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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65737_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65737_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65737_"><span class="title" itemprop="name">Childhood Extracranial Germ Cell Tumors Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: December 20, 2019.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062857__407">This PDQ cancer information summary has current information about the treatment of childhood extracranial germ cell tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062857__408">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000062857__1"><h2 id="_CDR0000062857__1_">General Information About Childhood Extracranial Germ Cell Tumors </h2><div id="CDR0000062857__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062857__172">Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__302">Childhood extracranial germ cell tumors may be benign or malignant.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__113">Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal extracranial tumors. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062857__246">Gonadal Germ Cell Tumors</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__212">Extragonadal Extracranial Germ Cell Tumors</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062857__2">There are three types of extracranial germ cell tumors.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062857__200">Teratomas</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__202">Malignant Germ Cell Tumors</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__420">Mixed Germ Cell Tumors</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062857__303">The cause of most childhood extracranial germ cell tumors is unknown.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__7">Having certain inherited disorders can increase the risk of extracranial germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__15">Signs of childhood extracranial germ cell tumors depend on where the tumor formed in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__19">Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__163">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062857__172"><h3>Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain.</h3><p id="CDR0000062857__366">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046382/" class="def">germ cell</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cell</a> that forms as a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046400/" class="def">fetus</a> (unborn baby) develops. These cells later become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257221/" class="def">sperm</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a> or eggs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>.</p><p id="CDR0000062857__270">This summary is about germ cell tumors that form in parts of the body that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443318/" class="def">extracranial</a> (outside the brain). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">Extracranial germ cell tumors</a> usually form in the following areas of the body:</p><ul id="CDR0000062857__383"><li class="half_rhythm"><div>Testicles.</div></li><li class="half_rhythm"><div>Ovaries.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443329/" class="def">Sacrum</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443343/" class="def">coccyx</a> (tailbone).</div></li><li class="half_rhythm"><div>Retroperitoneum (area in the back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> behind the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall and covers most of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046288/" class="def">Mediastinum</a> (area between the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>).</div></li><li class="half_rhythm"><div>Head and neck.</div></li></ul><a id="CDR0000062857__384"></a><div id="CDR0000062857__382" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Extracranial%20germ%20cell%20tumors%20form%20in%20parts%20of%20the%20body%20other%20than%20the%20brain&p=BOOKS&id=551912_CDR0000770217.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65737.14/bin/CDR0000770217.jpg" alt="Extracranial germ cell tumor; drawing shows parts of the body where extracranial germ cell tumors may form, including the head and neck, mediastinum (the area between the lungs, shown in blue), retroperitoneum (the area behind the abdominal organs, shown in red), sacrum, coccyx, testicles (in males), and ovaries (in females). Also shown are the heart and peritoneum." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Extracranial germ cell tumors form in parts of the body other than the brain. This includes the testicles, ovaries, sacrum (lower part of the spine), coccyx (tailbone), mediastinum (area between the lungs), retroperitoneum (the back wall of the abdomen), and the head and neck.</p></div></div><p id="CDR0000062857__385">Extracranial germ cell tumors are most common in adolescents.</p><p id="CDR0000062857__367">See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000719453/">Childhood Central Nervous System Germ Cell Tumors Treatment</a> for information on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046143/" class="def">intracranial</a> (inside the brain) germ cell tumors.</p></div><div id="CDR0000062857__302"><h3>Childhood extracranial germ cell tumors may be benign or malignant.</h3><p id="CDR0000062857__197">Extracranial germ cell tumors may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045614/" class="def">benign</a> (noncancer) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>).</p></div><div id="CDR0000062857__113"><h3>Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal extracranial tumors. </h3><p id="CDR0000062857__235">Malignant extracranial germ cell tumors are tumors that form outside the brain. They are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046147/" class="def">gonadal</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000661950/" class="def">extragonadal</a>.</p><div id="CDR0000062857__246"><h4>Gonadal Germ Cell Tumors</h4><p id="CDR0000062857__293">Gonadal germ cell tumors form in the gonads (testicles and ovaries).</p><ul id="CDR0000062857__2420"><li class="half_rhythm"><div class="half_rhythm"><b>Testicular germ cell tumors.</b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000695185/" class="def">Testicular germ cell tumors</a> are divided into two main types, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046577/" class="def">seminoma</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046255/" class="def">nonseminoma</a>. Nonseminomas are usually large and cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of disease. They tend to grow and spread more quickly than seminomas.</div><div class="half_rhythm">Testicular germ cell tumors usually occur before the age of 4 years or in adolescents and young adults. Testicular germ cell tumors in adolescents (11 years and older) and young adults are different from those that form in early childhood.