The majority of patients with disseminated germ cell cancer can be cured. However, subsets of these patients are either refractory to initial treatment or relapse after treatment. The management of these different clinical groups is reviewed. An enhanced understanding of the basic biological features of germ cell cancer may well lead to improvements in the management of this disease. Recent advances in the biological and genetic aspects of germ cell cancer which are pertinent to the behaviour of this malignancy are summarized.