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
Mature
teratoma
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
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.
Symptoms
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
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.
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