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Ovarian Cancer

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Ovarian Epithelial Cancer

Ovarian Germ Cell Tumors


Ovarian Epithelial Cancer

General Information About Ovarian Epithelial Cancer

Ovarian epithelial cancer is a disease in which malignant (cancer) cells form in the tissue covering the ovary.

The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).

Ovarian epithelial cancer is one type of cancer that affects the ovary.

Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer.

Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.

Some ovarian cancers are caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a personfs parents. Hereditary ovarian cancer makes up approximately 5% to 10% of all cases of ovarian cancer. Three hereditary patterns have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers.

Tests that can detect altered genes have been developed. These genetic tests are sometimes done for members of families with a high risk of cancer.

Women with an increased risk of ovarian cancer may consider surgery to prevent it.

Some women who have an increased risk of ovarian cancer may choose to have a prophylactic oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). It is not known if this procedure prevents ovarian cancer.

Ovarian cancer is hard to detect (find) early because usually there are no symptoms.

Some women who have early stage ovarian cancer may have symptoms such as vague gastrointestinal (GI) discomfort, pressure in the pelvis, pain, swelling of the abdomen, and shortness of breath. Most of the time, there are no symptoms or they are very mild. By the time symptoms do appear, the cancer is usually advanced.

When found in its early stages, ovarian epithelial cancer can be cured in many patients. Women with any stage of ovarian epithelial cancer should consider taking part in a clinical trial.

Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian cancer.

The following tests and procedures may be used:

  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

  • Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

  • CA 125 assay: A test that measures the level of CA 125 in the blood. CA 125 is a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition.

  • Barium enema (lower GI series): A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The tissue is removed in a procedure called a laparotomy (a surgical incision made in the wall of the abdomen).

Certain factors affect treatment options and prognosis (chance of recovery).

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer.
  • The type and size of the tumor.
  • The patientfs age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

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Stages of Ovarian Epithelial Cancer

After ovarian epithelial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.

The process used to find out if cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

An operation called a laparotomy is usually done to find out the stage of the disease. A doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will also perform a biopsy (cut out small pieces of tissue so they can be looked at under a microscope to see whether they contain cancer). Usually the doctor will remove the cancer and organs that contain cancer during the laparotomy.

The following stages are used for ovarian epithelial cancer:

Stage I

In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.

  • Stage IA: Cancer is found in a single ovary.

  • Stage IB: Cancer is found in both ovaries.

  • Stage IC: Cancer is found in one or both ovaries and one of the following is true:
    • cancer is found on the outside surface of one or both ovaries; or
    • the capsule (outer covering) of the tumor has ruptured (broken open); or
    • cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

Stage II

In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.

  • Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).

  • Stage IIB: Cancer has spread to other tissue within the pelvis.

  • Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

Stage III

In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

  • Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).

  • Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.

  • Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.

Cancer that has spread to the surface of the liver is also considered stage III disease.

Stage IV

In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer is found in the tissues of the liver.

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Recurrent Ovarian Epithelial Cancer

Recurrent ovarian epithelial cancer is cancer that has recurred (come back) after it has been treated.

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Treatment Option Overview

There are different types of treatment for patients with ovarian epithelial cancer.

Different types of treatment are available for patients with ovarian epithelial cancer. Some treatments are standard, and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the treatment currently used as standard treatment, the new treatment may become the standard treatment.

Three kinds of standard treatment are used. These include the following:

Surgery

Most patients have surgery to remove as much of the tumor as possible. Different types of surgery may include:

  • Hysterectomy: A surgical procedure to remove the uterus and cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

  • Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

  • Omentectomy: A surgical procedure to remove the omentum (a piece of the tissue lining the abdominal wall).

  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials. These include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patientfs immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodyfs natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

High-dose chemotherapy with stem cell transplantation

High-dose chemotherapy with stem cell transplantation is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the bodyfs blood cells.

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Treatment Options by Stage Stage I Ovarian Epithelial Cancer

Treatment of stage I ovarian epithelial cancer may include the following:

  • Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and examined under the microscope to look for cancer cells.

  • Hysterectomy, unilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and examined under the microscope to look for cancer cells.

  • Internal or external radiation therapy.

  • Chemotherapy.

  • Watchful waiting (closely monitoring a patientfs condition without giving any treatment until symptoms appear or change).

  • A clinical trial.

Stage II Ovarian Epithelial Cancer

Treatment of stage II ovarian epithelial cancer may be surgery to remove the tumor, hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and examined under the microscope to look for cancer cells.

After surgery, treatment may include the following:

  • Combination chemotherapy and internal or external radiation therapy.
  • Combination chemotherapy alone.
  • A clinical trial.

Stage III and IV Ovarian Epithelial Cancer

Treatment of stage III and stage IV ovarian epithelial cancer may be surgery to remove the tumor, hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.

