost always cured, even when they have spread throughout the body. They usually occur in teenage girls and young women.

Ovarian germ cell tumors are rare and are therefore difficult to study in large clinical trials. Treatment is often informed by testicular cancer research. Testicular cancer is also rare, but less rare than ovarian germ cell tumors.

The median age of diagnosis of women with ovarian germ cell tumors is 26 years. For epithelial tumors the median age is 63; for stromal tumors it is 50.

What are the typical signs and symptoms of this type of cancer?

Patients usually present with symptoms related to the ovarian mass (pain and swelling of the lower abdomen).

What are the risk factors for ovarian germ cell tumors?

There are no known risk factors.

How is this type of cancer treated?

Treatment is usually fertility-sparing surgery (removal of the affected ovary and fallopian tube and the visible tumor if possible) followed by chemotherapy. Fertility-sparing surgery is the preferred option (if possible), as the patients are young and likely to be cured and may desire future child bearing.

If a woman is diagnosed with an ovarian germ cell tumor, what are some questions she should ask her doctor?

The patient should discuss fertility with her doctor. Some patients experience early menopause or decreased fertility following surgery and chemotherapy. The patient may want to consider egg harvesting and freezing prior to treatment. Fertility preservation is more difficult for women than for men. Men simply need to provide a sperm sample that is then frozen, whereas women need to undergo egg harvesting.

Freezing unfertilized eggs is a new technique, and the success rate is not 100 percent. Embryo freezing is more common (although this requires fertilization with a partner’s sperm prior to freezing). Many young women do not have a partner with whom they know they want to have a child, so egg freezing (unfertilized) is the only option. (1)

Outcome and Prognostic Factors in Ovarian Germ Cell Malignancies

According to the results of a study recently published in Gynecologic Oncology, the prognosis for ovarian germ cell malignancies (OGCMs) is excellent if patients are managed with standard treatment initially.

Researchers in this recent study sought to determine the outcomes and prognostic factors in patients with OGCMs. A total of 93 patients diagnosed with OGCM were enrolled, 84 of whom had already received primary treatment. The remaining 9 patients were referred to outside sources for treatment and were then assigned to one of the following: follow-up (1 patient), continued chemotherapy (4 patients), or salvage chemotherapy when the disease recurred (4 patients). The treatment related characteristics, presentation, and pathology were analyzed for association with the occurrence of tumor recurrence/persistence and death.

Results of the study indicated that the average follow-up of survivors was 66 months. The average time to disease recurrence or progression was 8 months. Of the 93 patients, 11 were considered treatment failures and 6 of these patients died. The 5-year survival rate was 97% for the patients who received primary treatment initially compared to those who had been referred to outside sources for treatment. Further pathology analysis revealed that certain cell types were associated with treatment failures. Factors that impacted the patients’ overall survival included the cell type, treatment with high-dose chemotherapy, and remaining tumor after surgery.

Researchers concluded that standard treatment at the time of diagnosis improves survival for patients diagnosed with OGCMs. More aggressive management is needed for recurrent or persistent disease following primary treatment. Patients are encouraged to speak to their physician regarding treatment options for their specific situation. (2)

References:

  1. Information about fertility issues related to treatment can be found on the Memorial Sloan-Kettering website (mskcc.org/cancer-care/survivorship/women) and through Fertile Hope (fertilehope.org).
  2. Lai C, Chang T, Hush S, et al. Outcome and Prognostic Factors in Ovarian Germ Cell Malignancies. Gynecologic Oncology. 2005;96: 784-791.
Carol Aghajanian, MD*, is* Chief of Gynecologic Medical Oncology Service at Memorial Sloan-Kettering Cancer Center (MSKCC). Amedical oncologist who focuses exclusively on the medical treatment of gynecologic cancers, she also leads MSKCC’s research program in chemotherapy for patients newly diagnosed with ovarian cancer and has a particular expertise in the management of both advanced gestational trophoblastic disease (GTD) and germ cell tumors of the ovary. In addition, Dr. Aghajanian is the co-principal investigator for MSKCC participation in the Gynecologic Oncology Group (GOG) and serves on the Phase I committee and the Medical Oncology Committee for the GOG. Her recent honors include a career development award from the American Society of Clinical Oncology and the Boyer Award for outstanding young investigators at MSKCC.
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