What is the recommended treatment approach for ovarian cancer in teenage girls?

Treatment Approach for Ovarian Cancer in Teenage Girls

For teenage girls with ovarian cancer, fertility-sparing surgery with unilateral salpingo-oophorectomy followed by appropriate adjuvant therapy based on histologic type and stage is the recommended treatment approach.

Diagnosis and Initial Assessment

• Complete preoperative workup should include:

  • Abdomino-pelvic CT scan
  • Chest X-ray
  • Serum tumor markers (CA-125, AFP, beta-hCG)
  • Complete blood count and differential
  • Renal and hepatic function tests 1
  • Pulmonary function tests if bleomycin is being considered 1

• In young women (<35 years) with a pelvic mass, AFP levels can specifically indicate the presence of germ cell tumors 1

Surgical Management

Primary Considerations

• Surgery should be performed by a gynecologic oncologist (category 1 recommendation) 1
• The type of surgery depends on:
  1. Histologic type of tumor
  2. Stage of disease
  3. Desire for fertility preservation

Fertility-Sparing Approach

• For teenage girls desiring fertility preservation:

  • Unilateral salpingo-oophorectomy (USO) preserving the uterus and contralateral ovary 1
  • Appropriate for unilateral stage I tumors (stages IA and IC) 1
  • Comprehensive surgical staging still required to rule out occult higher-stage disease 1
  • Wedge biopsy of the contralateral ovary if it appears abnormal 1

• Fertility-sparing surgery should be considered for malignant germ cell tumors regardless of stage 1, 2

Treatment by Histologic Type

Malignant Germ Cell Tumors (Most Common in Teenagers)

• Most common ovarian cancer in teenage girls, with median age at diagnosis of 16-20 years 1
• Excellent prognosis with >85% 5-year survival rate after appropriate treatment 1
• After comprehensive surgical staging:
  • Stage I dysgerminoma or stage I grade 1 immature teratoma: Observation with monitoring 1
  • Any stage embryonal tumors or endodermal sinus tumors, stages II-IV dysgerminoma, or stage I grade 2-3 or stages II-IV immature teratoma: BEP (bleomycin/etoposide/cisplatin) chemotherapy for 3-4 cycles 1

Epithelial Ovarian Cancer (Less Common in Teenagers)

• For early-stage disease (FIGO I-IIA):

  • Stage IA/B, well-differentiated, non-clear cell histology: Surgery alone 1
  • Stage IA/B poorly differentiated, clear cell histology, or stage IC-IIA: Surgery plus adjuvant chemotherapy with carboplatin (AUC 5-7) 1

• For advanced disease (FIGO IIB-IV):

  • Maximal cytoreductive surgery followed by carboplatin/paclitaxel chemotherapy 1
  • For grade 1 (low-grade) serous carcinomas: Consider hormone therapy options (anastrozole, letrozole, leuprolide, or tamoxifen) as these tumors often respond poorly to chemotherapy 1

Special Considerations for Teenage Patients

• Surgery for children/adolescents may differ from adult protocols 1
• In early-stage germ cell tumors, comprehensive staging may be omitted in pediatric patients 1
• Studies show excellent prognosis with return of normal menstrual function and fertility after conservative surgery and chemotherapy for malignant ovarian germ cell tumors 2
• Patients who undergo fertility-sparing surgery should be monitored with ultrasound examinations; completion surgery can be considered after childbearing is finished 1

Follow-up Care

• Regular follow-up visits every 3-6 months for up to 5 years, then annually 3
• Monitoring should include:
  • Appropriate tumor markers based on histologic type
  • Imaging studies as indicated
  • Assessment of reproductive function

Prognosis

• Early-stage disease: 5-year survival rate of 70-95% 4
• Advanced-stage disease: 5-year survival rate of 10-40% 4
• Malignant germ cell tumors (most common in teenagers): >85% 5-year survival rate with appropriate treatment 1

The treatment of ovarian cancer in teenage girls requires careful consideration of both oncologic outcomes and future fertility. With appropriate surgical staging, fertility-sparing approaches when possible, and tailored adjuvant therapy, excellent survival rates can be achieved while preserving reproductive function.