After surgery, treatment may include the following:

  • Combination chemotherapy.
  • Combination chemotherapy followed by second-look surgery (surgery performed after the initial surgery to determine whether tumor cells remain).
  • A clinical trial.

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Treatment Options for Recurrent Ovarian Epithelial Cancer

Treatment of recurrent ovarian epithelial cancer may include the following:

  • Chemotherapy with or without surgery.
  • A clinical trial of chemotherapy or biologic therapy (treatment to stimulate or restore the ability of the immune system to fight cancer).

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General Information About Ovarian Germ Cell Tumors

Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.

Germ cell tumors begin in the reproductive cells (egg or sperm) of the body. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary.

The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).

Ovarian germ cell tumor is a general name that is used to describe several different types of cancer. The most common ovarian germ cell tumor is called dysgerminoma.

Possible signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.

Ovarian germ cell tumors can be difficult to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic examinations (checkups). A woman who has swelling of the abdomen without weight gain in other places should see a doctor. A woman who no longer has menstrual periods (who has gone through menopause) should also see a doctor if she has bleeding from the vagina.

Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor.

The following tests and procedures may be used:

  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

  • Laparotomy: A surgical incision made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope.

  • Lymphangiogram: A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • Blood tests: Tests to measure the levels of alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the blood. AFP and HCG are substances that may be signs of ovarian germ cell tumor when found at increased levels.

Certain factors affect prognosis (chance of recovery and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The type of cancer.
  • The size of the tumor.
  • The stage of cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
  • The way the cancer cells look under a microscope.
  • The patientfs general health.

Ovarian germ cell tumors are generally curable if found and treated early.

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Stages of Ovarian Germ Cell Tumors

After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.

The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. Certain tests are used in the staging process.

Many of the tests used to diagnose ovarian germ cell tumor are also used to determine the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, surgery is required to determine the stage of cancer in an operation called a laparotomy. The doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will cut out small pieces of tissue and look at them under a microscope to see whether they contain cancer. The doctor may also wash the abdominal cavity with fluid and then look at the fluid under a microscope to see if it contains cancer cells. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy.

The following stages are used for ovarian germ cell tumors:

Stage I

Stage I is divided into stage IA, stage IB, and stage IC as follows:

  • Stage IA: Cancer is limited to one ovary.

  • Stage IB: Cancer is found in both ovaries.

  • Stage IC: Cancer is found in one or both ovaries and one of the following occurs:
    • Cancer has spread to the outside surface of one or both ovaries; or
    • The outer covering of the tumor has ruptured (broken open); or
    • Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).

Stage II

Stage II is divided into stage IIA, stage IIB, and stage IIC as follows:

  • Stage IIA: Cancer is found in one or both ovaries and has spread into the pelvis and/or to the uterus and/or fallopian tubes.

  • Stage IIB: Cancer is found in one or both ovaries and has spread to other tissue within the pelvis.

  • Stage IIC: Cancer is found in one or both ovaries, has spread to the uterus, fallopian tubes, and/or to other tissues in the pelvis, and one of the following occurs:
    • Cancer is on the surface of one or both ovaries; or
    • The outer covering of the tumor has ruptured (broken open); or
    • Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum.

Stage III

Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:

  • Stage IIIA: Cancer is found in one or both ovaries and the pelvis, and microscopic cancer cells are found in the peritoneum.

  • Stage IIIB: Cancer is found in one or both ovaries and has spread to the peritoneum. The peritoneal tumors are no larger than 2 centimeters (about 3/4 inch).

  • Stage IIIC: Cancer is found in one or both ovaries and has spread beyond the pelvis to the peritoneum. The peritoneal tumors are larger than 2 centimeters and/or cancer is found in lymph nodes in the pelvis.

Cancer that has spread to the surface of the liver or has spread to the small bowel or omentum (a fold of peritoneum that encloses the bowel) is also considered stage III disease.

Stage IV

In stage IV, cancer is found in one or both ovaries and has metastasized (spread) not only to the pelvis and abdomen but also to other parts of the body. Cancer is found in the tissues of the liver.

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Recurrent Ovarian Germ Cell Tumors

Recurrent ovarian germ cell tumor is cancer that has recurred (come back) after it has been treated. The cancer may come back in the other ovary or in other parts of the body.

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Ovarian Germ Cell Tumors

Ovarian Germ Cell TumorsTreatment Option Overview

There are different types of treatment for patients with ovarian germ cell tumors.

Different types of treatment are available for patients with ovarian germ cell tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the gstandardh treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer using one of the following types of surgery.

  • Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

  • Hysterectomy: A surgical procedure to remove the uterus and cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

  • Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors may not be able to be completely removed.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered chemotherapy or radiation after surgery to kill any cancer cells that are left. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Following radiation or chemotherapy, an operation called a second-look laparotomy is sometimes done. This is similar to the laparotomy that is done to determine the stage of the cancer. During the second-look operation, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left.