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Ovarian germ cell tumors</b>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446560/" class="def">Ovarian germ cell tumors</a> are more common in adolescent girls and young women. Most ovarian germ cell tumors are benign <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature teratomas</a> (dermoid cysts). Some ovarian germ cell tumors, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature teratomas</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000672835/" class="def">dysgerminomas</a>, yolk sac tumors, or mixed germ cell tumors, are malignant.</div></li></ul></div><div id="CDR0000062857__212"><h4>Extragonadal Extracranial Germ Cell Tumors</h4><p id="CDR0000062857__294">Extragonadal extracranial germ cell tumors form in areas of the body other than the brain or gonads (testicles and ovaries).</p><p id="CDR0000062857__214">Most extragonadal extracranial germ cell tumors form along the midline of the body. This includes the following: </p><ul id="CDR0000062857__295"><li class="half_rhythm"><div>Sacrum (the large, triangle-shaped bone in the lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> that forms part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>).</div></li><li class="half_rhythm"><div>
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Coccyx (tailbone).</div></li><li class="half_rhythm"><div>
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Mediastinum (the area between the lungs).</div></li><li class="half_rhythm"><div>
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Back of the abdomen.</div></li><li class="half_rhythm"><div>
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Neck.</div></li></ul><p id="CDR0000062857__296">In children younger than 11 years, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are benign <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratomas</a> in the sacrum or coccyx.</p><p id="CDR0000062857__297">In older children, adolescents, and young adults (11 years and older), extragonadal extracranial germ cell tumors are often in the mediastinum.</p></div></div><div id="CDR0000062857__2"><h3>There are three types of extracranial germ cell tumors.</h3><p id="CDR0000062857__199">Extracranial germ cell tumors are also grouped into teratomas, malignant germ cell tumors, and mixed germ cell tumors: </p><div id="CDR0000062857__200"><h4>Teratomas</h4><p id="CDR0000062857__418">There are two main types of teratomas:</p><ul id="CDR0000062857__419"><li class="half_rhythm"><div><b>Mature teratomas.</b> These tumors are the most common type of extracranial germ cell tumor. Mature teratomas are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046079/" class="def">benign tumors</a> and not likely to become cancer. They usually occur in the sacrum or coccyx in newborns or in the testicles or ovaries at the start of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440113/" class="def">puberty</a>. The cells of mature teratomas look almost like normal cells under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>. Some mature teratomas release <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzymes</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a> that cause signs and symptoms of disease.</div></li><li class="half_rhythm"><div><b>Immature teratomas.</b> These tumors usually occur in areas other than the gonads in young children or in the ovaries at the start of puberty. They have cells that look very different from normal cells under a microscope. Immature teratomas may be cancer and spread to other parts of the body. They often have several different types of tissue in them, such as hair, muscle, and bone. Some immature teratomas release enzymes or hormones that cause signs and symptoms of disease.</div></li></ul></div><div id="CDR0000062857__202"><h4>Malignant Germ Cell Tumors</h4><p id="CDR0000062857__204"> Malignant germ cell tumors are cancer. There are two main types of malignant germ cell tumors:</p><ul id="CDR0000062857__273"><li class="half_rhythm"><div><b>Seminomatous germ cell tumors.</b> There are three types of seminomatous germ cell tumors:<ul id="CDR0000062857__368"><li class="half_rhythm"><div>Seminomas form in the testicle.</div></li><li class="half_rhythm"><div>Dysgerminomas form in the ovary.</div></li><li class="half_rhythm"><div>Germinomas form in areas of the body that are not the ovary or testicle, such as the mediastinum.</div></li></ul></div></li><li class="half_rhythm"><div><b>Nonseminomatous germ cell tumors.</b> There are five types of nonseminomatous germ cell tumors:<dl id="CDR0000062857__369" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Yolk sac tumors make a hormone called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP). They can form in the ovary, testicle, or other areas of the body.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">Choriocarcinomas</a> make a hormone called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a> (β-hCG). They can form in the ovary, testicle, or other areas of the body.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367442/" class="def">Embryonal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045963/" class="def">carcinomas</a> may make a hormone called β-hCG. They can form in the testicle or other areas of the body, but not in the ovary.</p></dd><dt>-</dt><dd><p class="no_top_margin">Gonadoblastomas.</p></dd><dt>-</dt><dd><p class="no_top_margin">Teratoma and yolk sac tumors.</p></dd></dl></div></li></ul></div><div id="CDR0000062857__420"><h4>Mixed Germ Cell Tumors</h4><p id="CDR0000062857__422">Mixed germ cell tumors are made up of at least two types of malignant germ cell tumor. They can form in the ovary, testicle, or other areas of the body.</p></div></div><div id="CDR0000062857__303"><h3>The cause of most childhood extracranial germ cell tumors is unknown.</h3></div><div id="CDR0000062857__7"><h3>Having certain inherited disorders can increase the risk of extracranial germ cell tumors.</h3><p id="CDR0000062857__9">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. </p><p id="CDR0000062857__381">Possible risk factors for extracranial germ cell tumors include the following:</p><ul id="CDR0000062857__285"><li class="half_rhythm"><div>Having certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndromes</a>:<dl id="CDR0000062857__286" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304688/" class="def">Klinefelter syndrome</a> may increase the risk of germ cell tumors in the mediastinum.</p></dd><dt>-</dt><dd><p class="no_top_margin">Swyer syndrome may increase the risk of gonadoblastoma and seminoma.</p></dd><dt>-</dt><dd><p class="no_top_margin">Turner syndrome may increase the risk of gonadoblastoma and dysgerminoma.</p></dd></dl></div></li><li class="half_rhythm"><div>Having an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044388/" class="def">undescended testicle</a> may increase the risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445090/" class="def">testicular cancer</a>.</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539103/" class="def">gonadal dysgenesis</a> (the gonad—ovary or testicle—has not formed normally) may increase the risk of gonadoblastoma.</div></li></ul></div><div id="CDR0000062857__15"><h3>Signs of childhood extracranial germ cell tumors depend on where the tumor formed in the body.</h3><p id="CDR0000062857__17"> Different tumors may cause the following signs and symptoms.
