Ovarian Germ Cell Tumors

What are ovarian germ cell tumors?

Ovarian germ cell tumors develop from reproductive cells (germ cells) of the ovaries. Your ovaries are two small organs in your pelvis. Ovaries are part of the female reproductive system. They produce eggs and female hormones.

Most germ cell tumors in the ovaries are benign (not cancer). Rarely, the tumors are malignant (cancerous). Ovarian germ cell tumors usually develop in young women under 20, but they can grow in older women, too. Most often, a tumor only grows in one ovary.

Treatment for malignant tumors includes surgery or chemotherapy. The outlook depends on the stage of the cancer, the tumor’s size and whether it has spread to other parts of your body. Most germ cell tumors are treatable.

How common are ovarian germ cell tumors?

Malignant ovarian germ cell tumors are rare. Most ovarian germ cell tumors are benign.

Malignant germ cell tumors are a form of ovarian cancer. In general, ovarian cancer affects about 1 in 70 women in the United States. Less than 5% of ovarian cancers are malignant germ cell tumors. About 20% to 25% of all benign ovarian tumors are germ cell tumors.

What are the types of ovarian germ cell tumors?

There are several types of germ cell tumors. The most common types of ovarian germ cell tumors are:

• Dysgerminoma: This is the most common type of malignant ovarian germ cell tumor.
• Mature teratoma (dermoid cyst or ovarian cyst): This is the most common type of benign ovarian germ cell tumor.These noncancerous tumors usually grow in teenage girls and young women.
• Immature ovarian teratoma: This malignant tumor can spread from your ovary to other parts of your body.
• Endodermal sinus tumors: Providers also call this malignant tumor a yolk sac tumor. These tumors grow very quickly and usually affect children and young women.

What are the symptoms of ovarian germ cell tumors?

It may be difficult to spot signs of ovarian germs cell tumors early on. Symptoms of malignant tumors don’t usually appear until cancer has advanced. Symptoms of all types of ovarian germ cell tumors include:

• Pelvic pain or tenderness: Pelvic discomfort, cramping and ovarian pain are common symptoms of germ cell tumors.
• Swollen belly (abdomen): Young women and girls may have a bloated belly with or without weight gain in other areas of the body.
• Nausea or difficulty eating.
• Changes in bowel habits (constipation).
• Irregular vaginal bleeding. This is a less common symptom of germ cell tumors. Sometimes, people with these tumors often mistake vaginal bleeding for their regular menstrual cycle. But bleeding that results from an ovarian germ cell tumor is not the same as bleeding during menstruation. Older women may have bleeding after menopause.

What causes ovarian germ cell tumors?

Anyone with ovaries can get ovarian germ cell tumors. However, young women under 30 are at higher risk of developing germ cell tumors.

How do healthcare providers diagnose ovarian germ cell tumors?

After asking about your symptoms, your provider will do several examinations, procedures and tests. These include:

• Pelvic exam, to check for growths and other abnormalities in your abdomen, pelvis and vagina.
• Pap smear, a test that looks for abnormal cells in your cervix (the lower part of the uterus).
• Laparoscopy, a procedure that uses small incisions (cuts) and helps your provider look at your organs. Providers may also remove ovaries and take tissue samples for testing (biopsy).
• Laparotomy, a procedure that requires a bigger incision to see a larger part of your abdomen.
• Transvaginal pelvic ultrasound, to see images of your reproductive organs.
• CT scan, to see detailed images of your reproductive organs and other soft tissues and to check for tumors.
• Serum tumor marker test, a blood test that checks the levels of certain substances in your body. Higher levels of alpha-fetoprotein (AFP), LDH or human chorionic gonadotropin (HCG) can be signs of germ cell tumors.
• MRI, an imaging test that produces pictures of organs, soft tissues and tumors using a high-powered magnet and radio waves.

What are the stages of ovarian germ cell tumor?

Germ cell tumors are diagnosed after surgery. Surgery to remove the ovary is known as oophorectomy. After diagnosing germ cell tumors, providers classify the disease using a process called staging. Providers measure the tumor size and look at its location. They determine whether the tumor has spread to surrounding tissues or other parts of the body.

To gather this information, your provider may order tests such as a CT-scan These tests help your cancer care team to determine the disease stage.

Generally, stage 1 germ cell tumor means the cancer has not spread beyond the ovaries, fallopian tubes or abdomen. Higher stages (stages 2 to 4) mean that the cancer is more advanced and the tumor is larger. It has spread (metastasized) to other parts of the body.

How do providers treat benign (noncancerous) ovarian germ cell tumors?

Healthcare providers remove benign tumors surgically. Sometimes, they need to remove the ovary (or part of the ovary) when removing the tumor. Benign tumors rarely grow back after providers remove them.

How do providers treat malignant (cancerous) ovarian germ cell tumors?

Treatment depends on the type of tumor and the stage of the disease. Sometimes, providers recommend observation after the tumor is removed surgically. This means they monitor you with regular visits to check for signs of tumor growth. More commonly, healthcare providers treat malignant ovarian germ cell tumors with:

• Surgery: Your provider may recommend an oophorectomy to remove one or both of your ovaries or fallopian tubes. If cancer has spread beyond the ovaries and fallopian tubes, you may need a total hysterectomy. During this procedure, your provider removes the uterus and the cervix. Your provider may recommend a minimally invasive technique. This procedure uses a smaller incision and requires less recovery time.
• Chemotherapy: Your provider delivers chemotherapy drugs into one of your veins, usually through an infusion. The drugs kill cancer cells and stop them from multiplying. You may receive chemo treatments over several weeks or months.

Can I prevent ovarian germ cell tumors?

You may not be able to prevent germ cell tumors. Be sure to get regular checkups so your provider can monitor your health and assess your risk of developing cancer.

What is the outlook for people with ovarian germ cell tumors?

The outlook for people with benign ovarian germ cell tumors is very good. Usually, benign tumors don’t grow back after providers remove them.

The outlook for malignant germ cell tumors varies depending on how far the cancer has spread. Cancer specialists measure cancer outlook by the five-year survival rate. If cancer hasn’t spread to other parts of the body, there is a 94% to 98% survival rate.

Cancers that have spread farther away from the original tumor site have a 73% five-year survival rate. Overall, the survival rate for germ cell tumors is around 93%. New fertility-saving treatments increase the chance that a woman can have a baby after treatment for germ cell tumors.

When should I see my healthcare provider about ovarian germ cell tumors?

If you or your child has signs of a germ cell tumor, see your provider right away. Some types of germ cell tumors grow very quickly. Finding them early and getting treatment as soon as possible can significantly improve the outlook.

What should I ask my healthcare provider?

If you’ve received an ovarian cancer diagnosis, you may want to ask your provider:

• What is the cancer’s stage, and what does that mean?
• What treatment options are most appropriate for me?
• Will I need more than one treatment?
• Are there clinical trials I can take part in?
• What can I expect after treatment?
• Will treatment affect my ability to have a baby?
• Can ovarian cancer come back?
• Am I at a higher risk for other cancers?

A note from Cleveland Clinic

If you or your child has signs of an ovarian germ cell tumor, see your provider right away. Although most ovarian germ cell tumors are benign, it’s essential to get an evaluation as soon as possible. Early diagnosis and treatment greatly improves the prognosis for malignant germ cell tumors. If you have a family history of germ cell tumors or you have changes on the BRCA gene, talk to your provider about scheduling regular checkups to monitor your health.