Surgery Malignant OGCTs are predominantly unilateral and chemosensitive, which means they are localized in only one side of the ovary. Fertility-preserving surgery is primarily standardized to keep the contralateral ovary and fallopian tube intact, also known as unilateral salpingo-oophorectomy. For Stage II patients with observable metastasis, cytoreductive surgery may be performed to debulk the volume of the<unk>  such as hysterectomy (removal of all or part of the uterus) and bilateral salpingo-oophorectomy. A surgical incision at the abdominal cavity after the completion of adjuvant chemotherapy, called second look laparotomy, is best applicable for patients reported with teratomatous elements after previous cytoreductive surgery. Adjuvant Chemotherapy A schematic diagram showing the operation of alt With a recurrence up to 15-25% for early-stage patients, adjuvant chemotherapy needs to couple with surgical resection of<unk> to ensure full salvage. For systemic chemotherapy (issued orally or intravenously), the regimen is standardised in every FIGO staging to comprise bleomycin, etoposide, and cisplatin, also known as the BEP treatment. Patients should be issued with 3-4 cycles of BEP to ensure full salvage. Depending on the personalised conditions, some patients who are non-responders to BEP therapy will be prescribed with salvage therapy, which consists of cisplatin, ifosfamide and paclitaxel. Yet, it is likely that OGCT survivors after BEP therapy will have premature menopause at a rough age of 36. Alternatively, some hospitals opted for platinum-based chemotherapy since the platinum complexes present in the drug intervenes DNA transcription by forming chemical cross-links within the DNA strands, which prevents the reproduction of cancerous cells. The major elements are cisplatin, carboplatin, and oxaliplatin. It has been reported with full recovery among early-stage patients and only a quarter of advanced-stage patients are not salvaged potentially due to drug resistance. For advanced-stage patients, after cytoreductive surgery, invisible microscopic cancerous cells or nodules may still be present at the site of infection. Therefore, doctors may instill a heated chemotherapy solution (~42-43 °C) into the abdominal cavity through carters tubes for 1.5 hours. Based on the principle that cancer cells normally dies at 40 °C, somatic cells remains unaffected since they die at 44 °C. This novel method is proven effective with only 10% recurrence rate and no mortality recorded. It is known as the hyperthermic intraperitoneal chemotherapy (HIPEC), containing docetaxel, and cisplatin. Given the drug is disseminated locally in intraperitoneal regions, it has no systemic side effects on other actively reproducing cells and is preferred over systemic chemotherapy. Typically, uncontrollable drug distribution in systemic chemotherapy results in myelosuppression, specifically with observed febrile neutropenia, neurotoxicity, ototoxicity, and nephrotoxicity. Remedial treatments to deal with chemotherapy-induced toxicities is through injection of granulocyte colony-stimulating factor or myeloid growth factors or oral intake of prophylactic antibiotics.
Ovarian germ cell tumors
Ovarian fibroma
Ovarian mucinous tumor
Ovarian serous cystadenoma
Germ cell tumor
Gonadoblastoma
Mixed Müllerian tumor
Follicular cyst of ovary