Ovarian Germ Cell Tumors

Ovarian germ cell tumors can be non-cancerous (benign) or cancerous (malignant). They originate from the germ cells of the ovary that would normally go on to develop parts of a fetus or placenta. 

Benign ovarian germ cell tumors (OGCT) are called mature cystic teratomas and are the most common type of OGCT. These are either observed or removed with surgical procedures. They do not require any additional treatment.

Malignant OGCT make up only 5% of all ovarian cancers and are commonly diagnosed in women between 10 and 30 years of age. Roughly 90% of OGCTs are malignant. These tumors include: 

• Dysgerminoma: Growth of these OGCTs can be rapid and may cause menstrual irregularities. More than 75% of these are found at an early stage (stage I). 
• Immature teratoma: These are made of all three germ cell layers and are common in the first two decades of life. How the tumor cells look under a microscope and how likely they are to grow and spread are the most important risk factors.
• Yolk sac (or endodermal sinus tumors): Most patients who are diagnosed with this tumor are in their early 20s. Unfortunately, the cancer is often found at an advanced stage. 
• Mixed germ cell tumors: Occurs when an OGCT is made up of multiple types of tumors. Most commonly a dysgerminoma is found with a yolk sac tumor.
• Embryonal carcinoma: This is a rare, aggressive type of OGCT. The average patient is typically diagnosed around age 15.
• Non-gestational choriocarcinoma: This is an exceedingly rare and highly malignant OGCT. These are distinguished from gestational choriocarcinoma by the absence of paternal DNA within the tumor.

Symptoms and Diagnosis

OGCT may grow rapidly but are more likely to be diagnosed at an early stage compared to other types of ovarian cancer. Symptoms may include:

• Abdominal pain
• Pelvic pain
• Abnormal vaginal bleeding
• Early signs of puberty (in young patients)
• Abdominal swelling or distention

Blood tests that look for elevated tumor markers can help diagnose OGCT. The tumor markers associated with OGCT are AFP (alpha-fetoprotein), LDH (lactate dehydrogenase), and bHCG. Preoperative blood work is often performed to help confirm the concern for a germ cell tumor prior to operation. However, a definitive diagnosis is made in collaboration with our gynecologic pathologists who evaluate tissues obtained during surgery under a microscope. 

Initial Treatment

Usually, malignant OGCTs are treated with surgery. Just like other types of ovarian cancer, the goal is to remove the affected ovary and any evidence of disease that has spread to other parts of the reproductive organs and pelvis. 

Because OGCTs often occur in young/reproductive age patients, a fertility-sparing procedure can be considered to leave the unaffected ovary and uterus in place. In children, treatment planning is often done in a collaborative fashion with pediatric surgeons, oncologists and fertility experts. Based on the risk of recurrence, patients may need to receive a combination of chemotherapy drugs after surgery. Patients who desire to preserve their fertility will be offered a reproductive endocrinology consultation to discuss options for assisted reproductive techniques prior to chemotherapy treatment. 

Rarely, these tumors are diagnosed in pregnant patients. If you are pregnant and have a concern for or confirmed diagnosis of OGCT, our maternal-fetal medicine specialists and gynecologic oncologists work together to optimize outcomes for you and your baby.

Treatment for Relapsed Disease 

Ovarian germ cell tumors most likely recur within the first two years after surgery and chemotherapy. Some patients may be a candidate for secondary surgery. Generally, chemotherapy is the mainstay of treatment for recurrent ovarian germ cell tumors. 

Why choose UChicago Medicine for ovarian germ cell tumor treatment?

UChicago Medicine is a nationally recognized leader in the treatment of gynecologic cancers, from rare to common diagnoses. Factors that set us apart include:

• A large, dedicated team of experts in gynecologic cancer diagnosis, treatment and supportive care. Our team is made up of specialists in several areas, including gynecologic oncology, gynecologic pathology, radiology, radiation oncology, oncofertility, supportive oncology, nursing and more.
• An active research community conducting both clinical and laboratory research into gynecologic cancer. UChicago Medicine cancer researchers were awarded a prestigious ovarian cancer Specialized Programs of Research Excellence (SPORE) grant from the National Cancer Institute. This important grant – awarded in partnership with Roswell Park Comprehensive Cancer Center – promotes collaborative, innovative research into many aspects of ovarian cancer. 
• Coordination of supportive oncology services, including social work, physical therapy, nutrition, wellness and psychosocial support
• Access to PRISM, a specialized program in sexual health for gynecologic cancer survivors