Ovarian dysgerminomas are a rare type of cancer that develop from germ-cells. Although ovarian dysgerminomas are considered to be rare tumours, they are the most common type of malignant germ-cell tumour in females, and are the counterpart to testicular seminomas in males.
Germ cell tumours are a rare group of neoplasms that arise from primordial germ cellsa cell that develops into reproductive cells (eggs in females, sperm in males) – the cells responsible for developing into reproductive cells (gametes) such as ovum and sperm. These tumours typically originate in the gonads, which are the organs that produce gametes (ovaries in females and the testicles in males). These tumours are referred to as gonadal germ cell tumours. In some cases, germ cells can migrate to other parts of the body during early embryonic development, leading to tumour formation outside of the gonads later in life. These are known as extragonadal germ cell tumours, and are most commonly found in the brain, mediastinum, retroperitoneum, or sacrococcygeal region.
Ovarian dysgerminomas, seminomas, and germinomas share similar histological characteristics and are often considered to be the same tumour, with the name of the tumour varying according to anatomical location. When arising in the ovary, the tumour is termed a dysgerminoma; in the testis, it is called a seminoma; and when occurring at extragonadal sites – most commonly within the central nervous system – it is referred to as a germinoma.
Ovarian dysgerminomas are generally diagnosed in women in their 20’s and 30’s, however it can affect almost anyone with ovaries – including women, children, teenagers, transgender men, non-binary individuals, and intersex people – at any age.
Treatment
If an ovarian dysgerminoma is detected, it will be staged and graded based on size, metastasis, and how the cancer cells look under the microscope. Staging and grading help your doctors determine the best treatment for you.
Ovarian cancers can be staged using the Federation of Gynaecology and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to one or both ovaries only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby organs in the pelvis, such as the uterus, fallopian tubes, bladder and/or bowel. This is also known as localised cancer.
- Stage III: the cancer has become larger and has spread beyond the pelvis into the lining of the abdomen (peritoneum). Lymph nodes are also often affected. This is also known as advanced or metastatic cancer.
- Stage IV: the cancer has spread to more distant organs, such as the lungs or the liver. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for ovarian dysgerminomas may include:
- Surgery, potentially including:
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- Unilateral salpingo-oophorectomy.
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- Lymphadenectomysurgical removal of lymph node(s).
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- Omentectomya surgical procedure to remove part or all of the omentum, a fatty layer of tissue that surrounds the abdominal organs.
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- Bilateral salpingo-oophorectomy (rare).
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- Hysterectomycomplete or partial removal of the uterus (rare).
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- Removal of other organs (only required in some cases where the cancer has spread beyond the pelvis).
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Ovarian Dysgerminoma Treatment and Fertility
Treatment for ovarian dysgerminoma may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
Because of how rare ovarian dysgerminomas are, there has been limited research done into the risk factors of this disease. However, potential links to gonadal dysgenesis, Y chromosome abnormalities and gonadoblastomas have been reported.
Symptoms
Early-stage ovarian dysgerminomas may be asymptomatic. As the cancer progresses, some of the following symptoms may appear:
- Abdominal pain.
- A palpable pelvic and/or abdominal mass.
- Abdominal distention.
- Pelvic fullness.
- Unexplained weight loss/loss of appetite.
- Polyuriafrequent urination.
- Dysuriaburning, tingling and/or stinging of the urethra when urinating.
- Increased human chorionic gonadotropin (hCG) and/or lactate dehydrogenase (LDH) levels.
- Hypercalcaemiaexcess levels of calcium in the blood.
- Dyspepsia (less common).
- Digestive disturbances (less common).
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have an ovarian dysgerminoma, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Pelvic examination.
- Imaging tests, potentially including:
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- Pelvic ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
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- Transvaginal ultrasounda type of pelvic ultrasound that involves inserting a device (known as a transducer) into the vagina to produce sound waves and create images of internal female reproductive organs in greater detail.
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- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
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- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
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- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Diagnostic laparoscopya minimally invasive surgical procedure that uses small incisions to access the body for procedures, also known as keyhole surgery.
- Biopsyremoval of a section of tissue to analyse for cancer cells.