Management of Malignant ovarian germ cell tumours Flashcards
What is the most common type of ovarian tumour in children and adolescents?
Germ cell
What age due borderline ovarian tumours typically occur?
30-40 years old
What age due epithelial ovarian tumours typically occur?
Over the age of 50
Which type of germ cell ovarian tumour arises from undifferentiated cells?
Dysgerminoma (malignant), 45% of germ cell tumours
Which type of germ cell ovarian tumours arise from the whole blastocyst?
Embryonal carcinoma (malignant), <5% of germ cell tumours
Which type of germ cell ovarian tumours arise from embryologic tissue?
Teratomas – mature teratoma (dermoid) = benign, immature teratoma = malignant
Which type of germ cell ovarian tumours arise from yolk sac tissue?
Yolk sac tumours = malignant, 20% of germ cell tumours
Which type of germ cell ovarian tumour arise from trophoblastic tissue?
Choriocarcinoma = malignant, <1% of germ cell tumours
From which cell lines do the following malignant germ cell tumours arise? A) dysgerminoma B) embryonal carcinoma C) immature teratoma D) choriocarcinoma E) yolk sac tumour
A- undifferentiated germ cells (45%) B- Whole blastocyst cells (<5%) C- embryologic tissue (20% but includes mature teratoma) D- trophoplastic tissue (<1%) E- yolk sac tissue (20%)
What is another name for a yolk sac germ cell tumour?
Endodermal sinus tumour
Which tumour markers are expressed by choriocarcinoma of the ovary?
HCG
Which tumour markers are expressed by yolk sac (endodermal sinus tumour) of the ovary?
AFP (sometimes LDH)
Which tumour markers are expressed by dysgerminoma?
Sometimes HCG, sometimes LDH, never AFP
Which tumour markers are expressed by immature teratomas?
Sometimes AFP, sometimes LDH, never HCG
What is the half life of HCG?
1-2 days
What is the half life of AFP?
5-7 days
How do malignant ovarian germ cell tumours typically present?
Child/adolescent/young woman
Rapidly enlarging, unilateral ovarian mass
Acute pain due to rupture/torsion
May be menstrual/urinary or rectal symptoms
Typically stage 1 disease at presentation
How common are bilateral dysgerminomas?
10-20% (malignant germ cell tumours typically present as unilateral)
What is the overall survival rate for germ cell tumours of the ovary?
90%
What is the overall survival rate for epithelial cell tumours of the ovary?
30%
If a 15 year presents acutely with large ovarian mass suspicious for germ cell malignancy, which pre-operative tests are recommended?
AFP, LDH, HCG, Ca125
Group and save
Chest x-ray (choriocarcinoma is associated with lung mets)
+/- staging CT or MRI to assess if unclear that it is malignant
How suspected stage 1 malignant germ cell tumours managed?
Surgery: Midline laparotomy, Oophorectomy (biopsy of contralateral ovary not recommended), Peritoneal washings, biopsies of omentum, peritoneum and suspicious lymph nodes for staging
Surveillance for 1A and 1B
Chemotherapy for 1C (sometimes also 1B)
How are advanced staged malignant germ cell tumours?
Chemotherapy first then surgery
How is tumour recurrence managed for patients with malignant germ cell tumours?
Surgical treatment is recommended followed by chemotherapy if histology confirms recurrence
What is the follow up regimen for patients with Stage 1A germ cell ovarian cancer?
Do not require chemo
Require surveillance for 10 years (blood tests every 2 weeks for first 6 months, then monthly for next 6 months, then 2 monthly for 1 year, then 3 monthly for 1 year, then 4 monthly for 1 year, then 6 monthly)
MRI and chest xrays will also be performed intermittently
Patients advised not to fall pregnant for 2 years
How are 1B and 1C stage malignant germ cell ovarian tumours managed?
Some centres will carry out surveillance on 1B after surgery
1C = Surgery then chemotherapy (BEP or POMB/ACE in high risk e.g. stage 3 or 4 disease)
Which chemotherapy causes ototoxicity?
Cisplatin
Which chemotherapy causes pneumotoxicity/lung fibrosis?
Bleomycin (this is dose related)
hich chemotherapy causes a long term risk of leukaemia?
Etoposide
After surgery for a malignant ovarian germ cell tumour, how long should patients wait until falling pregnant?
2 years as pregnancy makes surveillance results difficult to interpret
What is the role of radiotherapy in the management of malignant ovarian germ cell tumours?
They are highly chemosensitive and radiotherapy can cause ovarian failure, risk of future malignancy and infertility, therefore it is reserved for palliative use
What is the fertility rate in patients who have received chemotherapy for MOGCTs?
69-75% and there are no reported congenital abnormalities after treatment with chemotherapy
