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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: October 1, 2015.</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 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__2">There are three types of extracranial germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__113">Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal. </a></div></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 an extracranial germ cell tumor.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__15">Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is 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>. Sometimes while the fetus is forming, germ cells travel to parts of the body where they should not be and grow into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumor</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> may form before or after birth.</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> (bottom part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>).</div></li><li class="half_rhythm"><div>Retroperitoneum (the back wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).</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></ul><a id="CDR0000062857__384"></a><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062857382" co-legend-rid="figlgndCDR0000062857382"><a href="/books/NBK65737.2/figure/CDR0000062857__382/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062857382" rid-ob="figobCDR0000062857382"><img class="small-thumb" src="/books/NBK65737.2/bin/CDR0000770217.gif" src-large="/books/NBK65737.2/bin/CDR0000770217.jpg" alt="Extracranial germ cell tumors form in parts of the body other than the brain" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062857382"><h4 id="CDR0000062857__382"><a href="/books/NBK65737.2/figure/CDR0000062857__382/?report=objectonly" target="object" rid-ob="figobCDR0000062857382">Figure</a></h4><p class="float-caption no_bottom_margin">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), and retroperitoneum (the back wall of the abdomen). <a href="/books/NBK65737.2/figure/CDR0000062857__382/?report=objectonly" target="object" rid-ob="figobCDR0000062857382">(more...)</a></p></div></div><p id="CDR0000062857__385">Extracranial germ cell tumors are most common in teenagers 15 to 19 years of age.</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__2"><h3>There are three types of extracranial germ cell tumors.</h3><p id="CDR0000062857__199">Extracranial germ cell tumors are grouped into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature teratomas</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature teratomas</a>, and malignant germ cell tumors: </p><div id="CDR0000062857__200"><h4>Mature Teratomas </h4><p id="CDR0000062857__195">Mature teratomas 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 (bottom part of the spine) in newborns or in the ovaries of girls 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of disease.</p></div><div id="CDR0000062857__147"><h4>Immature Teratomas </h4><p id="CDR0000062857__196">Immature teratomas also usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or the ovaries of girls at the start of puberty. Immature teratomas have cells that look very different from normal cells under a microscope. Immature teratomas may be cancer. They often have several different types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> in them, such as hair, muscle, and bone. Some immature teratomas release enzymes or hormones that cause signs and symptoms of disease.</p></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>Germinomas: Tumors that make a hormone called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a> (β-hCG). There are three types of germinomas.<dl id="CDR0000062857__368" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000672835/" class="def">Dysgerminomas</a> form in the ovary in girls.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046577/" class="def">Seminomas</a> form in the testicle in boys.</p></dd><dt>-</dt><dd><p class="no_top_margin">Germinomas form in areas of the body that are not the ovary or testicle.</p></dd></dl></div></li><li class="half_rhythm"><div>Nongerminomas: There are four types of nongerminomas.<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 beta-human chorionic gonadotropin (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 and/or a hormone called AFP. They can form in the testicle or other parts of the body, but not in the ovary.</p></dd><dt>-</dt><dd><p class="no_top_margin">Mixed germ cell tumors are made up of both malignant germ cell tumor and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratoma</a>. They can form in the ovary, testicle, or other areas of the body.</p></dd></dl></div></li></ul></div></div><div id="CDR0000062857__113"><h3>Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal. </h3><p id="CDR0000062857__235">Malignant extracranial germ cell tumors 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 testicles in boys or ovaries in girls.</p><p id="CDR0000062857__248"><i><b><div class="milestone-start" id="CDR0000062857__207"></div>Testicular Germ Cell Tumors</b></i></p><p id="CDR0000062857__255"><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>.</p><ul id="CDR0000062857__298"><li class="half_rhythm"><div>Seminomas make a hormone called beta-human chorionic gonadotropin (β-hCG).</div></li><li class="half_rhythm"><div>Nonseminomas are usually large and cause signs or symptoms. They tend to grow and spread more quickly than seminomas.