Ovarian Dysgerminomas- Causes, Symptoms, and Management

What Are Ovarian Dysgerminomas?

Ovarian dysgerminomas are the most common type of malignant germ cell tumors and constitute approximately 1 % of all ovarian malignancies. Dysgerminomas occur prevalently in women younger than 30 years. However, during pregnancy, the tumor may be discovered accidentally. In addition, certain tumors develop in gonads with dysgenetic conditions.

What Are the Signs and Symptoms of Ovarian Dysgerminomas?

Early symptoms of ovarian dysgerminomas may be hard to recognize. Malignant tumor symptoms typically do not show up until the cancer has spread.

The signs and symptoms are as follows-

• Any particular symptoms do not diagnose dysgerminomas. The majority of patients have-
  • Palpable abdominopelvic mass.
  • Stomach pain.
• The following are some other symptoms that are frequently linked to dysgerminomas:
  • Pelvic fullness.
  • Pain.
  • Dysuria (painful and difficult urination).
  • Frequent urge to urinate.
  • Early satiety.
• Usually appearing as a unilateral lump, a dysgerminoma can spread quickly.
• Dysgerminomas are prone to torsion and rupture due to their potential for fast growth.
• Disturbances in digestion and other vague stomach symptoms like dyspepsia are less frequent.
• The slow-growing malignancy that affects female germ cells affects the beta-human chorionic gonadotropin (beta-hCG) hormone, which the body naturally generates in larger amounts during pregnancy.

What Causes Ovarian Dysgerminoma?

Ovarian germ cell tumors or dysgerminomas are not known to have a specific cause. Still, several inherited congenital disabilities or genetic disorders (chromosomal abnormalities or gene mutations) may raise the risk of getting the condition. Teenage girls, younger women, or women over 60 are the groups of people that develop this sort of tumor the most frequently.

How Are Ovarian Dysgerminomas Diagnosed?

The following examinations of the pelvic region, blood, and ovarian tissue may be carried out to detect ovarian germ cell cancers-

Physical Examination-

• The physical examination should be comprehensive to look for signs of metastatic disease outside the abdominal cavity, such as lymphadenopathy, pleural effusions, and other localized abnormalities. Such findings might help narrow the differential diagnosis even though dysgerminomas are not frequently observed.
• Pelvic Examination- The doctor may examine the vagina, cervix, fallopian tubes, ovaries, and rectum, checking for abnormalities. A Pap test to check the cervix for signs of disease may also be done.

Laparoscopy or Laparotomy- One or more abdominal incisions are made during this surgical procedure to examine the organs for signs of cancer. It is possible to take tissue samples for microscopic examination.

Computed Tomography (CT) Scan- To check for metastases, computed tomography (CT) scanning of the chest, abdomen, and pelvis is frequently used.

Transvaginal Ultrasound- Transvaginal ultrasonography is a helpful initial imaging technique to identify whether the mass is ovarian and, more importantly, whether it shows any signs of malignancy (example- thickened septations, solid and cystic components). The presence of free abdominal fluid and bilateral masses suggests the possibility of cancer.

Magnetic Resonance Imaging (MRI)- If a non-ovarian origin for the mass is suspected, pelvic magnetic resonance imaging may occasionally be required to determine anatomy more accurately.

Patients may exhibit gastrointestinal or genitourinary blockage symptoms or signs. In these circumstances, additional studies to take into account include-

• Colonoscopy.
• Barium enema.
• Intravenous pyelography (IVP).
• Upper gastrointestinal series.

Other Laboratory Studies- Dysgerminomas have most commonly been linked with elevations of certain hormones. As a result, the following tumor markers are helpful in the investigation of dysgerminomas-

• Beta-hCG (human chorionic gonadotropin hormone).
• LDH (lactate dehydrogenase).
• AFP (alpha-fetoprotein, a protein produced by a fetus).
• Cancer antigen 125 (CA-125)- For epithelial tumors.
• Inhibin A and B.

How Is the Staging of Ovarian Dysgerminomas Done?

