Ovarian Germ Cell Tumors: Current & Emerging Pediatric Therapies

This presentation provides an overview of current and emerging therapies for pediatric ovarian germ cell tumors. It begins with an introduction to gonadal germ cell tumors, differentiating between testicular and ovarian origins, though focusing primarily on ovarian tumors. The presentation details clinical manifestations such as abdominal pain, nausea, and other symptoms, and explores various treatment options including surgery and chemotherapy. Surgical interventions range from removing a single cancerous ovary to removing both ovaries and fallopian tubes, impacting future fertility. Chemotherapy regimens often involve drugs like cisplatin, bleomycin, and etoposide, with specific approaches for stage IA dysgerminoma and grade 1 immature teratoma. The presentation also addresses recurrent or persistent germ cell tumors and their treatment, including chemotherapy and radiation therapy. It concludes by summarizing the available treatment procedures and referencing relevant studies, emphasizing the importance of early detection and intervention. Desklib provides access to similar presentations and study resources for students.

Current and emerging
therapies for pediatric
gonadal germ cell tumors
(testicular and ovarian)

INTRODUCTION
A gonad can be considered as a sex or reproductive gland that
manages the production of the sex cells, gametes and the sex hormones
as well. In women, the reproductive cells are known as eggs whereas in
men, they are known as sperms. Germ cell tumors (GCTs) are the tumors
that are being derived from the germ cells and they may or may not be
cancerous. These tumors always originates on the outside of the gonads.
The reasons for gonadal germ cell tumours in children are still not fixed
but it has been said that they may occur at the time of development of the
child in the embryo itself, so can be considered as a birth defect.

Ovarian germ cell tumors
 Some very common signs of ovarian germ cell tumors can be swelling
of the abdomen, bleeding from the vagina even after the menopause.
 Although, in children, there tumors are rare but it can be lethal as well
because the germ cell tumor are quite common.
 This directly effects the ovaries of the girl as cancer cells starts forming
in it and slowly, it destroys the whole ovary.

Clinical Manifestations
 It has been observed that abdominal pain is the common symptom of
the ovarian GCT.
 Some people also feel some other symptoms. Like in case of children,
if any girl will be suffering from ovarian germ cell tumor, then in that
case, possible symptoms may include nausea, poor appetite, other
urinary infections such as swelling in the abdomen, rashes on the
vagina, huge loss in weight etc.

Therapies
Surgery
 The girls with the ovarian germ cell tumors can go for the surgery. If the
cancer is in one ovary only, in that case the cancerous ovary can be
removed by the surgery and it is a better option for those who are
interested in having child.
 But there are some cases where both the ovaries become cancerous, in
that case, both the ovaries are being removed and because of this, the
girl cannot become the mother and is not able to deliver a child in the
future. In removal of the ovaries, the fallopian tubes are also being
removed.

Chemotherapy
 Children who have germ cell tumors have to be treated with a chemo of
about three cycles.
 The whole process of chemotherapy includes the use of various drug's
cisplatin, bleomycin and etoposide. Dysgerminomas act very sensitive
to the chemotherapy, so sometimes, they can be treated with a
combination that is less toxic.
 There are other various drugs as well which can be used in the
chemotherapy that can help the girl.

Stage IA dysgerminoma
 If dysgerminoma has been limited for only one ovary, then in that case
one ovary can be removed along with the fallopian tubes without any
chemotherapy after the surgery.
 A close up on a continuous basis is required for this so that in case the
cancer happens again, then it can be found and treated at a very early
stage.
 It has been observed that various children who go through this have
done this and they never felt the need of chemotherapy.

Grade 1 immature teratoma
 Grade 1 immature teratoma is composed of non cancerous tissues and
after various observations, very few area that has been cancerous is
seen.
 Once removed from the body, there are very few chances of the tumor
coming back but in some cases, it happens.
 If it has been determined that grade 1 immature teratoma has been
observed in one ovary or in the both, in that case, both the ovaries are
being removed along with the fallopian tubes as well.

Recurrent or persistent germ cell
tumors
 Recurrent tumors are considered as the tumors that occurs again after
the initial treatment.
 These are also categorised as tumors that never disappear properly.
Even after the removal, they can happen at anytime.
 There are increased level of blood of the tumor markets such as HCG
and AFP and they act as a sign that some or more germ cells are still
present there.
 The treatment includes chemotherapy, radiation therapy

CONCLUSION
It can be concluded that the germ cell tumors can happen in
women as well as in men. So, in case of a girl, it occurs in the ovaries
whereas in case of a boy, it happens in the testes. In both these areas,
cancer cells starts appearing inside the ovaries and testes. For the
treatment procedure, the ovaries can be removed along with the fallopian
tubes in girls whereas in case of boys, testes are being removed. The girl
with no ovaries cannot fertile further by normal means, despite there are
some alternate artificial methods which can help. Various treatment
procedures are available such as chemotherapies or surgeries which can
help the people having germ cell tumors. IN cases, where the cancer has
reached to an extent level, in such cases, it provides relief to some
symptoms of it.

REFERENCES
 Billmire, D. F. And et.al., 2014. Surveillance after initial surgery for pediatric and
adolescent girls with stage I ovarian germ cell tumors: report from the
Children's Oncology Group. Journal of Clinical Oncology. 32(5). pp.465-470.
 Nogales, F. F., Dulcey, I. and Preda, O., 2014. Germ cell tumors of the ovary: an
update. Archives of Pathology and Laboratory Medicine. 138(3). pp.351-362.
 Prat, J., 2014. Staging classification for cancer of the ovary, fallopian tube, and
peritoneum. International Journal of Gynecology & Obstetrics. 124(1). pp.1-5.
 Talerman, A. and Vang, R., 2011. Germ cell tumors of the ovary. In Blaustein’s
pathology of the female genital tract (pp. 847-907). Springer US.

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