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Other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a> may cause these same signs and symptoms. Check with a doctor if your child has any of the following:</p><ul id="CDR0000062857__289"><li class="half_rhythm"><div>A lump in the neck, abdomen, or lower back.</div></li><li class="half_rhythm"><div> A painless lump in the testicle.</div></li><li class="half_rhythm"><div>Pain in the abdomen.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">Constipation</a>.</div></li><li class="half_rhythm"><div>In females, no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000410605/" class="def">menstrual periods</a> or unusual <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044308/" class="def">vaginal</a> bleeding.</div></li></ul></div><div id="CDR0000062857__19"><h3>Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors.</h3><p id="CDR0000062857__21">The following tests and procedures may be used:</p><ul id="CDR0000062857__22"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The testicles may be checked for lumps, swelling, or pain. A history of the patient's health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354469/" class="def">Serum tumor marker test</a></b>: A procedure in which a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor markers</a>. </div><div class="half_rhythm">Some malignant germ cell tumors release tumor markers. The following tumor markers may be used to detect extracranial germ cell tumors:
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<dl id="CDR0000062857__237" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Alpha-fetoprotein (AFP).</p></dd><dt>-</dt><dd><p class="no_top_margin">Beta-human chorionic gonadotropin (β-hCG).</p></dd></dl>
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For testicular germ cell tumors, blood levels of the tumor markers help show if the tumor is a seminoma or nonseminoma.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.<div id="CDR0000062857__409" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Computed%20tomography%20(CT)%20scan%20of%20the%20abdomen&p=BOOKS&id=551912_CDR0000775531.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65737.14/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan of the abdomen; drawing shows a child lying on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).<div id="CDR0000062857__410" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Magnetic%20resonance%20imaging%20(MRI)%20of%20the%20abdomen&p=BOOKS&id=551912_CDR0000775532.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65737.14/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) of the abdomen; drawing shows a child lying on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The picture can be printed to be looked at later.<div id="CDR0000062857__411" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Abdominal%20ultrasound&p=BOOKS&id=551912_CDR0000775457.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65737.14/bin/CDR0000775457.jpg" alt="Abdominal ultrasound; drawing shows a child lying on an exam table during an abdominal ultrasound procedure. A technician is shown pressing a transducer (a device that makes sound waves that bounce off tissues inside the body) against the skin of the abdomen. A computer screen shows a sonogram (picture)." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm">
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of cells or tissues so they can be viewed under a microscope by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. Sometimes an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046698/" class="def">incisional biopsy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045798/" class="def">needle biopsy</a> is done before <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove a sample of tissue. Sometimes the tumor is removed during surgery and then a sample of tissue is removed from the tumor.</div><div class="half_rhythm">The following tests may be done on the sample of tissue that is removed:<dl id="CDR0000062857__358" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic analysis</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a> of cells in a sample of tissue are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> cancer, plan treatment, or find out how well treatment is working. </p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A laboratory test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.</p></dd></dl></div></li></ul></div><div id="CDR0000062857__163"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000062857__165">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000062857__423"><li class="half_rhythm"><div>The patient's age and general health.</div></li><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer (whether it has spread to nearby areas, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or to other places in the body).</div></li><li class="half_rhythm"><div>Where the tumor first began to grow.</div></li><li class="half_rhythm"><div>How well the tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responds</a> to treatment.</div></li><li class="half_rhythm"><div>The type of germ cell tumor.</div></li><li class="half_rhythm"><div>Whether the patient has gonadal dysgenesis.</div></li><li class="half_rhythm"><div>Whether the tumor can be completely removed by surgery.</div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000062857__276">The prognosis for childhood extracranial germ cell tumors, especially ovarian germ cell tumors, is good.</p></div></div><div id="CDR0000062857__26"><h2 id="_CDR0000062857__26_">Stages of Childhood Extracranial Germ Cell Tumors</h2><div id="CDR0000062857__26.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062857__27">After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas or to other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__184">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__344">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__387">Stages are used to describe the different types of extracranial germ cell tumors.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062857__460">Testicular germ cell tumors in patients younger than 11 years</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__437">Testicular germ cell tumors in patients 11 years and older</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__392">Ovarian germ cell tumors</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__403">Extragonadal extracranial germ cell tumors</a></div></li></ul></li></ul></div><div id="CDR0000062857__27"><h3>After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas or to other parts of the body. </h3><p id="CDR0000062857__29">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread from where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> started to other
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parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the
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staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is important to know
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the stage in order to plan treatment. In some cases, staging may follow <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor. </p><p id="CDR0000062857__277">The following procedures may be used:</p><ul id="CDR0000062857__239"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body, such as the brain or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. This procedure is also called nuclear magnetic resonance imaging.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or lymph nodes, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046499/" class="def">Bone scan</a></b>: A procedure to check if there are rapidly dividing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, such as cancer cells, in the bone. A very small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046612/" class="def">Thoracentesis</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> from the space between the lining of the chest and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, using a needle. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the fluid under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046713/" class="def">Paracentesis</a></b>: The removal of fluid from the space between the lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and the organs in the abdomen, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.