Germ cell tumours of the ovary (ovarian teratoma)
This information is about a rare type of ovarian cancer. It should ideally be read with our general information about ovarian cancer.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
We've got more information about ovarian cancer that's written just for teens and young adults. You can also find out how to speak to others who understand what you're going through.
The ovaries are two small, oval-shaped organs, which are part of the female reproductive system. Each month, in women of childbearing age, an egg leaves one of the ovaries and is released into the pelvic cavity, where it then passes down the fallopian tube to the womb (uterus). If the egg is not fertilised, it breaks down and is shed, along with the lining of the womb, as part of the monthly period.
The ovaries also produce the female sex hormones oestrogen and progesterone. As a woman nears the menopause, her ovaries make less of these hormones and her periods gradually stop.
Germ cell tumours of the ovary are a rare type of ovarian cancer. They form about 5% (5 in 100) of all ovarian cancers. Germ cell tumours differ widely from each other in the way they behave and how they are treated. This information is a general guide, and it is important to speak to your specialist team about your individual situation.
Germ cell tumours start in the egg-producing (ovum-producing) cells of the ovary. They are different from the more common type of ovarian cancer (epithelial cancer), and the treatment for them also differs. Some tumours produced by germ cells are benign (non-cancerous) and others are malignant (cancerous). Germ cell tumours tend to affect only one ovary, and most are curable even if they’re diagnosed at an advanced stage.
Types of germ cell tumours
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These are benign tumours that are also known as mature teratoma. They are the most common type of germ cell tumour. They are more commonly seen in young women, but may also affect children and elderly women.
This type of germ cell tumour is malignant and more frequently affects both of the ovaries. It is most common in women in their twenties.
Non-dysgerminomatous germ cell tumours
These tumours are also malignant and usually affect only one ovary. They are usually diagnosed in girls or young women. There are different types of non-dysgerminomatous germ cell tumour, some of which are very rare.
The different types are:
yolk sac tumours
mixed primitive germ cell tumours
Causes of germ cell tumours
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The cause of germ cell tumours is unknown. Germ cells are a normal part of the ovary, but sometimes changes in these cells make them divide and grow too quickly. This results in a tumour forming.
Signs and symptoms of germ cell tumours
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The most common symptoms include:
a feeling of fullness or abdominal swelling
sometimes an increasing need to pass urine.
Some women may have irregular vaginal bleeding. These symptoms can be caused by many other things, but it’s important to tell your doctor if you have any of them.
How germ cell tumours are diagnosed
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Your GP will examine you and arrange for any further tests that may be necessary. You’ll need to be referred to a hospital specialist for these tests, and for expert advice and treatment.
At the hospital, your doctor will carry out an internal pelvic examination to check the shape and position of the pelvic organs.
Several tests may be used to diagnose germ cell tumours of the ovary. One or more of the following tests may be carried out:
You may have a test to see whether or not chemicals called tumour markers are being released into the bloodstream. These are useful in the diagnosis and treatment of certain types of germ cell tumour. The two main markers produced by germ cell tumours are AFP (alpha-fetaprotein) and HCG (human chorionic gonadotrophin).
A small device like a microphone, which produces sound waves, is moved over the abdomen. The sound waves are converted into a picture by a computer to clearly show the ovaries.
Ultrasound scans can also be carried out vaginally. A small device (about the size of a tampon) is put into the vagina. This also produces sound waves, which are converted into a picture by a computer.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
Occasionally, a simple operation called a laparoscopy is done. A small cut is made in the skin of the abdomen. A thin, rigid tube with a light and camera (called a laparoscope) is then inserted through the cut and into the abdomen. This acts as a mini telescope and allows the doctor to look at the ovaries and the surrounding area. The doctor may be able to remove the affected ovary in this way or, more usually, by doing an operation called a laparotomy.
Once the ovary has been removed, it is sent for examination under a microscope. The doctor can then tell whether it’s a germ cell tumour and if so, what type it is.
