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Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Robert D. Morgan, Andrew R. Clamp, Gordon C. Jayson
Ovarian germ cell tumors are rare but aggressive malignancies and are more prevalent among girls and young women.141 They arise from primordial germ cells of the ovary, are commonly unilateral, and are often curable. The histological subtypes of ovarian germ cell tumors are heterogenous and include dysgerminomas, yolk sac tumors, immature teratomas, and mixed germ cell tumors, as well as other rarer subtypes.25 The tumors are staged using the FIGO staging system used for adenocarcinoma, although there is debate regarding the extent of surgical staging required, given the favorable sensitivity of these diseases to cytotoxic chemotherapy. Whether fertility-sparing surgery or more aggressive cytoreduction is performed, all tumors except for Stage IA pure dysgerminoma and Stage IA Grade 1 pure immature teratoma are treated with cytotoxic chemotherapy. Bleomycin, etoposide, and cisplatin is the standard of care regimen.142 Evaluation of the disease and its response to treatment can be performed using radiological imaging as well as the tumor markers AFP, β-HCG, and LDH. These diseases are curable, but rare, and so there is a strong case for them to be managed by specialist teams incorporating oncologists with experience of managing male germ cell tumors. Treatment of germ cell tumors is reviewed in more detail in Chapter 17.
Ovarian Cancer
Published in Dongyou Liu, Tumors and Cancers, 2017
Malignant ovarian germ cell tumors (e.g., dysgerminoma, endodermal sinus tumor, embryonal carcinoma) are generally treated with surgery and chemotherapy, but not radiotherapy. For conservation of fertility, only unilateral oophorectomy and surgical staging are carried out. Current use of bleomycin, etoposide, and cisplatin (BEP) leads to a 5-year survival rate of up to 100% for dysgerminomas and 85% for nondysgerminomatous tumors.
Adnexal masses in the neonate, child, and adolescent
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Lisa Allen, Nathalie Fleming, Julie Strickland, Heather C. Millar
Surgical staging is paramount for malignant ovarian neoplasms, as stage of disease guides decisions for postoperative adjuvant chemotherapy. Pediatric germ cell tumors are staged using the system developed by the Pediatric Oncology Group. Epithelial tumors are staged according to the International Federation of Gynecology and Obstetrics (FIGO) system for primary carcinoma of the ovary. Rupture of a malignant neoplasm at surgery can result in upstaging of the patient; hence, most suspicious tumors are optimally approached by laparotomy. If a germ cell tumor is suspected, the primary tumor is resected with a unilateral salpingo-oophorectomy without interruption of the ovarian capsule on the surgical field. Intraoperative staging includes collection of ascites or peritoneal washings for cytology, inspection, and palpation of peritoneal surfaces, the contralateral ovary, pelvic and/or para-aortic nodes bilaterally, and omentum with biopsy only for abnormalities. Extensive germ cell tumors should be biopsied for diagnosis, but aggressive surgical procedures are not undertaken at the risk of harm to vital structures due to the effective response observed to multiagent chemotherapy in these tumors. Postoperative chemotherapy with bleomycin, etoposide, and cisplatin has resulted in marked advances in survival compared with previous regimens. Six-year survival rates of 93%–98% are reported for malignant ovarian germ cell tumors after four cycles of BEP.66 With meticulous staging and careful postoperative monitoring to determine need for salvage chemotherapy, 50%–60% of stage I malignant germ cell tumors can now be managed without the need for postoperative chemotherapy.67 This emphasizes the importance of preoperative risk stratification, to select patients appropriately for complete surgical staging.
Incorporating age into International Germ Cell Consensus Classification (IGCCC): a time to move forward?
Published in Expert Review of Anticancer Therapy, 2018
The SEER database search was restricted to the duration from 2004 to 2014 (because tumor marker data were not reliably available before that date). To identify eligible records, histology codes ‘9060–9099’ were selected. Only tumors arising in the testis, retroperitoneum, or mediastinum were included. Ovarian germ cell tumors were not included in the current study because they were not included in the original publication and classification of IGCCC. Cases with stage IA/IB testicular germ cell tumor were not included (because these were – by definition – not included in the original IGCCC analysis and publication) [8]. Cases of seminoma with elevated or unknown alfa fetoprotein (AFP) were excluded. Cases with insufficient information about survival, IGCCC class, or age were excluded.
From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach
Published in Gynecological Endocrinology, 2022
Patrycja Rojewska, Blazej Meczekalski, Grzegorz Bala, Stefano Luisi, Agnieszka Podfigurna
Among ovarian germ cell tumors, both immature teratomas and gonadoblastomas are often found to secrete androgens. Both have been found capable of secreting DHEA, while gonadoblastomas have also been found to produce androstenedione and testosterone. Determining the presence and assessing the concentration of these androgens by laboratory means is often helpful in guiding the diagnostic process of androgen-secreting ovarian tumors[25].
Balancing efficacy with long-term side-effects: can we safely de-escalate therapy for germ cell tumors?
Published in Expert Review of Anticancer Therapy, 2023
In ovarian germ cell tumors, which are comparatively rare, the risk of continued overtreatment remains high. We need to reach a consensus on how chemo-sensitive immature teratoma is and what, if any, is the role of chemotherapy for these patients. If these tumors are inherently chemo-resistant as seems likely, then many adult patients are being exposed to unnecessary therapy – the question lends itself well to a randomized trial.