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
