Update on the management of ovarian germ cell tumors.

Malignant germ cell tumors of the ovary are rare. In contrast to epithelial ovarian cancer, malignant germ cell tumors occur primarily in girls and young women. In addition, with the refinement of chemotherapeutic regimens in the last several decades, overall disease-free survival rates are >95%. Recent advances have focused on preservation of fertility in the management of patients with these tumors. In a girl or young woman who presents with a pelvic mass, a gynecologist must consider the diagnosis of an ovarian germ cell tumor in the initial workup. Elevated tumor markers may assist in determining the diagnosis preoperatively. Appropriate intraoperative decision making is crucial to adequately treat and stage the cancer without compromising future fertility. For patients with stage I dysgerminoma or stage I low grade immature teratoma, no additional chemotherapy is indicated. However, patients with stage I disease of other germ cell histologies, as well as advanced-stage disease of all germ cell histologies, require adjuvant treatment with bleomycin, etoposide and cisplatin.