🩺 Managing Malignant Germ Cell Tumours: Key Insights and Surveillance Strategies


 🩺 Managing Malignant Germ Cell Tumours: Key Insights and Surveillance Strategies



Malignant ovarian germ cell tumours (MOGCTs) are a rare yet critical subset of ovarian cancers, constituting 1.5% of cases in Europe. 
With approximately 100 diagnoses annually in the UK, effective management and meticulous follow-up are essential. Here are some crucial points and surveillance strategies for managing MOGCTs:

 🔍 Early Detection and Treatment

- Prevalence: MOGCTs represent 1.5% of ovarian cancers in Europe.

- Early Diagnosis: 60-70% are diagnosed at an early stage.

- Initial Treatment: Typically treated with surgery followed by active surveillance or adjuvant chemotherapy.

- Chemotherapy Sensitivity: MOGCTs are more responsive to chemotherapy compared to other ovarian tumour 

 🏥 Surgical Considerations

- Radical Surgery: Recommended for women who have completed their family or are beyond childbearing age, including total hysterectomy and bilateral salpingo-oophorectomy.
- Less Invasive Staging: Current trends emphasize less invasive surgical staging to reduce morbidity associated with full lymphadenectomy.


💊 Chemotherapy Regimens and Complications


- Standard Regimens:
  - if age is above...EP (Etoposide and Cisplatin)
  - if age is below 40years.BEP (Bleomycin, Etoposide, and Cisplatin)
- Adverse Effects: Potential short and long-term complications include:
  - Ototoxicity and hearing loss
  - Nephrotoxicity
  - Pulmonary dysfunction
  - Raynaud's phenomenon
  - Avascular necrosis
  - Secondary malignancies (e.g., acute myeloid leukemia)
Also premature ovarian insufficiency in 3%

- Fertility Preservation:Oocyte cryopreservation is advised before chemotherapy due to the risk of inferility.



 📅 Active Surveillance

- Recurrence Risk: Highest in the first two years post-treatment.
- Surveillance Plan:
 Based on RCOG and European guidelines, involving:
  - Regular examinations
  - Pelvic ultrasounds
  - Tumour marker assessments
  - Chest X-rays (CXR)
  - CT abdomen and pelvis (CTAP)

-  The program described by Vasquez and Rustin includes a demanding visiting schedule to detect recurrence over a 10-year period.



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