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Treatment of malignant germ cell tumors of the ovary

David M Gershenson, MD
Section Editors
Barbara Goff, MD
Alberto S Pappo, MD
Don S Dizon, MD, FACP
Deputy Editors
Sadhna R Vora, MD
Sandy J Falk, MD, FACOG


Ovarian germ cell tumors (OGCTs) are derived from primordial germ cells of the ovary (figure 1). They may be benign or malignant. Malignant germ cell cancers of the ovary include dysgerminomas and nondysgerminomas, which include immature teratomas, embryonal cell carcinoma, yolk sac tumors, primary ovarian (nongestational) choriocarcinomas, polyembryoma, and mixed germ cell tumors [1]. In contrast to epithelial ovarian cancer (EOC), they constitute a rare form of ovarian malignancy. (See "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum".)

Dysgerminomas differ from other malignant OGCTs in several ways: they are more likely to be localized to the ovary at diagnosis (approximately two-thirds of cases are stage IA, (table 1)), bilateral ovarian involvement is more common (10 to 15 percent), they are more likely to spread in a predictable fashion, and they are more sensitive to radiation therapy (RT).

The management of malignant OGCTs will be reviewed here. Pathology and clinical manifestations of these neoplasms, as well as the treatment of benign OGCTs, are reviewed separately. (See "Ovarian germ cell tumors: Pathology, clinical manifestations, and diagnosis".)


In general, the treatment principles for all types of malignant ovarian germ cell tumors (OGCTs) are similar to those that guide the management of the more common epithelial ovarian cancer (EOC), with some exceptions:

Many OGCTs produce tumor products (alpha fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH]) that can be measured in the serum. The presence of these markers provides a highly sensitive and specific indicator of the presence of certain histologic components (table 2). Testing for serum tumor markers prior to definitive treatment can provide a diagnostic clue to the presence of an OGCT. In a child, teen, or young woman, the tumor marker results may help with surgical planning, resulting in the preservation of fertility potential. Furthermore, serial assay of these tumor markers is useful for monitoring the response to chemotherapy and for subsequent posttreatment follow-up. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 11, 2016.
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