Ovarian germ cell tumor surgery: Difference between revisions

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{{Ovarian germ cell tumor}}
{{Ovarian germ cell tumor}}
{{CMG}}; {{AE}} {{MD}}
{{CMG}}; {{AE}} {{MD}} {{Sahar}}
 


==Overview==
==Overview==
Surgical intervention is not recommended for the management of [disease name].
[[Surgical]] [[intervention]] is the mainstay of management of [[ovarian]] [[germ cell]] [[tumors]]. [[Surgery]] is recommended both for [[Cancer staging|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.  
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for mature teratoma.
 
[[Surgery]] is the mainstay of treatment for ovarian germ cell tumors.<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>
 
==Surgery==
==Surgery==
[[Surgery]] is the mainstay of treatment for ovarian [[germ cell]] [[tumors]]:<ref name="xxx">Stage I Ovarian Germ Cell Tumors
* [[Surgery]] is the mainstay of management of [[ovarian]] [[germ cell]] [[tumors]].<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/_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/_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/_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>
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
===Mature teratoma===
* [[Surgery]] is recommended both for [[Cancer staging|staging]] and choosing appropriate treatment approaches. accordingly.<ref name="Gershenson2007">{{cite journal|last1=Gershenson|first1=David M.|title=Management of Ovarian Germ Cell Tumors|journal=Journal of Clinical Oncology|volume=25|issue=20|year=2007|pages=2938–2943|issn=0732-183X|doi=10.1200/JCO.2007.10.8738}}</ref>
* [[Surgery]] is the mainstay of [[treatment]] for mature teratoma.<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
* [[Surgical]] options depends upon the choice of preserving fertility.
**Nonsurgical management may be considered in those with [[tumors]] smaller than 6 cm, especially those who is planning to get [[pregnant]].<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
{| class="wikitable"
***[[Surgery]] increses the risk of [[Adhesions|band adhesion]] formation that may be associated with future [[fertility]] in women.
|+
===Dysgerminoma===
! colspan="2" |Management of Mature Teratoma
* Surgery is the mainstay of treatment in dysgerminomas. 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="pmid22407668">{{cite journal |vauthors=A L Husaini H, Soudy H, El Din Darwish A, Ahmed M, Eltigani A, A L Mubarak M, Sabaa AA, Edesa W, A L-Tweigeri T, Al-Badawi IA |title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients |journal=Med. Oncol. |volume=29 |issue=4 |pages=2944–8 |date=December 2012 |pmid=22407668 |doi=10.1007/s12032-012-0194-z |url=}}</ref>
|Mature Teratoma
===Stage I ovarian germ cell tumors===
|
* Dysgerminomas
*[[Surgery]] is the mainstay of [[treatment]] for [[Mature cystic teratoma|mature teratoma]].<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
:* Unilateral [[salpingo-oophorectomy]] with or without [[lymphangiography ]]or [[computed tomography]] (CT)
*Nonsurgical management may be considered in those with [[tumors]] smaller than 6 cm, especially those who is planning to get [[pregnant]].<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
:* Unilateral salpingo-oophorectomy followed by observation
*[[Surgery]] increases the risk of [[Adhesions|band adhesion]] formation that may be associated with future [[fertility|infertility]] in women.
:* Unilateral salpingo-oophorectomy with adjuvant [[radiation therapy]] or [[chemotherapy]]
*[[Surgery]] is usually reserved for patients with either:<ref name="CaspiAppelman1997" />
* Other germ cell tumors
:* Unilateral salpingo-oophorectomy with adjuvant chemotherapy
:* Unilateral salpingo-oophorectomy followed by observation
 
===Stage II ovarian germ cell tumors===
* Dysgerminomas
:* Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
:* Unilateral salpingo-oophorectomy with adjuvant chemotherapy
* Other germ cell tumors
:* Unilateral salpingo-oophorectomy with [[adjuvant chemotherapy]]
:* Second-look laparotomy
 
===Stage III ovarian germ cell tumors===
* Dysgerminomas
:* Total abdominal [[hysterectomy]] and bilateral salpingo-oophorectomy
:* Unilateral salpingo-oophorectomy with adjuvant chemotherapy
* Other 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 IV ovarian germ cell tumors===
* Dysgerminomas
:* Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
:* Unilateral salpingo-oophorectomy with adjuvant chemotherapy
* Other 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
 
==Indications==
 
*Surgical intervention is not recommended for the management of [disease name].
OR
 
*[[Surgery]] is not the [[first-line treatment]] option for patients with mature teratoma. [[Surgery]] is usually reserved for patients with either:<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
**[[Tumor]] size larger than 6 cm
**[[Tumor]] size larger than 6 cm
**No plans for future [[pregnancy]]
**No plans for future [[pregnancy]]
**[[Menopausal|Post-menopausal]] women
**[[Menopausal|Post-menopausal]] women
|-
! colspan="2" |Management of [[Dysgerminoma|Dysgerminomas]]<ref name="xxx" /><ref name="abc" /><ref name="aaa" /><ref name="ccc" />
|-
|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 [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
* Postoperative [[lymphangiography]] or [[CT]] is [[Indication (medicine)|indicated]] for those who have not had the careful [[surgical]] and [[pathological]] examination of [[pelvic]] and [[Paraaortic lymph nodes|para-aortic lymph nodes]] during [[surgery]].
* 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
|
* 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]].
|}


==Surgery==
===Management options of Other Ovarian Tumors===
*Surgery is the mainstay of treatment for dysgerminoma.<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>
:*  
 
{| class="wikitable"
==Contraindications==
|+
 
! colspan="2" |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 [[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]].
|-
|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==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Surgery]]
[[Category:Surgery]

Latest revision as of 14:00, 22 April 2019

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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

Management of Mature Teratoma
Mature Teratoma
Management of Dysgerminomas[1][2][3][4]
Stage I ovarian germ cell tumors
Stage II ovarian germ cell tumors
Stage III ovarian germ cell tumors
Stage IV ovarian germ cell tumors

Management options of Other Ovarian Tumors

Surgical options for other ovarian tumors
Stage I ovarian germ cell tumors
Stage II ovarian germ cell tumors
Stage III ovarian germ cell tumors
Stage IV ovarian germ cell tumors

References

  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
  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
  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
  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
  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.
  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.
  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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