Doctors must ascertain the patient's cancer stage before proposing a course of treatment. According to FIGO (The International Federation of Gynecology and Obstetrics) staging given in 2014, the ovarian dysgerminomas are staged as follows-

Stage 1: Cancer limited to ovaries and fallopian tubes.

• Stage 1A- A single ovary or fallopian tube is affected by cancer.
• Stage 1B- Both the ovaries and fallopian tubes have cancer.
• Stage 1C- In addition to one of the following, cancer is present in one or both fallopian tubes or ovaries-
  • Stage 1C1- Surgical spill (during surgery, the tissue (capsule) enclosing the tumor bursts, potentially allowing cancer cells to flow into the pelvis and abdomen).
  • Stage 1C2- Tumor on the ovarian surface or capsule rupture before surgery.
  • Stage 1C3- Ascites or peritoneal washings containing cancerous cells.

Stage 2: Other pelvic organs have become infected after the disease spread from the ovaries or fallopian tubes.

• Stage 2A- Uterine or fallopian tube involvement.
• Stage 2B- Cancer extension to the rectum or bladder.

Stage 3:The cancer has spread to lymph nodes, other pelvic or abdominal organs, or both.

• Stage 3A
  • Stage 3A1- Cancer spread to retroperitoneal lymph nodes.
    • Stage 3A1(i)- Metastasis less than or equal to 10 mm.
    • Stage 3A1(ii)- Metastasis more than 10 mm.
  • Stage 3A2- Cancer spreads in the abdominal and nearby areas in the pelvis.
• Stage 3B- A smaller than 2 cm square patch of the peritoneum has been infested by cancer that has spread from the pelvis. Lymph nodes in the abdominal cavity may or may not have it.
• Stage 3C- More than 2 cm of the region is malignant. The spleen and the inside of the liver have not been affected, and it has not migrated to other distant places. However, it may have spread to lymph nodes behind the peritoneum.

Stage 4: Other parts of the body have been affected by cancer outside the abdomen (distant metastases).

• Stage 4A- The fluid surrounding the lungs has been found to contain cancer cells (pleural effusions).
• Stage 4B- Outside of the abdomen, cancer has spread to various tissues, organs, and lymph nodes, including the groin.

What Is the Treatment of Ovarian Dysgerminoma?

The location and stage of cancer determine the recommended method of treatment.

The commonly utilized therapies are listed below-

1. Surgical Management- The most frequent treatment for ovarian dysgerminoma is surgery to remove the malignancy. The following types of surgical procedures can be done-

• Unilateral Salpingo-Oophorectomy- A technique known as a unilateral salpingo-oophorectomy allows for the removal of one ovary and fallopian tube. Additional biopsies and lymph node samples are occasionally required.
• Total Hysterectomy- A total hysterectomy, which involves removing the entire uterus and cervix, may be necessary for more severe situations.
• Radical Hysterectomy- In addition to the uterus and cervix, the ovaries, fallopian tubes, and surrounding tissues are also removed during a radical hysterectomy.
• Tumor Debulking- A surgeon will remove the largest portion of the cancerous tumor during a technique known as tumor debulking.

2. Radiation- To eliminate or stop the growth of cancer cells, high-energy X-rays or other types of radiation are utilized.

3. Chemotherapy- Chemotherapy stops cancer cells from proliferating. A combination of chemotherapy medications may be used to treat ovarian dysgerminomas.

What Is the Prognosis of Ovarian Dysgerminoma?

The stage of the malignancies affects the prognosis. If the tumor is contained within the ovary, the five-year survival rate is 96 %; if it extends outside the ovaries, it is 63 %. Most ovarian cancers do not affect prognosis during pregnancy, although issues like torsion and rupture may lead to more spontaneous abortions or preterm births.

Conclusion:

Dysgerminomas typically affect young women and are the most prevalent ovarian germ cell tumors. Even though dysgerminomas are all thought to be cancerous, only around one-third of them are aggressive. These tumors typically respond favorably to treatment. A unilateral salpingo-oophorectomy, surgical resection, and staging are the most accepted treatments for most stage I ovarian dysgerminomas. If resection is the only course of treatment, follow-up care with periodic pelvic exams and evaluation of tumor markers is necessary.