</div></li></ul><p id="CDR0000062857__251">The results from <a href="#CDR0000062857__19">tests and procedures</a> used to detect and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">extracranial germ cell tumors</a> may also be used in staging.</p></div><div id="CDR0000062857__184"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062857__184_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062857__184_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062857__344"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000062857__344_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062857__344_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062857__346">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor is the same type of cancer as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>. For example, if an extracranial germ cell tumor spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, the cancer cells in the liver are actually cancerous <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046382/" class="def">germ cells</a>. The disease is metastatic extracranial germ cell tumor, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>.</p><div id="CDR0000062857__461" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000062857__387"><h3>Stages are used to describe the different types of extracranial germ cell tumors.</h3><div id="CDR0000062857__460"><h4>Testicular germ cell tumors in patients younger than 11 years</h4><p id="CDR0000062857__436">The following stages are from the Children's Oncology Group.</p><ul id="CDR0000062857__443"><li class="half_rhythm"><div class="half_rhythm"><b>Stage I</b></div><div class="half_rhythm"> In stage I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicle</a> only. The testicle and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615541/" class="def">spermatic cord</a> are completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and all of the following are true:<ul id="CDR0000062857__2404"><li class="half_rhythm"><div>the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>) did not rupture (break open) and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was not done before the tumor was removed; and</div></li><li class="half_rhythm"><div>all <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are smaller than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeter</a> in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> on a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a>.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage II</b></div><div class="half_rhythm">In stage II, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicle</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615541/" class="def">spermatic cord</a> are removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and one of the following is true:<ul id="CDR0000062857__2405"><li class="half_rhythm"><div>the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>) ruptured (broke open) or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was done before surgery; or</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that can only be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> remains in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046573/" class="def">scrotum</a> or in the spermatic cord near the scrotum and after surgery <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor marker</a> levels do not return to normal or do not decrease. </div></li></ul></div><div class="half_rhythm">Cancer has not spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage III</b></div><div class="half_rhythm">In stage III, one of the following is true:<ul id="CDR0000062857__2406"><li class="half_rhythm"><div> the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> at the back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; or</div></li><li class="half_rhythm"><div>lymph nodes are at least 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> and either have not changed or are growing when a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> is repeated within 4 to 6 weeks.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage IV</b></div><div class="half_rhythm">In stage IV, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, bone, and brain.</div></li></ul></div><div id="CDR0000062857__437"><h4>Testicular germ cell tumors in patients 11 years and older</h4><p id="CDR0000062857__439">See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000257530/">Testicular Cancer Treatment</a> for more information about staging used for testicular germ cell tumors in patients 11 years and older.</p></div><div id="CDR0000062857__392"><h4>Ovarian germ cell tumors</h4><p id="CDR0000062857__394">Two staging systems are used for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446560/" class="def">ovarian germ cell tumors</a>: Children's Oncology Group and the International Federation of Gynecology and Obstetrics (FIGO).</p><p id="CDR0000062857__434">The following stages are from the Children's Oncology Group.</p><ul id="CDR0000062857__448"><li class="half_rhythm"><div class="half_rhythm"><b>Stage I</b></div><div class="half_rhythm">In stage I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> is completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and all of the following are true:<ul id="CDR0000062857__2408"><li class="half_rhythm"><div>the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the tumor) did not rupture (break open) and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was not done before the tumor was removed; and</div></li><li class="half_rhythm"><div>there is no sign that the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread through the capsule; and</div></li><li class="half_rhythm"><div> no cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; and</div></li><li class="half_rhythm"><div> no cancer is seen in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the abdomen or found in tissue samples taken during a biopsy; and</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are smaller than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeter</a> in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> on a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> or no cancer is found in lymph node tissue samples taken during a biopsy.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage II</b></div><div class="half_rhythm"> In stage II, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> is completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> is done before surgery and one of the following is true:<ul id="CDR0000062857__2409"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread through all or part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the tumor); or</div></li><li class="half_rhythm"><div>the tumor is larger than 10 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> and is removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000637280/" class="def">laparoscopic surgery</a>; or</div></li><li class="half_rhythm"><div>the tumor is removed by being broken up into small pieces and it is not known if cancer has spread through the capsule.</div></li></ul></div><div class="half_rhythm">Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are not found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. Cancer is not seen in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the abdomen and cancer is not found in tissue samples taken during a biopsy.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage III</b></div><div class="half_rhythm"> In stage III, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> is removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and one of the following is true:<ul id="CDR0000062857__2410"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are at least 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> and either have not changed or are growing when a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> is repeated 4 to 6 weeks after surgery; or</div></li><li class="half_rhythm"><div>the tumor is not completely removed by surgery or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was done before surgery; or</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> (including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature teratoma</a>) are found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; or</div></li><li class="half_rhythm"><div>cancer (including immature teratoma) is found in lymph nodes; or</div></li><li class="half_rhythm"><div>cancer (including immature teratoma) is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that lines the abdomen.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage III-X</b>
