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Germ cell ovarian cancer, causes, Symptoms, Diagnosis, and treatment

Ovarian cancer is the 6th most common type cancer occur in women and the young ones. Around 7,400 women in the U.K. are diagnosed with ovarian cancer every year. Survival is improving and has almost doubled in the last 40 years in the UK but it still claims 11 lives every day. There are several types of ovarian cancer, but the most common is Epithelial Ovarian Cancer .ovarian cancer rates increases with age. More than 5 in 10 cases occur in women over 65 of age.

With germ cell ovarian cancer, germ cell refers to the precursor cells that develop into an egg in the ovary, Ovarian refers to ovary of which there are two that sit on either side of the uterus which is where the germ cells live and grow. So, a germ cell ovarian cancer refers to a situation where these precursor germ cells become cancerous and form tumors.

Germ-cell-ovarian-cancer
Germ cell ovarian cancer

During fetal development, the entire body derives from three layers, called germ layers, the ectoderm, mesoderm, endoderm. These germ layers are made of germ cells and the germ cells migrate out and differentiate into all of the different types of tissue, for example, some ectodermal germ cells become cells of the brain and spinal cord, some mesodermal from bone and muscle, and endodermal cells become cells in the gastrointestinal tract. Some very special germ cells, though, stay as germ cells- meaning that unlike the cells that differentiate, these germ cells retain their ability to turn into other cells types.

They’re like ancient little shape-shifters. Normally, during the development of germ cells, these germ cells head to the ovary in women or testicle in men where they remain for decades, eventually developing into eggs or sperm, respectively.

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Now, if those germ cells in the ovaries start to divide uncontrollably, it can either from a benign tumor which means that it does not invade nearby tissue or not spread to other tissues of the body, or it can be a malignant tumor which means that it can both invade and spread to other tissues.

Compared with benign tumor cells, malignant tumor cells have key features like not having a well-defined border or like have slightly less organized nuclei. Now, there are four types of germ cell tumors occur in the ovary and each type is named after the type of cell that these pluripotent germ cells develop into. The first, are teratomas, Cerato monster and oma is a tumor. So, teratomas are a monster tumor, and they are called that because they contain all different types of tissues of the human body, including hair, eyes, teeth, bone, and neuron-kind of like a Frankenstein that’s got bits of this and that stitched together.

Now the teratomas are of two types, the first is mature cystic teratomas, which are the most common ovarian tumors in young women and are formed from tissue that comes from any of the three germ layers. One example is a struma ovarii tumor which is made up of only thyroid tissue and can release thyroid hormone which leads to hyperthyroidism.

The other type is immature teratomas, and they develop specifically from neuroectoderm cellswhich come from the ectoderm layer. Immature teratomas tend to be malignant and metastasize quickly.

The second subtype is a yolk sac tumor, which can also be called an endodermal sinus tumor, and it’s made of germ cells that differentiate into yolk sac tissue of the human body. These are the most common germ cell tumor in children, and the tumor can be very aggressive. Under the microscope, they form Schiller-Duval bodies which are the ring of cells around a central blood vessel

The third subtype is choriocarcinoma and it’s made of germ cells that turn into syncytiotrophoblast cells which are the ones that help from the placenta. These types of tumors are usually smaller, bleed easily, and often spread beyond the ovaries. The syncytiotrophoblast cells secrete high levels of the hormone beta-hCG, and that can cause ovarian cysts to form.

The fourth subtype is a dysgerminoma and it’s made of germ cells that turn into oocytes, which is the normal pattern, but then they start to grow uncontrollably. It turns out that these are the most common malignant types of ovarian tumors occur. Under the microscope, the germ cells have a central nucleus surrounded by a well defined clear cytoplasm. so during ovulation, the follicle ruptures and release an egg which inadvertently leads to epithelial cells damage. To fix that damage the epithelial cells have to undergo cell division to replace and heal the tissue. Each time cells divide, there is a chance of a mutation in the cell during cell division and the possibility of tumor formation.

So this means that with more and after every ovulatory cycle there’s an increased risk of ovarian tumor formation. So things that are associated with a decreased risk of ovarian cancer include things that reduce the number of ovulatory cycles like pregnancy, breastfeeding, and oral contraceptive use. On the first side, some things that are associated with an increased risk include a certain type of medical condition like endometriosis and polycystic ovarian syndrome. There are also some genetic risk factors like having the BRCA-1 or BRCA-2 mutation, which is both autosomal dominant mutation, which in addition to ovarian cancer, carry with them an increased risk of breast cancer.

There are also hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome, which increases the risk of developing a number of cancer, including ovarian cancer.

Symptoms of ovarian cancers can be subtle and nonspecific. Common symptoms at the early stage can include abdominal distension, bloating, as well as abdominal or pelvic pain, which can come from an ovarian torsionwhere the ovary gets twisted. Occasionally, ovarian tumors can cause ascites, abdominal masses, bowel obstruction, or dyspareunia, which pain in sexual intercourse. A classic finding is a Sister Mary Joseph nodule which happens when the cancer metastasis to the umbilicus. This finding is often linked with some types of cancer-one of which is ovarian cancer.

Diagnosis of ovarian cancer typically involves looking for specific tumor markers like B-hCG, as well as having a transvaginal ultrasound. Tumor biopsies are done to figure out whether o growth is benign or malignant, and imaging with a CT or MRI scan can be done to look for evidence of metastasis.

Treatment of ovarian cancer typically involves chemotherapy, surgery, and sometimes radiotherapy. Surgery may be enough for malignant tumors confined to the ovary, whereas chemotherapy might be needed for a disease that has spread. Carbohydrate antigen 125, called CA 125, is a protein produced by various types of ovarian tumors so tracking level of this biomarker in the blood can help monitor response to therapy and potential relapse.

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