Germ cell tumors may recur in the pelvis, the abdominal cavity, liver, lungs and lymph nodes . Symptoms may include pelvic or abdominal pain, nausea, vomiting, abdominal swelling, weight loss and chronic cough.
• Women with recurrent cancer usually undergo an exploratory laparotomy with aggressive surgical debulking of
  the tumor.
• Women with recurrent dysgerminoma who did not receive radiation therapy previously can be treated with
  pelvic radiation up to a dose of 3,000 to 5,000 cGy over four to five weeks and whole-abdomen radiation
  therapy, up to 1,500 cGy, with a boost of up to 1,500 cGy to the para-aortic area over several weeks.
• Women with recurrent dysgerminoma who were initially treated with radiation therapy are treated with
  combination chemotherapy such as cisplatin + etoposide + bleomycin , cisplatin + ifosfamide + etoposide,
  vincristine + actinomycin-D + Cytoxan or carboplatin + ifosfamide.
• Women with non-dysgerminomatous tumors are generally treated with chemotherapy after surgery, as
  radiation is not effective for these tumors. The chemotherapeutic drugs of choice are cisplatin + etoposide +
  bleomycin, cisplatin + ifosfamide + etoposide or ifosfamide, vinblastine or vincristine + actinomycin-D +
  Cytoxan, or carboplatin + ifosfamide.