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</div><div class="half_rhythm">In stage III-X, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> can be described as stage I or stage II, except:<ul id="CDR0000062857__2411"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> lining the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> were not collected; or</div></li><li class="half_rhythm"><div>a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> larger than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeter</a> in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> was not done; or</div></li><li class="half_rhythm"><div>a biopsy of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> from the lining of the abdomen was not done; or</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a> was not completed during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> but will be completed during a second surgery.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage IV</b></div><div class="half_rhythm"> In stage IV, one of the following is true:<ul id="CDR0000062857__2412"><li class="half_rhythm"><div> the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> to other areas of the body, such as the bone, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, or brain.</div></li><li class="half_rhythm"><div>cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> in the lung.</div></li></ul></div></li></ul><p id="CDR0000062857__398">The following stages are from the International Federation of Gynecology and Obstetrics (FIGO).</p><ul id="CDR0000062857__399"><li class="half_rhythm"><div class="half_rhythm"><b>Stage I</b>
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</div><div class="half_rhythm">In stage I, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in one or both of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.<ul id="CDR0000062857__400"><li class="half_rhythm"><div>Stage IA: Cancer is found in one ovary.</div></li><li class="half_rhythm"><div>Stage IB: Cancer is found in both ovaries.</div></li><li class="half_rhythm"><div>Stage IC: Cancer is found in one or both ovaries and one of the following is true:<ul id="CDR0000062857__219"><li class="half_rhythm"><div>cancer is also found on the outside surface of one or both ovaries; or</div></li><li class="half_rhythm"><div>the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> ruptured (broke open) before or during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>; or
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</div></li><li class="half_rhythm"><div>cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000700145/" class="def">washings</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046125/" class="def">peritoneal cavity</a> (the body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> that contains most of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen).</div></li></ul></div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage II</b>
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</div><div class="half_rhythm">In stage II, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> and has spread into other areas of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> is found. Stage II is divided into stage IIA and stage IIB.<ul id="CDR0000062857__401"><li class="half_rhythm"><div>Stage IIA: Cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a> and/or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a> (the long slender tubes through which eggs pass from the ovaries to the uterus).
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</div></li><li class="half_rhythm"><div>Stage IIB: Cancer has spread to other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>.
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</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage III</b>
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</div><div class="half_rhythm">In stage III, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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is found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> is found. Cancer has spread outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> to other parts of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and/or to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> at the back of the abdomen.
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Stage III is divided into stage IIIA, stage IIIB, and stage IIIC. <div id="CDR0000062857__218" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Tumor%20sizes%20are%20often%20measured%20in%20centimeters%20(cm)%20or%20inches&p=BOOKS&id=551912_CDR0000415526.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65737.14/bin/CDR0000415526.jpg" alt="Drawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).</p></div></div><ul id="CDR0000062857__402"><li class="half_rhythm"><div>In stage IIIA, one of the following is true:<ul id="CDR0000062857__307"><li class="half_rhythm"><div>cancer has spread to lymph nodes at the back of the abdomen only; or</div></li><li class="half_rhythm"><div>cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that can be seen only with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> have spread to the surface of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> outside the pelvis. Cancer may have spread to nearby lymph nodes at the back of the abdomen.</div></li></ul></div></li><li class="half_rhythm"><div>Stage IIIB: Cancer has spread to the peritoneum outside the pelvis and the cancer in the peritoneum is 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller. Cancer may have spread to lymph nodes at the back of the abdomen.</div></li><li class="half_rhythm"><div>Stage IIIC: Cancer has spread to the peritoneum outside the pelvis and the cancer in the peritoneum is
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larger than 2 centimeters. Cancer may have spread to
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lymph nodes at the back of the abdomen or to the surface of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage IV</b>
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</div><div class="half_rhythm">Stage IV is divided into stage IVA and IVB.<ul id="CDR0000062857__435"><li class="half_rhythm"><div>Stage IVA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in extra <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> that builds up around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</div></li><li class="half_rhythm"><div>Stage IVB: Cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li></ul></div></li></ul></div><div id="CDR0000062857__403"><h4>Extragonadal extracranial germ cell tumors</h4><p id="CDR0000062857__440">The following stages are from the Children's Oncology Group.</p><ul id="CDR0000062857__454"><li class="half_rhythm"><div class="half_rhythm"><b>Stage I</b></div><div class="half_rhythm"> In stage I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and all of the following are true:<ul id="CDR0000062857__2413"><li class="half_rhythm"><div>no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the area where the tumor was removed; and </div></li><li class="half_rhythm"><div>the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the tumor) did not rupture (break open) and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was not done before the tumor was removed; and</div></li><li class="half_rhythm"><div>cancer cells are not found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a>, if the tumor is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; and</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are smaller than 1 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeter</a> on a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> of the abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, and chest.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage II</b>
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</div><div class="half_rhythm">In stage II, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is not completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and one of the following is true:<ul id="CDR0000062857__2414"><li class="half_rhythm"><div>cancer that can only be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> remains after surgery; or</div></li><li class="half_rhythm"><div>cancer that can be seen with the eye remains after surgery and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>) ruptured (broke open) or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was done.</div></li></ul></div><div class="half_rhythm">Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are not found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> taken from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. There is no sign of cancer in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or chest on a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage III</b>
