Teratoma is a tumor consisting of different types of tissue, as of skin, hair, teeth and muscle, caused by the development of independent germ cells
Ovarian teratoma is a type of germ cell tumour.
Germ cell tumours are cancers that begin in egg cells in women or sperm cells in men.
There are 2 main types of ovarian teratoma
Mature teratoma, which is benign
Immature teratoma, which is cancerous
The mature teratoma is the most common type of ovarian germ cell tumour. It is most often diagnosed in women during their reproductive years (from teens to forties).
Mature teratoma is often called a dermoid cyst. It is removed with surgery and the condition is then cured.
Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare.
They are called immature because the cancer cells are at a very early stage of development.
Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage.
The most common symptoms include:
Intense throbbing and blinding headache
Severe and excruciating abdominal pain
a feeling of fullness or abdominal swelling
sometimes an increasing need to pass urine.
Some women may have irregular vaginal bleeding.
But these symptoms are not specific for ovarian teratoma and can be caused by many other things, but it’s important that the Patient mentions to her Doctor if she had or had any of them.
Grading and staging ovarian teratoma
The grade and stage of Ovarian cancer is very important because they help the Specialist to decide what treatment the Patient needs.
The grade describes how the cells look under a microscope. The less developed the cells look, the higher the grade. Higher grade cancers grow more quickly than low grade.
There are 3 different grades of immature teratoma.
Generally, grade 1 teratomas are the slowest growing and least likely to spread.
The stage of a cancer tells you how far it has grown.
In ovarian teratoma
Stage 1 means the cancer is only in the ovary (or both ovaries)
Stage 2 means the cancer has spread into the fallopian tube, womb, or elsewhere in the area circled by the hip bones (the pelvis)
Stage 3 means the cancer has spread to the lymph nodes or to the tissues lining the abdomen (called the peritoneum)
Stage 4 means the cancer has spread to another body organ some distance away, for example the lungs
Treating ovarian teratoma
Surgery and chemotherapy are the treatments Medical Doctors most often use for immature teratoma of the ovary.
During surgery, the Surgeon (Gynaecological Oncologist) will remove the affected ovary but the other unaffected ovary will be left.
This type of surgery is very different to surgery for the most common type of ovarian cancer, epithelial ovarian cancer.
As most women with ovarian teratoma are young, Doctors are aware that they may want to have children in the future and so will remove as little tissue as possible.
During the operation, the Surgeon examines the inside of the abdomen and the abdominal organs for signs of cancer. They may take biopsies and send them to the lab to look for cancer cells. The Surgeon will also wash out the inside of the abdomen and send the fluid to be checked for cancer cells. This all helps to make absolutely sure that the cancer hasn't spread.
If the tumour is a grade 1 immature teratoma that has not spread outside the ovary (stage 1) then surgery is likely to cure it and the Patient may not need chemotherapy.
If the cancer has spread beyond the ovary, the Surgeon will remove some or all of the tumour, depending on where it is. It is not uncommon to have tumour left behind. The Patient would then have chemotherapy once she has recovered from surgery. If there is any cancer left after chemotherapy, a further follow up surgery would be done to remove it then.
Immature teratomas of the ovary can often be cured with a combination of surgery and chemotherapy, even if they have spread when they are diagnosed.
The exact treatment programme has to be decided by the specialist based on the reports of the Laboratory tests, but the most common combination of drugs used is BEP, that is bleomycin, etoposide and cisplatin.
Doctors use this combination because it is very good at preventing the teratoma from coming back.
The chemotherapy Doctors use for ovarian teratoma does not usually affect the Patient’s fertility. Women frequently have successful pregnancies after they have had this type of treatment.
This type of chemotherapy is given as several cycles of treatment. Each cycle lasts about 3 weeks. The Patient would have several days of chemotherapy at the beginning of the cycle and then a break until the start of the next cycle.
Follow up visits are arranged for the Patient after she has finished treatment, the specialist will see her regularly.
At diagnosis, the Patient would have had blood tests that may have shown up chemicals released by the cancer cells. These are called markers. The markers produced by most immature teratomas are called HCG and AFP. Not everyone with a teratoma has raised markers. But if a Patient had them when she was diagnosed, the specialist can use them to monitor her health at the follow up appointments.
The Patient will have blood tests regularly to check for these markers. If they show up in the blood test, this could mean that the cancer has come back.
At follow up appointments, the specialist will also examine the patient and ask how she’s feeling. The patient may have CT scans from time to time, but not everyone needs these.
The specialist will talk through the Patient’s follow up with her in detail.