Management of malignant germ cell tumors of the ovary

Malignant germ cell tumors of the ovary are rare gynecologic tumors usually affecting young women. These tumors are commonly divided into two main groups: dysgerminomas and nondysgerminomas, although frequently many may contain mixed pathology. In contrast to epithelial ovarian cancers, ovarian germ cell tumors (OGCT) commonly present at an early stage and may frequently be confined to one ovary. They commonly respond well to initial chemotherapy and many patients may be salvaged with second-line therapy. Moreover, dysgerminomas are exquisitely radiosensitive. OGCT frequently produce tumor markers detected in the serum that may be helpful in the initial management and follow-up of these patients. The current management of women with OGCT emphasizes initial conservative surgery (in women desiring future fertility) with comprehensive surgical staging and surgical cytoreduction of advanced disease, followed by prompt institution of combination intravenous chemotherapy as adjuvant or primary therapy in the majority of cases. The combination of surgical resection and systemic chemotherapy cures the majority of women affected with OGCT and many may retain normal reproductive function after the completion of therapy.