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</div><div class="half_rhythm">In stage III, one of the following is true:<ul id="CDR0000062857__2415"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is not completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and cancer that can be seen with the eye remains after surgery or only a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> was done; or</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are at least 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> and either have not changed or are growing when a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> is repeated within 4 to 6 weeks.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Stage IV</b>
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</div><div class="half_rhythm">In stage IV, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, bone, or brain.</div></li></ul></div></div></div><div id="CDR0000062857__48"><h2 id="_CDR0000062857__48_">Recurrent Childhood Extracranial Germ Cell Tumors</h2><p id="CDR0000062857__49"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">extracranial germ cell tumor</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body. </p><p id="CDR0000062857__279">The number of patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> that come back is small. Most recurrent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a> come back within three years of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. About half of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratomas</a> that recur in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443329/" class="def">sacrum</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443343/" class="def">coccyx</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>, so <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> is important. </p></div><div id="CDR0000062857__50"><h2 id="_CDR0000062857__50_">Treatment Option Overview</h2><div id="CDR0000062857__50.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062857__51">There are different types of treatment for children with extracranial germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__136">Children with extracranial germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__258">Treatment for childhood extracranial germ cell tumors may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__55">Three types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062857__57">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__84">Observation</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__64">Chemotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062857__79">New types of treatment are being tested in clinical trials. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062857__351">High-dose chemotherapy with stem cell transplant</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__412">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__2417">Targeted therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062857__186">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__188">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__190">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062857__51"><h3>There are different types of treatment for children with extracranial germ cell tumors.</h3><p id="CDR0000062857__53">Different types of treatments are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">extracranial germ cell tumors</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.</p><p id="CDR0000062857__54">Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. </p></div><div id="CDR0000062857__136"><h3>Children with extracranial germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.</h3><p id="CDR0000062857__138">Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a>, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who are experts in treating children with extracranial germ cell tumors and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000062857__139"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">Pediatric surgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318822/" class="def">Pediatric hematologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046439/" class="def">Endocrinologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000690737/" class="def">Child life professional</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723337/" class="def">Geneticist</a>.</div></li></ul></div><div id="CDR0000062857__258"><h3>Treatment for childhood extracranial germ cell tumors may cause side effects.</h3><p id="CDR0000062857__258_76">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p><p id="CDR0000062857__260">
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Side effects from cancer treatment that begin after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer treatment may include the following:</p><ul id="CDR0000062857__261"><li class="half_rhythm"><div>Physical problems, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046348/" class="def">infertility</a>, trouble hearing and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a> problems.</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer), such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>.</div></li></ul><p id="CDR0000062857__262">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information).
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</p></div><div id="CDR0000062857__55"><h3>Three types of standard treatment are used:</h3><div id="CDR0000062857__57"><h4>Surgery</h4><p id="CDR0000062857__59"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to completely remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is done whenever possible. If the tumor is very large, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may be given first, to make the tumor smaller and decrease the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that needs to be removed during surgery. A goal of surgery is to keep <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046564/" class="def">reproductive</a> function. The following types of surgery may be used:</p><ul id="CDR0000062857__140"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a>: Surgery to remove tissue or part or all of an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>.</div></li><li class="half_rhythm"><div>Radical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046346/" class="def">inguinal orchiectomy</a>: Surgery to remove one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a> through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> (cut) in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322894/" class="def">Unilateral salpingo-oophorectomy</a>: Surgery to remove one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> and one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tube</a> on the same side.</div></li></ul><p id="CDR0000062857__386">After the doctor removes all the cancer that can be seen
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at the time of the surgery, some patients may be given
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chemotherapy after surgery to kill any
