Ovarian Germ Cell Tumor

Ovarian germ cell tumor is a type of ovarian cancer where the tumor (growth) arises from the reproductive cells (eggs) of the ovary.

Ovaries (singular – ovary) are a pair of female reproductive organs that produce ova (eggs), which when fertilized by sperm cell forms a zygote (that develops into a fetus in the womb – baby).

Types of ovarian cancer:

1. Epithelial ovarian cancer
2. Borderline tumors
3. Stromal ovarian cancer (those which develop from surrounding tissue)
4. Germ cell ovarian cancers

Ovarian Cancer Causes

The risk factors involved in the formation of ovarian cancer are:

• Age: Higher the age higher the risk. Women over the age of 50 have greater chance, while over 65 years are even more.
• Family history: Risks are higher if close relative suffers from ovarian or even breast cancer.
• Ovulatory relation:
  1. More pregnancies reduce the risk.
  2. Early menarche and late menopause increases the risk.
  3. Contraceptive pills and infertility treatments increase the risk.
• Patients who are on HRT (hormone replacement therapy) are at a slightly higher risk.
• Obesity
• Smoking
• Endometriosis (a condition of the womb causing heavy bleeding)

Ovarian Cancer Signs and Symptoms

Since diagnosis is difficult, ovarian cancer symptoms and physical examinations followed by imaging help, establish the diagnosis.

The symptoms and signs of ovarian cancer are:

• Pain and swelling in the abdomen
• Tiredness
• Loss of appetite
• Swelling of the legs
• Changes in bladder and bowel habits
• Painful sexual intercourse
• Weight loss
• Nausea
• Indigestion
• Bleeding per vagina after menopause or in between periods
• A vaginal examination by the doctor may show changes in the ovaries and uterus.

Ovarian Cancer Stages

Following are the different stages of Ovarian Cancer.

• Stage 1 – Stage 1a, 1b, and 1c – Confined to the ovary and the tube (fallopian tube).
• Stage 2 – Stage 2a and 2b – Spread to the other organs in the pelvis such as (bladder, rectum, and colon).
• Stage 3 – Stage 3a1, 3a2, 3b and 3c – Spread to the lymph nodes and the abdominal lining.
• Stage 4 – Stage 4a and 4b – Spread to distant organs such as the liver, spleen, lungs etc.
• Ovarian cancer is also graded; the grading is based on the type of cancer cells present in the tumor, their appearance and behavior.
• In simple terms, if they are closer to normal body cells, they are less dangerous (low grade).
• Grading is done after observing the biopsy sample in the lab.

Investigations

The doctor recommends following tests for diagnosis.

• Imaging studies such as CT, MRI and ultrasound.
• Chest X ray to rule out any spread to the lungs.
• Biopsy – A piece of the growth is taken and studied under a microscope.
• Blood tests: Blood count and CA-125 test.
  Ovarian tumor markers such as AFP (alpha fetoprotein), HCG (human chorionic gonadotropin), and LDH (lactate dehydrogenase) are helpful to establish the diagnosis. Genetic counseling: Your doctor may even advise you to undergo genetic screening to rule
• Genetic counseling: Your doctor may even advise you to undergo genetic screening to rule out if you have inherited genes responsible for ovarian cancer and/or for any other cancers.

Ovarian Cancer Treatment and Prognosis

Treatment of ovarian cancer depends on the stage, grade, type and also the general condition of the patient.

1. Surgery

   • First preferred treatment
   • The patient undergoes removal of both the ovaries, fallopian tubes, the lymph nodes and uterus as well – Hysterectomy with bilateral saphingo-oophorectomy.
   • If the tumor is of very low grade, only the affected ovary and tube is removed.
   • Hospital stay is for 3-7 days.
   • Most germ cell tumors require the above-mentioned procedure. But epithelial ovarian cancers or widely spread ovarian cancers require removal of other structures involved as well, such as colon etc, this is called debulking.

2. Chemotherapy

   • Use of drugs (chemicals) will destroy the cancer cells.
   • The patient undergoes 3-6 sittings, 3-4 weeks apart for each sitting.
   • Before the surgery, chemotherapy helps to shrink the tumor while after surgery; it kills cells, which surgery cannot remove.
   • Side effects are nausea, vomiting, anemia, hair loss, mouth sores.

3. Targeted therapy

   • Use of newer drugs like olaparib has reduced the risk of damage to the normal cells unlike chemotherapy.

4. Radiation Therapy

   • Use of X-rays to kill cancer cells.
   • Rarely used in ovarian cancer treatment, but helps if the spread is to the other organs.

5. Complementary Therapy

   • Many patients also go for complementary therapies to boost their strength to fight cancer along with the prescribed treatment plan.

Prognosis depends on various factors such as:

• Size, type, and grade of tumor
• Patient’s general health
• Advanced cases after surgery have 50% survival rate chance of 6 years.

Cost of Ovarian Cancer Treatment in India

Radiation therapy – USD 3000, Chemotherapy – USD 4000, Surgery – USD 5000