Other types of treatment are being tested in clinical trials. These include the following:

High-dose chemotherapy with bone marrow transplantation

High-dose chemotherapy with bone marrow transplantation is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the bodyfs blood cells.

New treatment options

Combination chemotherapy (the use of more than one chemotherapy drug to fight cancer) is being tested in clinical trials.

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Treatment Options By Stage

Stage I Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

  • Unilateral salpingo-oophorectomy with or without lymphangiography (an x-ray study of the lymph system, the tissues and organs that filter and destroy harmful substances and help fight infection and disease) or CT scan (a series of detailed pictures of areas inside the body, created by a computer linked to an x-ray machine).

  • Unilateral salpingo-oophorectomy followed by observation (closely monitoring a patientfs condition without giving any treatment until symptoms appear or change).

  • Unilateral salpingo-oophorectomy followed by radiation therapy.

  • Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may be either:

  • unilateral salpingo-oophorectomy followed by careful observation; or

  • unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

Stage II Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may be either:

  • hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or

  • unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

  • Unilateral salpingo-oophorectomy followed by combination chemotherapy.

  • Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).

  • A clinical trial evaluating new treatment options.

Stage III Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

  • Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible.

  • Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

  • Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.

  • Unilateral salpingo-oophorectomy followed by chemotherapy.

  • Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).

  • A clinical trial evaluating new treatment options.

Stage IV Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may include the following:

  • Hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy, with removal of as much of the cancer in the pelvis and abdomen as possible.

  • Unilateral salpingo-oophorectomy followed by chemotherapy.

Treatment of other germ cell tumors may include the following:

  • Hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.

  • Unilateral salpingo-oophorectomy followed by chemotherapy.

  • Second-look surgery (surgery performed after primary treatment to determine whether tumor cells remain).

  • A clinical trial evaluating new treatment options.

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Treatment Options for Recurrent Ovarian Germ Cell Tumors

Treatment depends on whether the tumor is dysgerminoma or another type of germ cell tumor.

Treatment of dysgerminoma may be:

  • Chemotherapy with or without radiation therapy.

Treatment of other germ cell tumors may include the following:

  • Chemotherapy.
  • Surgery with or without chemotherapy.
  • A clinical trial of high-dose chemotherapy followed by bone marrow transplantation.
  • A clinical trial evaluating new treatment options.

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Stages of Ovarian Low Malignant Potential Tumors

After ovarian low malignant potential tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body. The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Certain tests or procedures are used to determine stage. Staging laparotomy (a surgical incision made in the wall of the abdomen to remove ovarian tissue) may be used. Most patients are diagnosed with stage I disease.

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Recurrent Ovarian Low Malignant Potential Tumors

Recurrent ovarian low malignant potential tumor is cancer that has recurred (come back) after it has been treated. The cancer may come back in the other ovary or in other parts of the body.

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Treatment Option Overview

There are different types of treatment for patients with ovarian low malignant potential tumor.

Different types of treatment are available for patients with ovarian low malignant potential tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the gstandardh treatment, the new treatment may become the standard treatment.

Two types of standard treatment are used:

Surgery

The type of surgery (removing the tumor in an operation) depends on the extent of the disease and the womanfs plans for having children. Surgery may include the following:

  • Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.

  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.

  • Hysterectomy and bilateral salpingo-oophorectomy: A surgical procedure to remove the uterus, cervix, and both ovaries and fallopian tubes. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

  • Partial oophorectomy: A surgical procedure to remove part of one ovary or part of both ovaries.

  • Omentectomy: A surgical procedure to remove the omentum (a piece of the tissue lining the abdominal wall).

Even if the doctor removes all disease that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any tumor cells that are left. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic treatment). When chemotherapy is placed directly into the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

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Treatment Options By Stage

Early Stage Ovarian Low Malignant Potential Tumors (Stage I/II)

Surgery is the standard treatment for early stage ovarian low malignant potential tumor. The type of surgery usually depends on whether a woman plans to have children.

For women who plan to have children, surgery is either:

  • unilateral salpingo-oophorectomy; or
  • partial oophorectomy.

To prevent recurrence of disease, most doctors recommend surgery to remove the remaining ovarian tissue when a woman no longer plans to have children.

For women who do not plan to have children, treatment may be:

  • hysterectomy and bilateral salpingo-oophorectomy.
Late Stage Ovarian Low Malignant Potential Tumors (Stage III)

Treatment for late stage ovarian low malignant potential tumor may be:

  • hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A lymph node dissection may also be performed.

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Treatment Options for Recurrent Ovarian Low Malignant Potential Tumors

Treatment for recurrent ovarian low malignant potential tumor may include the following:

  • Surgery.
  • Surgery followed by chemotherapy.

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Ovarian Cancer