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cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p></div><div id="CDR0000062857__84"><h4>Observation</h4><p id="CDR0000062857__86"> Observation is closely <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454803/" class="def">monitoring</a> a patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> without giving any treatment until <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> appear or change. For childhood extracranial germ cell tumors, this includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exams</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000732562/" class="def">tumor marker tests</a>.</p></div><div id="CDR0000062857__64"><h4>Chemotherapy</h4><p id="CDR0000062857__66">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an organ, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). </p><p id="CDR0000062857__417">The way the chemotherapy is given depends on the type and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer being treated. Systemic chemotherapy is used to treat extracranial germ cell tumors.</p></div></div><div id="CDR0000062857__79"><h3>New types of treatment are being tested in clinical trials. </h3><p id="CDR0000062857__253">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062857__351"><h4>High-dose chemotherapy with stem cell transplant</h4><p id="CDR0000062857__2444">High doses of chemotherapy are given to kill cancer cells. Healthy cells, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>-forming cells, are also destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> is a treatment to replace the blood-forming cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> of the patient or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. These reinfused stem cells grow into (and restore) the body's blood cells.</p></div><div id="CDR0000062857__412"><h4>Radiation therapy</h4><p id="CDR0000062857__414"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000062857__415"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000062857__416">The way the radiation therapy is given depends on the type of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back.</p></div><div id="CDR0000062857__2417"><h4>Targeted therapy</h4><p id="CDR0000062857__2419"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapy is being studied for the treatment of extracranial germ cell tumors that have come back.</p></div></div><div id="CDR0000062857__186"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062857__186_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062857__186_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000062857__186_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000062857__188"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062857__188_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062857__188_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000062857__190"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062857__190_55">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062857__190_56">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p><p id="CDR0000062857__181">For childhood extracranial germ cell tumors, follow-up may include regular physical exams, tumor marker tests, and imaging tests such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">chest x-ray</a>.</p></div></div><div id="CDR0000062857__159"><h2 id="_CDR0000062857__159_">Treatment Options for Childhood Extracranial Germ Cell Tumors </h2><p id="CDR0000062857__463">For information about the treatments listed below, see the <a href="#CDR0000062857__55">Treatment Option Overview</a> section.</p><div id="CDR0000062857__93"><h3>Mature and Immature Teratomas</h3><p id="CDR0000062857__371">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature teratomas</a> includes the following:</p><ul id="CDR0000062857__372"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">observation</a>.</div></li></ul><p id="CDR0000062857__373">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature teratomas</a> includes the following:</p><ul id="CDR0000062857__374"><li class="half_rhythm"><div>Surgery to remove the tumor followed by observation for stage I tumors.</div></li><li class="half_rhythm"><div>Surgery to remove the tumor for stage II–IV tumors. In young children, surgery is followed by observation; the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> after surgery is controversial. In adolescents and young adults, chemotherapy is given after surgery. </div></li></ul><p id="CDR0000062857__342">Sometimes a mature or immature teratoma also has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratoma</a> with malignant cells may need to be treated differently.</p><p id="CDR0000062857__TrialSearch_93_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062857__266"><h3>Malignant Gonadal Germ Cell Tumors</h3><div id="CDR0000062857__96"><h4>Malignant Testicular Germ Cell Tumors </h4><p id="CDR0000062857__97">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000695185/" class="def">testicular germ cell tumors</a> may include the following:</p><p id="CDR0000062857__301">For boys younger than 11 years:</p><ul id="CDR0000062857__182"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (radical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046346/" class="def">inguinal orchiectomy</a>) followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">observation</a> for stage I <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div>Surgery (radical inguinal orchiectomy) followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">chemotherapy</a> for stage II-IV tumors.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> of surgery followed by observation for stage I tumors or chemotherapy for stage II-IV tumors.</div></li><li class="half_rhythm"><div>A clinical trial of a new chemotherapy regimen for stage II-IV tumors.</div></li></ul><p id="CDR0000062857__292">For boys 11 years and older:</p><p id="CDR0000062857__153">Malignant testicular germ cell tumors in boys 11 years and older are treated differently than they are in young boys. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000257530/">Testicular Cancer Treatment</a> for more information.)</p><ul id="CDR0000062857__2445"><li class="half_rhythm"><div>Surgery to remove the tumor. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> are also removed.</div></li><li class="half_rhythm"><div>A clinical trial of a new regimen of surgery followed by observation for stage I tumors or chemotherapy for stage II-IV tumors.</div></li><li class="half_rhythm"><div>A clinical trial of a new chemotherapy regimen.</div></li></ul><p id="CDR0000062857__TrialSearch_96_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062857__99"><h4>Malignant Ovarian Germ Cell Tumors </h4><div id="CDR0000062857__359"><h5>Dysgerminomas</h5><p id="CDR0000062857__360">Treatment of stage I <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000672835/" class="def">dysgerminomas</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> may include the following:</p><ul id="CDR0000062857__348"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322894/" class="def">unilateral salpingo-oophorectomy</a>) followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">observation</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Chemotherapy</a> may be given if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor marker</a> levels do not decrease after surgery or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> comes back.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> of surgery followed by observation.</div></li></ul><p id="CDR0000062857__361">Treatment of stages II–IV dysgerminomas of the ovary may include the following:</p><ul id="CDR0000062857__362"><li class="half_rhythm"><div>Surgery (unilateral salpingo-oophorectomy) followed by chemotherapy.</div></li><li class="half_rhythm"><div>Chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).</div></li><li class="half_rhythm"><div>A clinical trial of a new regimen of surgery followed by chemotherapy.</div></li><li class="half_rhythm"><div>A clinical trial of a new chemotherapy regimen.</div></li></ul></div><div id="CDR0000062857__363"><h5>Nongerminomas</h5><p id="CDR0000062857__349">Treatment of nongerminomas of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, such as yolk sac tumors, mixed germ cell tumors, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">choriocarcinoma</a>, and embryonal carcinomas, in young girls may include the following:</p><ul id="CDR0000062857__364"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">observation</a> for stage I <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>. </div></li><li class="half_rhythm"><div>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">chemotherapy</a> for stage I-IV tumors.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> of surgery followed by observation for stage I tumors.</div></li><li class="half_rhythm"><div>A clinical trial of a new regimen of surgery followed by chemotherapy for stage II-IV tumors.</div></li></ul><p id="CDR0000062857__427">Treatment of nongerminomas of the ovary in adolescents and young women may include the following:</p><ul id="CDR0000062857__426"><li class="half_rhythm"><div>Surgery and chemotherapy for stage I-IV tumors.</div></li><li class="half_rhythm"><div>A clinical trial of a new regimen of surgery followed by observation or chemotherapy.