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Chapter 093. Gynecologic Malignancies (Part 5)

Malignant germ cell tumors are usually large (median—16 cm). Bilateral disease is rare except in dysgerminoma (10–15% bilaterality). Abdominal or pelvic pain in young women is the usual presenting symptom. Serum human chorionic gonadotropin (β-hCG) and α fetoprotein levels are useful in the diagnosis and management of these patients. Before the advent of chemotherapy, extensive surgery was routine, but it has now been replaced by careful evaluation of extent of spread, followed by resection of bulky disease and preservation of one ovary, the uterus, and the cervix, if feasible. This allows many affected women to preserve fertility. After surgical. | Chapter 093. Gynecologic Malignancies Part 5 Malignant germ cell tumors are usually large median 16 cm . Bilateral disease is rare except in dysgerminoma 10-15 bilaterality . Abdominal or pelvic pain in young women is the usual presenting symptom. Serum human chorionic gonadotropin 0-hCG and a fetoprotein levels are useful in the diagnosis and management of these patients. Before the advent of chemotherapy extensive surgery was routine but it has now been replaced by careful evaluation of extent of spread followed by resection of bulky disease and preservation of one ovary the uterus and the cervix if feasible. This allows many affected women to preserve fertility. After surgical staging 60-75 of women have stage I disease and 25-30 have stage III disease. Stages II and IV are infrequent. Most of the malignant germ cell tumors are managed with chemotherapy after surgery. Regimens similar to those used in testicular cancer such as BEP bleomycin etoposide and cisplatin with three or four courses given at 21-day intervals have produced 95 long-term survival in patients with disease stages IIII. This regimen is the treatment of choice for all malignant germ cell tumors except grade I stage I immature teratoma where surgery alone is adequate and perhaps early-stage dysgerminoma where surgery and radiation therapy are used. Dysgerminoma is the ovarian counterpart of testicular seminoma. The tumor is very sensitive to radiation therapy. The 5-year disease-free survival is 100 in early-stage patients and 61 in stage III disease. Unfortunately the use of radiation therapy makes many patients infertile. BEP chemotherapy is equally or more effective and does not cause infertility. In incompletely resected patients with dysgerminoma treated with BEP the 2-year disease-free survival is 95 and infertility is not observed. Combination chemotherapy BEP has replaced postoperative radiation therapy as the treatment of choice in women with ovarian dysgerminoma. Ovarian Stromal Tumors