Germ cell tumors represent 2-3% of all ovarian malignancies. This group of tumors typically occurs in patients younger than age 25 and commonly will occur during the teenage years. This set of tumors is unique because they usually occur only in young girls and are highly curable with moderate treatment. This group of tumors also has tumor markers associated with the malignancy and measurable in the blood. This allows suspicion of the type of tumor prior to surgery, and allows confirmation the tumor has resolved by monitoring these blood markers after surgery. Alpha-fetoprotein (AFP) and the pregnancy hormone (hCG) are often used to monitor this group of cancers. Modern chemotherapy has changed this group of cancers from a universally lethal problem to a situation where even advanced disease with multiple areas of spread can be cured.
Fertility sparing surgery is very appropriate for most of these patients. Chemotherapy may cure even patients with stage IV disease and diffuse metastases. Much of the recent research involves identifying patients who need only surgery to remove the tumor and can be cured without additional therapy.
Tumor types of ovarian germ cell tumors:
- 40% of ovarian germ cell tumors, 4% of all ovarian cancers, aggressively malignant
Endodermal sinus tumor
- 20% of ovarian germ cell tumors and aggressively malignant
- 20% of ovarian germ cell tumors and behavior varies according to the grade
- Very rare and extraordinarily aggressive, often present as component of mixed germ cell tumor
- Very rare and aggressively malignant; often present as component of mixed germ cell tumor
- Very rare
Mixed germ cell tumor
- 10-15% of ovarian germ cell tumors and behavior depends on the components
- Made up of thyroid tissue. May cause hyperthyroidism in one third of cases; usually benign but may develop malignant transformation