Ovarian germ cell tumors
Which are the symptoms?
The symptoms of onset are pain, abdominal tension and the appearance of an abdominopelvic mass. Sometimes the symptomatology is represented by an acute abdominal pain determined by the rapid growth of the tumor mass with consequent rupture or torsion. Fever, bleeding from the genitals and endocrine manifestations are rarer. Sometimes the disease can be asymptomatic.
- abdominal distension
- abdominal-pelvic pain
- lack of appetite
- pollakiuria (frequent urination)
- dyspareunia (pain during sexual intercourse)
How is it diagnosed?
Most patients are currently diagnosed at an early stage. The clinical suspicion of a tumor of the genital sphere requires instrumental examinations: gynecological ultrasonography, CT abdominopelvic and plasma dosage of specific markers (alpha fetal protein, bhcg, ca125 LDH). Definitive diagnosis can only be obtained by histological examination.
How is it treated?
Until the late 1970s, the prognosis of patients with germ cell tumors of the ovary was almost always poor. Surgical treatment was the only therapeutic option. There were no adjuvant treatments useful to reduce the number of recurrences and improve survival: germ cell tumors, in fact, are in most cases not radiosensitive and the chemotherapeutic treatments used at that time were not effective. Prognosis was radically improved after the introduction of chemotherapy according to the PEB scheme (cisplatin, bleomycin and etoposide) with survival rates above 90% even in advanced stages. The high chemo-sensitivity of these tumors makes possible a conservative surgical approach aimed, subject to the young age of onset, at maintaining fertility in young women.
The standard treatment is conservative surgery with peritoneal staging and eventual lymphadenectomy.
For patients with stage I disease, adjuvant treatment should be prescribed with regard to prognostic factors. For all other stages, chemotherapy is necessary.
It is possible to evaluate the possibility of oocyte cryopreservation before starting the chemotherapy treatment or after 12 months from the end of the treatment.