Understanding Ovarian Germ Cell Tumors: Diagnosis and Treatment

Ovarian germ cell tumor

Ovarian germ cell tumors are uncommon cancers in the ovary that originate in the reproductive (germ) cells of the ovary - the cells that create eggs. These are in contrast to more common epithelial ovarian cancers.

Types of Ovarian Germ Cell Tumors

• Dysgerminoma - the most frequent malignant germ cell tumor; it is frequent among teenagers and young women.
• Immature Teratoma - contains a variety of tissue (such as bone, muscle, hair); grade defines aggressiveness.
• Endodermal Sinu (Yolk Sac) Tumor- very aggressive yet is sensitive to chemotherapy.
• Choriocarcinoma (non-gestational) - uncommon, aggressive, high levels of hCG.
• Mixed Germ Cell Tumors - include a mixture of the above.

Ovarian germ cell tumors treatment in India

Initial Surgery (Primary Treatment)

• Purpose: Diagnose, stage the disease and excise the tumor.

Fertility-sparing surgery (in young women):

• Removal of the affected ovary and fallopian tube (unilateral salpingo-oophorectomy)
• Uterus and opposite ovary are saved where possible.

Staging can be done on a grand scale and can comprise:

• Biopsy of lymph nodes, omental biopsy, peritoneal washings.
• Advanced disease: It might need a more elaborate surgery, yet physicians attempt to retain fertility where possible.

Chemotherapy

• The majority of the malignant OGCTs are very responsive to chemotherapy.
• Standard regimen: BEP
• Bleomycin + Etoposide + Cisplatin
• Usually given for 3–4 cycles.
• Other cases (low-risk stage I dysgerminoma or grade 1 immature teratoma) might not require chemotherapy, in case of complete resected cases.
• Respondence is high.

Radiation Therapy

• Rarely used nowadays.
• Was used in case of dysgerminomas, however chemotherapy has replaced it to a very large extent due to fertility concerns and due to the toxic effects in the long-term.

Follow-Up / Surveillance

• Regular tumor markers (AFP, hCG, LDH) used to notice recurrence in its initial stages.
• Imaging (USG/CT/MRI) at intervals.
• Follow-up (particularly with fertility-preserving treatment) is a long-term process.

Best hospitals for ovarian germ cell tumors in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Chemotherapy for ovarian germ cell tumors

When is Chemotherapy Needed?

Almost always for malignant germ cell tumors, except:

• IA Dysgerminoma (completely resected) Stage IA Dysgerminoma usually does not require any chemo other than surveillance.
• Grade 1 Immature Teratoma, Stage IA Stage IA of Immature Teratoma generally requires no more than surgery.
• Other stages/types all the rest are indicated to receive adjuvant chemotherapy.

Standard First-Line Chemotherapy

• Regimen: BEP
• Bleomycin
• Etoposide
• Platin (Cisplatin)
• Typical schedule:
• 3–4 cycles (each cycle = 3 weeks)
• Oncologists administer drugs intravenously.

Alternative Regimens

• EP (Etoposide + Cisplatin): This is employed when Bleomycin is intolerable (because of lung toxicity).
• Regimens based on carboplatin: It is sometimes used on patients unable to receive Cisplatin.

Monitoring During Chemo

• Tumor markers (AFP, hCG, LDH) → should decline during the treatment.
• Kidney function tests & hearing tests (due to Cisplatin).
• Pulmonary performance (when taking Bleomycin).

Response & Prognosis

• OGCTs are very susceptible to chemo-sensitivity.

Cure rates:

• Early-stage → >95%
• Even advanced/metastatic → 70–90%
• Majority of patients can be treated and be able to have children.

Ovarian germ cell tumors surgery in India

Goals of Surgery:

• Diagnosis/staging (to establish tumor type and dissemination).
• Remove the tumor completely.
• Protect fertility at all costs (most patients are teenagers or young women).

Types of Surgery

Fertility-Sparing Surgery (desirable in most instances). Unilateral salpingo-oophorectomy (USO):

• Removal of the affected ovary + fallopian tube.
• Uterus and the other ovary are spared.
• This is the norm in young women with small scale disease.
• Allows future pregnancy in most cases.

Staging Procedures, Meanwhile, the surgeon can do:

• Peritoneal washes (fluid sampling of cancer cells).
• Inspection & palpation of abdomen/pelvis.
• Omentectomy (losing fatty tissue around stomach).
• Lymph node sampling/biopsy (enlarged).
• Biopsies from suspicious peritoneal surfaces.
• (Full radical staging such as in epithelial ovarian cancer is unnecessary, because germ cell tumours are highly chemo-sensitive.)

More Extensive Surgery

• In case tumor is large or has spread, additional tissue can be required.
• Cytoreductive (debulking) surgery → objective is to debride as many tumor as possible.
• Uncommonly, bilateral salpingo oophorectomy (removal of both tubes and ovaries) and hysterectomy can be required, although it is generally not done in young women.

Emergency Surgery

• In some instances, the OGCTs rupture or torsion or bleeding causing acute abdominal pains.
• Surgery can be done in case of emergencies → usually the removal of affected ovary.

Post-Surgery Treatment

• Stage IA Dysgerminoma / Stage IA, Grade 1 Immature Teratoma: Surgery alone, then surveillance.
• All other cases: Surgery + adjuvant chemotherapy (BEP regimen).

Fertility Outcomes

• The majority of women do not lose their normal menstrual cycles following fertility-sparing surgery.
• A number of people conceive naturally following treatment.

Top oncologists for ovarian germ cell tumors in India

• Dr. Rupinder Sekhon
• Dr. Sabhyata Gupta
• Dr. Rama Joshi
• Dr. Kanika Batra Modi

Ovarian germ cell tumors treatment in India with GetWellGo

Hospitals & Doctors

GetWellGo collaborates with NABH-recognized Indian hospitals, which are similar to JCI standards and the following are some of the examples:

• Medanta -The Medicity, Gurgaon
• Fortis Hospitals (e.g., Gurgaon, Faridabad)
• Artemis Hospital, Gurgaon
• Max Super Specialty Hospital, Delhi

They also provide the accessibility of qualified gynaecological oncologists who have good records when it comes to the treatment of ovarian cancer.

Treatment Pathway

GetWellGo contains the complete range of OGCT care including:

Surgical Management

• Unilateral salpingo-oophorectomy, with fertility saved, with staging when necessary.
• More extensive surgery can also be designed on an individual basis in advanced or bilateral cases. 

Chemotherapy

• Predominantly BEP regimen (Bleomycin, Etoposide, Cisplatin) for adjuvant treatment.
• This is the core method in the high stages or post-debulking surgery. 

Post-Treatment Support & Follow-Up

• GetWellGo simplifies the process of medical appointments, continuing attention, and subsequent care logistics, which guarantees an efficient recovery process.

Why Choose GetWellGo for Ovarian Germ Cell Tumor Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Ovarian Germ Cell Tumor treatment.
• Expert Gynaecology Oncologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food