Ovarian germ cell tumor surgery: Difference between revisions

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Latest revision as of 14:00, 22 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

Surgical intervention is the mainstay of management of ovarian germ cell tumors. Surgery is recommended both for staging and choosing appropriate treatment approaches. accordingly. Surgical management of the ovarian germ cell tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not.

Surgery

Surgery is the mainstay of management of ovarian germ cell tumors.^[1]^[2]^[3]^[4]
Surgery is recommended both for staging and choosing appropriate treatment approaches. accordingly.^[5]
Surgical options depends upon the choice of preserving fertility.


Management of Mature Teratoma
Mature Teratoma	Surgery is the mainstay of treatment for mature teratoma.^[6] Nonsurgical management may be considered in those with tumors smaller than 6 cm, especially those who is planning to get pregnant.^[7] Surgery increases the risk of band adhesion formation that may be associated with future infertility in women. Surgery is usually reserved for patients with either:^[7] Tumor size larger than 6 cm No plans for future pregnancy Post-menopausal women
Management of Dysgerminomas^[1]^[2]^[3]^[4]
Stage I ovarian germ cell tumors	Unilateral salpingo-oophorectomy with or without lymphangiography or computed tomography (CT) Unilateral salpingo-oophorectomy followed by observation Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies. Postoperative lymphangiography or CT is indicated for those who have not had the careful surgical and pathological examination of pelvic and para-aortic lymph nodes during surgery. Patients with surgically staged stage IA tumors may be observed carefully after surgery without the need for adjuvant treatment. Patients with incompletely staged tumor through surgery or those with higher stages may need adjuvant treatment.
Stage II ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy This option is considered for younger patients and those who desire to preserve their fertility for future pregnancies. Radiotherapy has been associated with ovarian failure. Adjuvant chemotherapy with the platinum-based regimen has replaced radiation therapy except in the rare patient in whom chemotherapy is not considered appropriate.
Stage III ovarian germ cell tumors	Unilateral salpingo-oophorectomy with adjuvant chemotherapy Second-look laparotomy This strategy is not beneficial in patients with completely resected tumors who receive cisplatin-based adjuvant treatment. Second-look surgery may be beneficial in those whose tumor was not completely resected at the initial surgical procedure and who had teratomatous elements in their primary tumor.
Stage IV ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy Unilateral salpingo-oophorectomy with adjuvant chemotherapy Chemotherapy is the preferred treatment in the patient who wants to preserve fertility.

Management options of Other Ovarian Tumors


Surgical options for other ovarian tumors
Stage I ovarian germ cell tumors	Unilateral salpingo-oophorectomy with adjuvant chemotherapy Unilateral salpingo-oophorectomy followed by observation Unilateral salpingo-oophorectomy with conservation of uterus and contralateral ovar is indicated in those who plan for future pregnancies. Chemotherapy is usually done postoperatively in those with ovarian germ cell tumors other than pure dysgerminoma and low grade (grade 1) immature teratoma, but it can also preserved for those whose tumors relapse after the surgery.
Stage II ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy Second-look laparotomy
Stage III ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage IV ovarian germ cell tumors	Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

References

↑ ^1.0 ^1.1 Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015
↑ ^2.0 ^2.1 Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015
↑ ^3.0 ^3.1 Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015
↑ ^4.0 ^4.1 Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015
↑ Gershenson, David M. (2007). "Management of Ovarian Germ Cell Tumors". Journal of Clinical Oncology. 25 (20): 2938–2943. doi:10.1200/JCO.2007.10.8738. ISSN 0732-183X.
↑ Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
↑ ^7.0 ^7.1 Caspi, Benjamin; Appelman, Zvi; Rabinerson, David; Zalel, Yaron; Tulandi, Togas; Shoham, Zeev (1997). "The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women". Fertility and Sterility. 68 (3): 501–505. doi:10.1016/S0015-0282(97)00228-8. ISSN 0015-0282.

Template:WikiDoc Sources [[Category:Surgery]

[xxx-1] 1.0 ^1.1 Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015

[abc-2] 2.0 ^2.1 Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015

[aaa-3] 3.0 ^3.1 Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015

[ccc-4] 4.0 ^4.1 Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015

[Gershenson2007-5] Gershenson, David M. (2007). "Management of Ovarian Germ Cell Tumors". Journal of Clinical Oncology. 25 (20): 2938–2943. doi:10.1200/JCO.2007.10.8738. ISSN 0732-183X.

[Yayla_AbideBostancı_Ergen2018-6] Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.