Staging of germ cell tumours
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The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors decide on the most appropriate treatment for you.
Germ cell cancer of the ovary, like ovarian cancers, is staged using the FIGO system. The FIGO system gives a number between 1-4 to the cancer, depending on how widespread the cancer has become. For example, stage 1 cancer means that one or both ovaries are affected by the cancer. Stage 4 means that the cancer has spread to other organs. A letter a, b or c can also sometimes be added after the number to give more detail about how the tumour has spread within the ovary
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes
‘Local recurrence’ means the cancer has come back in the same area after treatment
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
Treatment for germ cell tumours
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Improvements have been made in treating germ cell tumours, and most women can now be completely cured. The treatment you’ll have will depend on the site and type of germ cell tumour. Treatment will usually involve a combination of surgery and chemotherapy.
The initial treatment for germ cell tumours is removal of the affected ovary and fallopian tube (called unilateral salpingo-oophorectomy). This is done during an operation known as a laparotomy, where a cut is made into the abdominal wall to allow the surgeon to remove the ovary.
In most cases, it's only necessary to remove the affected ovary and the fallopian tube, which won't affect a woman's ability to have children. Sometimes, however, it may be necessary to remove both ovaries, both fallopian tubes, and the womb (called a total abdominal hysterectomy and bilateral salpingo-oophorectomy).
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells.
The drugs are usually given as injections or drips into a vein in your arm (intravenously). Often a combination of chemotherapy drugs is given. Sometimes it isn't necessary to follow the surgery with chemotherapy if the tumour is discovered at a very early stage.
If chemotherapy is necessary, it’s usually given every 3-4 weeks, for four or more sessions of treatment.
Radiotherapy treats cancer by using high-energy rays that destroy cancer cells, while doing as little harm as possible to normal cells. It is sometimes given to treat particular types of germ cell tumours of the ovary.
One of the main aims of treatment in young women is to preserve fertility, and this is taken into consideration when treatment is being decided. If you have had both your ovaries removed, or you have had radiotherapy to the ovaries, you’ll be infertile. If only one of your ovaries has been removed, the remaining ovary will continue to produce eggs.
If you have had both your ovaries removed, you’ll immediately start your menopause. Women who have had radiotherapy to the ovaries will also begin the menopause, although this will take a few months.
If you have chemotherapy treatment, it may affect your remaining ovary and you may notice that your monthly periods stop or become irregular. Once the chemotherapy is finished, your periods should return to normal. However, this may take several months. Some older women may start their menopause due to chemotherapy.
Women who begin the menopause may benefit from taking HRT (hormone replacement therapy), which can help to relieve menopausal symptoms. Your doctor can give you further advice.
Younger women in particular often find it difficult to come to terms with the fact that they can no longer have children if they lose their fertility. They may also feel that they have lost a part of their female identity. It can help to discuss any fears or worries with a sympathetic friend, family member or a specialist nurse. Counselling can be arranged either by the hospital or through your GP.
We have more information about cancer treatments and fertility for women.
After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems, or notice any new symptoms, in between, let your doctor know as soon as possible.
During your diagnosis and treatment of cancer you are likely to experience a number of different emotions, from shock and disbelief to fear and anger. At times, these emotions can be overwhelming and hard to control. These feelings are natural and it's important to be able to express them.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. You may wish to contact our cancer support specialists for advice and information on counselling in your local area.
This information has been compiled using information from a number of reliable sources, including:
Raghavan, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
Souhami, et al. Oxford Textbook of Oncology. 2nd edition. 2001. Oxford University Press.
Tobias, Hochauser. Cancer and its management. 6th edition. 2010. Oxford Blackwell.
Thank you to Dr Susan Lalondrelle, Consultant Clinical Oncologist, and all of the people affected by cancer who reviewed this edition.
Reviewing information is just one of the ways you could help when you join our Cancer Voices network.