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77

NCCN Guidelines for Patients

®

:

Ovarian Cancer, Version 1.2017

6

Treatment guide

Malignant germ cell tumors

Guide 24

covers diagnosis, tests results, and

treatment options for germ cell tumors. If diagnosed

with dysgerminoma or grade 1 immature teratoma,

you will have imaging tests and blood tests (tumor

markers will be measured). Tumor markers can

be high in blood levels and indicate that cancer or

another medical condition is present. Tumor markers

cannot be used alone to diagnose cancer.

Your imaging and tumor marker test results will

determine which treatment options you are offered.

If positive on imaging and tumor marker tests, you

will be offered fertility-sparing surgery and will have

surgical staging. If you don’t want to have babies,

completion surgery will come next.

If you are negative on imaging and tumor marker

tests, you will be observed.

For embryonal, endodermal sinus (yolk sac tumor),

grade 2 to 3 immature teratoma, and tumors of

mixed histology you will also have imaging and blood

tests (tumor markers will be measured). If positive

on imaging and tumor marker tests, you will be are

offered fertility-sparing surgery and will have surgical

staging. If you don’t want to have babies, you will

have completion surgery. If other remaining cancer

can likely be removed, then tumor reductive surgery

is recommended. Your doctor will remove as much of

the cancer as possible This is called tumor reduction

surgery.

Guide 24. Malignant germ cell tumors with incomplete surgical staging

Diagnosis Test results Treatment options

Dysgerminoma

or

Grade 1 immature

teratoma

ª

• Positive imaging and

positive tumor markers

ª

Fertility desired

• Fertility-sparing surgery and

comprehensive staging

Fertility not desired

• Completion staging surgery

• Negative imaging and

positive tumor markers

ª

• Consider observation

• Negative imaging and

negative tumor markers

ª

• Consider observation

Embryonal,

endodermal sinus

tumor (yolk sac

tumor), grade 2-3

immature teratoma, or

mixed histology

ª

• Positive imaging and

positive tumor markers

ª

Fertility desired

• Fertility-sparing surgery and

comprehensive staging

Fertility not desired

• Completion staging surgery with

possible tumor reductive surgery

or

• Chemotherapy

• Negative imaging and

positive or negative tumor

markers

ª

• See Guide 25

for treatment

options per stage