Question 16

A 23 yo presents with severe abdominal pain and bloating. A 16-cm solid-appearing left complex pelvic mass is found. She has exploratory laparotomy with left salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and partial omentectomy as well as peritoneal biopsies and pelvic washings. Final pathology shows grade I immature teratoma in left ovary. All other specimens are benign. What is the best post-op management?

Answer Choices:

IV bleomycin, etoposide and cisplatin

IV carboplatin and paclitaxel

IV etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine

IV paclitaxel plus IP cisplatin and paclitaxel

Observation

Correct Answer:

Observation

Explanation:

  • Ovarian germ cell tumors are usually in women in their early 20s, 60-70% are stage I at diagnosis

  • Germ cell tumors are highly responsive to chemo

  • Most patients with germ cell tumors will receive IV bleomycin, etoposide and cisplatin

  • Stage IA grade 1 immature teratoma have a high 5-year survival rate with no clear evidence that chemo improves outcome so observation is appropriate

  • If Stage IA grade 2 or 3 à chemo recommended due to higher relapse rate

  • Toxicities of Bleomycin- pulmonary damage, Etoposide- secondary hematologic malignancies and cisplatin- neuropathy and nephropathy

  • Choice B is for epithelial ovarian cancer and choice C is for gestational trophoblastic neoplasia