Immature Teratoma Treatment and Prognosis

A Type of Ovarian Germ Cell Malignancy

If you've been told you have an immature teratoma, you're likely very frightened. Not only does this mean cancer, but these tumors are usually found when people are very young.

What exactly is this type of germ cell tumor, and how is it treated?

A doctor discusses a report with a patient
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Immature teratomas are made of tissues that resemble those found in an embryo. They are the malignant cousins of the very common mature cystic teratomas or dermoid cysts. When immature teratomas occur in combination with other germ cell tumors, they are then called "mixed germ cell tumors."

A pure immature teratoma is extremely rare and represents approximately 1 percent of all ovarian cancers—but within the germ cell tumor group, it is the second most common malignancy.

Age of Women With Immature Teratomas

In women under 20 years of age, these tumors represent 10 percent to 20 percent of all ovarian malignancies. Approximately half of all immature teratomas can occur even earlier, between the ages of 10 to 20 years. They rarely occur in postmenopausal women.


Treatment for an immature teratoma includes both surgery and chemotherapy, Patients with stage Ia grade 1 immature teratoma are usually treated with surgery alone because the prognosis is excellent. When the grade of the tumor advances to 2 or 3, or the stage goes beyond Ia, chemotherapy is usually recommended.

The grade of an immature teratoma refers to the proportion of tissue that contains immature neural elements (which look like fetal organs). For instance, according to the American Cancer Society, a grade 1 immature teratoma consists of mostly noncancerous tissue, and only a few areas of cancerous tissue, which can be seen under the microscope. The stage of an immature teratoma refers to how far it has spread—a stage I tumor means its growth is limited to the ovaries.

Surgical Treatment

In reproductive-age women who desire to retain fertility, removal of the involved ovary and surgical staging can be performed, leaving the uterus and the other ovary alone. This can be done because the other ovary is rarely involved, but staging is still required to make sure cancer has not spread.

When it spreads, it usually does so as with epithelial ovarian cancer—in and around the organs inside the peritoneal cavity. Less commonly, it may spread to the lymph nodes, and metastasize to distant areas such as the lungs and liver through the bloodstream.


Since this is a rare tumor, little research data is available compared to what we have for the much more common epithelial ovarian cancers.

The specific drugs in these combinations, known as BEP when used together, are:

  • Bleomycin
  • Etoposide
  • Cisplatin

A second-line treatment, known as VAC, includes:

  • Vincristine
  • Adriamycin
  • Cyclophosphamide

Much of the information about this disease comes from experience in male patients with testicular cancer—however, the Gynecologic Oncology Group (GOG) has published a few smaller multicenter trials. At this time, the BEP regimen is the recommended initial treatment in most cases, but the VAC regimen can also be used, especially when there is a recurrence.

Follow-Up After Treatment

Follow-up after treatment for an immature teratoma is usually based on clinical exams, symptoms, and imaging tools like a CAT scan. What this means is that your healthcare provider may order a scan if you have new symptoms or something is felt on examination. As of now, routine scans are not recommended, and there are no reliable tumor markers.


The grade of the tumor is the single most important prognostic factor in early-stage disease—prognosis refers to a person's chance of recovery. In other words, even if an immature teratoma is in an advanced stated, the grade is very important (assuming all of visible cancer can be removed surgically).

Across all stages, the five-year survival for grade 1 disease is approximately 82 percent and drops to approximately 30 percent when grade 3 disease is present. The five-year survival rate for stage 1 disease is 90 percent to 95 percent, while advanced stage survival drops to about 50 percent with Grade 1 to 2 cancer and to 25 percent or less when the tumors are found to be Grade 3.

Coping With the Diagnosis

A diagnosis of cancer is frightening at the same time that you are being called on to make major decisions about your own or your child's health. Here are some tips to help guide you through this difficult time:

  • Ask a lot of questions.
  • Consider getting second opinions.
  • Learn all you can about your diagnosis—this appears to have benefits that not only keep you informed but may affect prognosis as well.
  • Ask your healthcare provider about clinical trials.
  • Learn what can be done to preserve fertility with cancer.

Since this is an uncommon tumor, you probably don't have a support group in your community, but online cancer communities can often allow you to talk to many others who are facing this same rare disease.

Keep in mind that the treatments for cancer are improving (statistics are numbers that tell us how well someone did in the past, possibly before newer treatments were available). Learn how to advocate for yourself or your child as a cancer patient so that you can feel empowered in your journey.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Alwazzan AB, Popwich S, Dean E, Robinson C, Lotocki R, Altman AD. Pure Immature Teratoma of the Ovary in Adults: Thirty-Year Experience of a Single Tertiary Care CenterInt J Gynecol Cancer. 2015 Nov;25(9):1616-22. doi:10.1097/IGC.0000000000000541

  2. Iavazzo C, Vorgias G, Iavazzo PE, Gkegkes ID. Fertility sparing approach as the standard of care in young patients with immature teratomas. J Turk Ger Gynecol Assoc. 2017;18(1):43-47. doi:10.4274/jtgga.2016.0090

  3. American Cancer Society. Treatment for Germ Cell Tumors of the Ovary.

  4. National Cancer Institute. Ovarian Germ Cell Tumors Treatment (PDQ®)–Health Professional Version.

  5. Gynecologic Oncology Group (GOG). The Gynecologic Oncology Group: 43 Years of Success.

By Steven Vasilev, MD
Dr. Steven Anatol Vasilev is an ovarian cancer expert double board-certified in gynecologic oncology and obstetrics/gynecology.