Dysgerminoma is a malignant tumor that affects the female ovary. The disease is also called seminoma of the ovary and is one of the malignant tumors of the germ cells. In the majority of cases, a dysgerminoma does not exhibit hormonal activity. Dysgerminoma is composed of virtually undifferentiated germ cells and is characterized by rapid growth.
What is a dysgerminoma?
Basically, dysgerminoma represents that tumor of female germ cells that occurs with the greatest frequency. Approximately two to five percent of all malignant ovarian tumors are dysgerminomas. Dysgerminoma most frequently affects women at a young age. About 90 percent of all patients have not yet completed the third decade of life. Due to its occurrence in young women, dysgerminoma is diagnosed by chance in numerous cases during examinations during pregnancy.
Causes
At the present time, no definite statements can be made regarding the exact causes for the pathogenesis of dysgerminoma. On the one hand, genetic dispositions come into question as possible factors in the development of dysgerminomas. On the other hand, in the case of tumors in general, environmental factors are also capable of influencing and promoting the development of carcinomas. In addition, a combination of genetic and external influencing factors is possible, with gene disposition making one particularly susceptible to certain environmental factors. Various medical studies are currently researching the causes of dysgerminoma.
Symptoms, complaints, and signs
Dysgerminoma usually causes few specific symptoms, so diagnosis is often delayed and in numerous cases is made too late. Pain in the area of the abdomen is typical of dysgerminoma. If the tumor becomes ischemic, the symptoms sometimes resemble an acute abdomen. More than two-thirds of dysgerminomas extend to only a single ovary. Far less commonly, dysgerminoma affects both ovaries. In addition, dysgerminoma is associated with lymph node involvement in about one-third of cases. This is the highest rate among all germ cell tumors.
Diagnosis
Basically, dysgerminoma is a malignant tumor, so immediate therapy of the patient is required in all cases. This also applies to early stages of dysgerminoma. However, since the tumor causes relatively unspecific symptoms, it develops unnoticed for a long time in numerous women. For this reason, the diagnosis of dysgerminoma is often made only when the tumor has already progressed considerably in its growth. Alternatively, dysgerminoma is often discovered by chance, for example during preventive examinations at the gynecologist or during medical checkups during pregnancy. The diagnosis of dysgerminoma must be made by a specialized physician. The medical history focuses on the symptoms of the dysgerminoma as well as family history. This is because an accumulation of dysgerminoma in the family is possible. The patient provides the physician with information about how long she has had which symptoms. The anamnesis serves to prepare the subsequent clinical examination, which initially makes use of various imaging procedures such as ultrasound or CT examinations. In this way, the germ cell tumor can be visualized, which contributes significantly to a reliable diagnosis. Smears, which are analyzed histologically, are also important. In this way, malignant degenerations of cells can be detected. Blood tests of the patient also play an important role, because the serum sometimes contains certain marker substances that indicate the tumor disease.
Complications
Because dysgerminoma is a malignant tumor disease, the usual complications of cancer occur. At worst, these can lead to death. This case occurs relatively often with a dysgerminoma, because the disease is diagnosed too late. In most cases, it is not associated with pain or further discomfort and can therefore only be discovered during control examinations. Further treatment usually depends on the stage of the tumor. First and foremost, radiation therapy is used, which can also be supported by surgery. If all affected regions can be removed, there are usually no further complications.Often, the affected person still has to undergo chemotherapy after treatment. Life expectancy is greatly reduced, but in most patients the tumors cannot be completely removed. It is also not possible to prevent this tumor disease. For this reason, regular check-ups by a gynecologist are especially important for women to avoid further complications.
When should you go to the doctor?
If pain and pressure sensations are noticed in the abdominal area that rapidly increase in intensity and duration, a general practitioner or the gynecologist should be consulted immediately. Although these symptoms do not necessarily indicate a dysgerminoma, a serious cause cannot be ruled out. A concrete suspicion is justified if the typical signs of an acute abdomen appear. Thus, nausea and vomiting as well as diarrhea, constipation and fever must be clarified immediately. These clear initial symptoms usually do not manifest themselves until later in the course of the dysgerminoma – which makes an immediate visit to the doctor all the more important. If the lymph nodes swell or cause pain, this should be clarified immediately. A medical emergency exists if there is bowel obstruction or cardiovascular problems with possible circulatory collapse. Women who show signs of these symptoms are best to call 911 directly or go to the nearest hospital. In the event of serious complications, it may be necessary to administer first aid directly on the scene.