[CaspiAppelman1997-7] 7.0 ^7.1 Caspi, Benjamin; Appelman, Zvi; Rabinerson, David; Zalel, Yaron; Tulandi, Togas; Shoham, Zeev (1997). "The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women". Fertility and Sterility. 68 (3): 501–505. doi:10.1016/S0015-0282(97)00228-8. ISSN 0015-0282.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Ovarian germ cell tumor}}
-{{CMG}}; {{AE}} {{Sahar}}
+{{CMG}}; {{AE}}  {{MD}} {{Sahar}}
 ==Overview==
@@ Line 16: / Line 16: @@
 {| class="wikitable"
 |+
-!
+! colspan="2" |Management of Mature Teratoma
-!
-!
 |-
 |Mature Teratoma
@@ Line 29: / Line 27: @@
 **No plans for future [[pregnancy]]
 **[[Menopausal|Post-menopausal]] women
-|
 |-
-!
+! colspan="2" |Management of [[Dysgerminoma|Dysgerminomas]]<ref name="xxx" /><ref name="abc" /><ref name="aaa" /><ref name="ccc" />
-!Management of [[Dysgerminoma|Dysgerminomas]]<ref name="xxx" /><ref name="abc" /><ref name="aaa" /><ref name="ccc" />
-!Other tumors
 |-
 |Stage I ovarian germ cell tumors
@@ Line 44: / Line 39: @@
 * Patients with [[Surgery|surgically]] staged stage IA [[tumors]] may be observed carefully after [[surgery]] without the need for [[adjuvant treatment]].
 * Patients with incompletely staged [[tumor]] through [[surgery]] or those with higher stages may need [[adjuvant treatment]].
-|
 |-
 |Stage II ovarian germ cell tumors
@@ Line 53: / Line 47: @@
 ** [[Radiotherapy]] has been associated with [[ovarian failure]].
 ** [[Adjuvant]] [[chemotherapy]] with the [[platinum]]-based regimen has replaced [[radiation therapy]] except in the rare patient in whom [[chemotherapy]] is not considered appropriate.
-|
 |-
 |Stage III ovarian germ cell tumors
@@ Line 61: / Line 54: @@
 :** This strategy is not beneficial in patients with completely resected [[tumors]] who receive [[cisplatin]]-based [[adjuvant treatment]].
 :** Second-look [[surgery]] may be beneficial in those whose [[tumor]] was not completely resected at the initial [[surgical]] procedure and who had teratomatous elements in their primary [[tumor]].
-|
 |-
 |Stage IV ovarian germ cell tumors
@@ Line 68: / Line 60: @@
 :* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
 :** [[Chemotherapy]] is the preferred treatment in the patient who wants to preserve [[fertility]].
-|
 |}
-===Mature teratoma===
+===Management options of Other Ovarian Tumors===
-**
-===Management of ===
-* [[Surgery]] is the mainstay of treatment in [[Dysgerminoma|dysgerminomas]].
-* Depending upon the staging and severity adjuavant Additional [[chemotherapy]] and/or [[radiotherapy]] depend on the [[stage]] of the [[tumor]].<ref name="VicusBeiner2010">{{cite journal|last1=Vicus|first1=Danielle|last2=Beiner|first2=Mario E.|last3=Klachook|first3=Shany|last4=Le|first4=Lisa W.|last5=Laframboise|first5=Stephane|last6=Mackay|first6=Helen|title=Pure dysgerminoma of the ovary 35 years on: A single institutional experience|journal=Gynecologic Oncology|volume=117|issue=1|year=2010|pages=23–26|issn=00908258|doi=10.1016/j.ygyno.2009.12.024}}</ref>
-* Stage 1A: [[fertility]]-preserving [[surgery]] without [[adjuvant]] [[chemotherapy]] or [[radiotherapy]].<ref name="AL HusainiSoudy2012">{{cite journal|last1=AL Husaini|first1=Hamed|last2=Soudy|first2=Hussein|last3=Darwish|first3=Alaa El Din|last4=Ahmed|first4=Mohamed|last5=Eltigani|first5=Amin|last6=AL Mubarak|first6=Mustafa|last7=Sabaa|first7=Amal Abu|last8=Edesa|first8=Wael|last9=AL-Tweigeri|first9=Taher|last10=Al-Badawi|first10=Ismail A.|title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients|journal=Medical Oncology|volume=29|issue=4|year=2012|pages=2944–2948|issn=1357-0560|doi=10.1007/s12032-012-0194-z}}</ref>
-**
-* Other [[germ cell]] [[tumors]]
-:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
-:* Unilateral [[salpingo-oophorectomy]] followed by [[observation]]
-:* Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
-:* [[Chemotherapy agent|Chemotherapy]] is usually done postoperatively in those with [[ovarian]] [[germ cell]] [[tumors]] other than pure [[dysgerminoma]] and low grade (grade 1) immature [[teratoma]], but it can also preserved for those whose [[tumors]] [[relapse]] after the [[surgery]].
-*
-:**
-* Other [[germ cell]] [[tumors]]
-* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
 :*
-* Other [[germ cell]] [[tumors]]
+{| class="wikitable"
-:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
+|+
-:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
+! colspan="2" |Surgical options for other ovarian tumors
-:* Second-look [[laparotomy]]
+|-
+|Stage I ovarian germ cell tumors
-* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
+|
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
+* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
+* Unilateral [[salpingo-oophorectomy]] followed by [[observation]]
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
+* Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
-. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
+* [[Chemotherapy agent|Chemotherapy]] is usually done postoperatively in those with [[ovarian]] [[germ cell]] [[tumors]] other than pure [[dysgerminoma]] and low grade (grade 1) immature [[teratoma]], but it can also preserved for those whose [[tumors]] [[relapse]] after the [[surgery]].
-:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
+|-
-:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
+|Stage II ovarian germ cell tumors
-* Other [[germ cell]] [[tumors]]
+|
-:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]] with or without [[neoadjuvant chemotherapy]]
+* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
-:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]] with or without [[neoadjuvant chemotherapy]]
+* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
+* Second-look [[laparotomy]]
+|-
+|Stage III ovarian germ cell tumors
+|
+* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
+* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
+|-
+|Stage IV ovarian germ cell tumors
+|
+* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]] with or without [[neoadjuvant chemotherapy]]
+* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]] with or without [[neoadjuvant chemotherapy]]
+|}
 ==References==
 {{reflist|2}}