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Controversies in the management of germ cell tumours of the ovary

Patterson, Daniel M; Rustin, Gordon JS

doi: 10.1097/01.cco.0000239891.44031.38
Gynecologic cancer
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Purpose of review Ovarian germ cell tumours are rare, but curable at all stages of disease. This review gives an outline of the main controversies regarding the management of this disease.

Recent findings Pelvic malignancies are very rare during pregnancy, which should avoid the need for radical surgery or termination in these patients. Also during pregnancy, AFP-L2 looks to be a promising tumour marker in detecting relapse. Malignant transformation of mature teratomas may be predicted by preoperative squamous cell antigen and tumour size. OCT4 immunohistochemistry has been shown to be a very useful adjunct in the diagnosis of dysgerminomas. The traditional method for grading immature teratomas is challenged by a new classification. Patients receiving cisplatin-based chemotherapy are at a higher risk of developing cardiovascular risk factors. There is a hint that high-dose chemotherapy may play a role in relapsed patients.

Summary Rarity of the disease means many controversies are difficult to resolve, with much reliance on using data from testicular cancer studies. Many clinicians still advocate adjuvant chemotherapy for stage I nondysgerminomatous tumours of grade 2 and above despite good evidence that surveillance is a safe option, and increasing concerns about life-threatening long-term effects of treatment.

Mount Vernon Cancer Centre, Northwood, Middlesex, UK

Correspondence to Professor Gordon J.S. Rustin, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK Tel: +44 (0)1923 844190; fax: +44 (0)1923 844840; e-mail: grustin@nhs.net

© 2006 Lippincott Williams & Wilkins, Inc.