Treatment and therapy
Therapy for dysgerminoma depends primarily on the stage of the disease as well as whether or not the patient in question still wishes to have children. In stage 1A, an adnexa is usually removed during surgery if there is still a desire to have children. If this is not the case, bilateral adnexectomy, omentectomy and hysterectomy are performed. Such measures should also be taken in advanced stages of omentectomy. In addition, radiation therapy of dysgerminoma may be considered, as the tumor is relatively sensitive to radiation. Such treatment methods are especially appropriate following surgical intervention to prevent recurrences. Chemotherapy is not necessary in stage 1A. However, it is helpful in cases of incomplete removal of the dysgerminoma and advanced stages of the disease. Patients usually undergo three chemotherapeutic sessions. The substances cisplatin, etoposide and bleomycin are used. The prognosis of dysgerminoma is comparatively good, provided that the tumors are treated in a timely and appropriate manner. Thus, about 75 to 90 percent of all patients are still alive ten years after diagnosis and therapy of dysgerminoma, which is relatively high for malignant tumors. However, this survival rate only applies to cases in which the dysgerminoma is less than ten centimeters in size, has an intact capsule and there is no ascites. Adhesions with surrounding tissue are then also excluded.
Outlook and prognosis
The prognosis of dysgerminoma depends on the size and stage of the diagnosed tumor. The larger it is, the worse the outlook for recovery. In most cases, the tissue change can be successfully removed in a surgical procedure. This is followed by treatment with cancer therapy. This is associated with numerous side effects and impairments. If the tumor is smaller than 10 cm, the prognosis is good. Nevertheless, approximately 10-25% of patients die within ten years after the initial manifestation of the disease. Without medical treatment, the patient is at risk of premature death. According to current scientific knowledge, a dysgerminoma can only be removed in a surgical procedure. There is no spontaneous healing or prevention of further disease progression. Since a dysgerminoma is asymptomatic, it is often found incidentally during a routine examination or pregnancy. This increases the risk that the tumor will be detected too late. The prospect of a complete cure decreases as soon as the lymphatic system is also affected by the cancer cells. In addition, there is an increased risk of lifelong infertility for the woman as a result of the procedure. The vulnerability of mental illness is increased overall and may have a poor impact on the overall prognosis.
Prevention
At the present time, dysgerminoma cannot be specifically prevented. This is because the causes of dysgerminoma development have not yet been researched enough to derive and test appropriate preventive measures. Instead, timely diagnosis of dysgerminomas is important, supported by regular checkups with a gynecologist.
Follow-up
In the case of a dysgerminoma, the affected person is primarily dependent on the rapid and early diagnosis of the disease, so that the tumor does not spread to the other regions of the body. For this reason, early detection of the disease is the primary concern with dysgerminoma. The earlier the dysgerminoma is detected, the better the further course of the disease usually is. The measures of aftercare are very limited. Even after successful removal of the tumor, the patient is still dependent on regular examinations of the body in order to detect a new tumor at an early stage. In most cases, this tumor is treated with the help of chemotherapy or radiation therapy. Although no particular complications occur during the therapies, those affected are dependent on the help and support of family and friends. Intensive discussions are also helpful in preventing psychological upsets or depression. In most cases, however, dysgerminoma significantly reduces the life expectancy of the affected person. The further course is strongly dependent on the time of diagnosis, so that no general prediction can be made in this regard.
What you can do yourself
If a tumor is suspected, a doctor should first be consulted. If a dysgerminoma is actually present, treatment must be initiated immediately. Accompanying this, patients should identify possible causes of the disease and strive to change their lifestyle. If the carcinoma is based on an unhealthy diet, an individualized diet must be created. The new diet plan must be tailored to the dysgerminoma and the symptoms it triggers. In addition, it is necessary to organize accompanying medicines. This task is best handled by the physician in charge, as effective painkillers and sedatives often require a prescription. In most cases, dysgerminoma patients require surgery or treatment with radiation or chemotherapy. Since these procedures place a great strain on the body, bed rest and relaxation are always indicated. The patient should take care of himself physically and mentally, and work out a good accompanying treatment together with the doctor or a therapist. If the course is severe, it is advisable to consult a psychologist. Talking to a professional can not only relieve anxiety, it often opens up new possibilities for those affected.
