Surgery Surgical removal of the involved ovary or ovaries and removal of as much of the
grossly visible tumor as possible is performed in all cases. If there is no spread beyond the ovaries, treatment will involve meticulous surgical staging , including sampling of the pelvic and para-aortic lymph nodes , and, sometimes, washings of the abdominal cavity to look for malignant cells and careful inspection of the abdominal surfaces with multiple, random biopsies from the diaphragms and surfaces of the abdominal cavity. A partial omentectomy (removal of fatty tissue attached to the stomach and large intestine) will also be performed.
The cell type of the tumor is an extremely important factor in determining the prognosis and the appropriate therapy after surgery.
Chemotherapy Women with a tumor confined to one ovary (Stage I) or with a well-differentiated
(Grade 1) immature teratoma or dysgerminoma do not require postoperative chemotherapy. All others are usually treated with multi-drug chemotherapy.
Until recently, external radiation therapy to the abdomen and pelvis (1,500 to 3,000 cGy with a 1,500 cGy boost to the para-aortic region given in divided doses daily over five to six weeks) was standard therapy for dysgerminomas, but chemotherapy is now used more often to preserve fertility.
Women with other malignant germ cell tumors are treated with chemotherapy after surgery because radiation therapy is ineffective. The most commonly used chemotherapeutic drug regimen includes cisplatin , bleomycin and etoposide given monthly for three courses.