</div></li><li class="half_rhythm"><div>A clinical trial of a new chemotherapy regimen.</div></li></ul><p id="CDR0000062857__428">Treatment of nongerminomas of the ovary that cannot be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000589417/" class="def">primary</a> surgery without risk to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> may include the following:</p><ul id="CDR0000062857__429"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a> followed by chemotherapy and surgery.</div></li></ul><p id="CDR0000062857__TrialSearch_99_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div></div><div id="CDR0000062857__103"><h3>Malignant Extragonadal Extracranial Germ Cell Tumors </h3><p id="CDR0000062857__104">Treatment of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> extragonadal extracranial germ cell tumors in young children may include the following:</p><ul id="CDR0000062857__430"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> for stage I-IV <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a> followed by chemotherapy and possibly surgery for stage III and IV tumors.</div></li></ul><p id="CDR0000062857__431">In addition to stage of the disease, treatment of malignant extragonadal extracranial germ cell tumors also depends on where the tumor formed in the body:</p><ul id="CDR0000062857__105"><li class="half_rhythm"><div>For tumors in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443329/" class="def">sacrum</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443343/" class="def">coccyx</a>, chemotherapy to shrink the tumor followed by surgery to remove the sacrum and/or coccyx.</div></li><li class="half_rhythm"><div>For tumors in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046288/" class="def">mediastinum</a>, chemotherapy before or after surgery to remove the tumor in the mediastinum.</div></li><li class="half_rhythm"><div>For tumors in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> followed by chemotherapy to shrink the tumor and surgery to remove the tumor in the abdomen.</div></li><li class="half_rhythm"><div>For tumors in the head and neck, surgery to remove the tumor in the head or neck followed by chemotherapy.</div></li></ul><p id="CDR0000062857__432">Treatment of childhood malignant extragonadal extracranial germ cell tumors in adolescents and young adults may include the following:</p><ul id="CDR0000062857__433"><li class="half_rhythm"><div>Surgery.</div></li><li class="half_rhythm"><div>Chemotherapy.</div></li><li class="half_rhythm"><div>Chemotherapy followed by surgery to remove the tumor.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> of surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">observation</a> or chemotherapy.</div></li><li class="half_rhythm"><div>A clinical trial of a new chemotherapy regimen.</div></li></ul><p id="CDR0000062857__TrialSearch_103_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062857__107"><h3>Recurrent Childhood Malignant Extracranial Germ Cell Tumors </h3><p id="CDR0000062857__2443">Treatment of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">extracranial germ cell tumors</a> may include the following:</p><ul id="CDR0000062857__234"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> given before or after surgery, for most <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> extracranial germ cell tumors including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature teratomas</a>, malignant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000695185/" class="def">testicular germ cell tumors</a>, and malignant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446560/" class="def">ovarian germ cell tumors</a>.</div></li><li class="half_rhythm"><div>Chemotherapy for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> malignant testicular germ cell tumors and recurrent nongerminomas of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> that were stage I at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> followed by surgery to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has spread to the brain.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> that checks a sample of the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. The type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> that will be given to the patient depends on the type of gene change.</div></li><li class="half_rhythm"><div>A clinical trial of chemotherapy alone compared with high-dose chemotherapy followed by stem cell transplant.</div></li></ul><p id="CDR0000062857__TrialSearch_107_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062857__192"><h2 id="_CDR0000062857__192_">To Learn More About Childhood Cancer</h2><p id="CDR0000062857__341">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444992/" class="def">extracranial germ cell tumors</a>, see the following.</p><ul id="CDR0000062857__343"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/extracranial-germ-cell" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Extracranial Germ Cell Tumor (Childhood) Home Page</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li></ul><p id="CDR0000062857__192_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000062857__192_45"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062857__AboutThis_1"><h2 id="_CDR0000062857__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062857__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062857__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062857__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062857__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062857__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood extracranial germ cell tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062857__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062857__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062857__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062857__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062857__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062857__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062857__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062857__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062857__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062857__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Extracranial Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/extracranial-germ-cell/patient/germ-cell-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/extracranial-germ-cell/patient/germ-cell-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389180]</p><p id="CDR0000062857__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062857__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062857__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062857__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062857__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65737</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389180" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389180</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65737.14/?report=reader">PubReader</a></li><li><a href="/books/NBK65737.14/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65737" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65737" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Patient Version. 2019 Dec 20. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65737.21/">NBK65737.21</a></span> July 19, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65737.20/">NBK65737.20</a></span> February 3, 2023</li><li><span class="bk_col_itm"><a 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Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062857__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Extracranial Germ Cell Tumors </a></li><li><a href="#CDR0000062857__26" ref="log$=inpage&link_id=inpage">Stages of Childhood Extracranial Germ Cell Tumors</a></li><li><a href="#CDR0000062857__48" ref="log$=inpage&link_id=inpage">Recurrent Childhood Extracranial Germ Cell Tumors</a></li><li><a href="#CDR0000062857__50" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062857__159" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Extracranial Germ Cell Tumors </a></li><li><a href="#CDR0000062857__192" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Cancer</a></li><li><a href="#CDR0000062857__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65877/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" 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