</div></li></ul><p id="CDR0000062857__254">Testicular germ cell tumors usually occur before the age of 4 years or in teenagers and young adults. Testicular germ cell tumors in teenagers and young adults are different from those that form in early childhood.</p><p id="CDR0000062857__299">Boys older than 14 years with testicular germ cell tumors are treated in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046245/" class="def">pediatric</a> cancer centers, but the treatment is much like the treatment used in adults. (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000257530/">Testicular Cancer Treatment</a> for more information.)<div class="milestone-end"></div></p><p id="CDR0000062857__249"><i><b><div class="milestone-start" id="CDR0000062857__209"></div>Ovarian Germ Cell Tumors</b></i></p><p id="CDR0000062857__211"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446560/" class="def">Ovarian germ cell tumors</a> are more common in teenage girls and young women. Most ovarian germ cell tumors are benign teratomas. Sometimes immature teratomas, dysgerminomas, yolk sac tumors, and mixed germ cell tumors (cancer) occur. (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000062967/">Ovarian Germ Cell Tumors Treatment</a> for more information.)<div class="milestone-end"></div></p></div><div id="CDR0000062857__212"><h4>Extragonadal Extracranial Germ Cell Tumors</h4><p id="CDR0000062857__294">Extragonadal extracranial germ cell tumors form in areas other than the brain, testicles, or 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 spine 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 (the small bone at the bottom of the spine, also called the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481390/" class="def">tailbone</a>).</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 younger children, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are teratomas in the sacrum or coccyx.</p><p id="CDR0000062857__297">In older children, teenagers, and young adults, extragonadal extracranial germ cell tumors are often in the mediastinum.</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 an extracranial germ cell tumor.</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 germ cell tumors in the testicles or ovaries.</p></dd><dt>-</dt><dd><p class="no_top_margin">Turner syndrome may increase the risk of germ cell tumors in the ovaries.</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 developing a testicular germ cell tumor.</div></li></ul></div><div id="CDR0000062857__15"><h3>Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is 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 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>.</div></li><li class="half_rhythm"><div>In females, 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, 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">Most malignant germ cell tumors release tumor markers. The following tumor markers are 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 dye 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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062857409" co-legend-rid="figlgndCDR0000062857409"><a href="/books/NBK65737.2/figure/CDR0000062857__409/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062857409" rid-ob="figobCDR0000062857409"><img class="small-thumb" src="/books/NBK65737.2/bin/CDR0000775531.gif" src-large="/books/NBK65737.2/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan of the abdomen" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062857409"><h4 id="CDR0000062857__409"><a href="/books/NBK65737.2/figure/CDR0000062857__409/?report=objectonly" target="object" rid-ob="figobCDR0000062857409">Figure</a></h4><p class="float-caption no_bottom_margin">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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062857410" co-legend-rid="figlgndCDR0000062857410"><a href="/books/NBK65737.2/figure/CDR0000062857__410/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062857410" rid-ob="figobCDR0000062857410"><img class="small-thumb" src="/books/NBK65737.2/bin/CDR0000775532.gif" src-large="/books/NBK65737.2/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) of the abdomen" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062857410"><h4 id="CDR0000062857__410"><a href="/books/NBK65737.2/figure/CDR0000062857__410/?report=objectonly" target="object" rid-ob="figobCDR0000062857410">Figure</a></h4><p class="float-caption no_bottom_margin">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 class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062857411" co-legend-rid="figlgndCDR0000062857411"><a href="/books/NBK65737.2/figure/CDR0000062857__411/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062857411" rid-ob="figobCDR0000062857411"><img class="small-thumb" src="/books/NBK65737.2/bin/CDR0000775457.gif" src-large="/books/NBK65737.2/bin/CDR0000775457.jpg" alt="Abdominal ultrasound" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062857411"><h4 id="CDR0000062857__411"><a href="/books/NBK65737.2/figure/CDR0000062857__411/?report=objectonly" target="object" rid-ob="figobCDR0000062857411">Figure</a></h4><p class="float-caption no_bottom_margin">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. In some cases, the tumor is removed during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and then a biopsy is done.</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 cells in a sample of tissue are viewed under a microscope to look for certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a>. </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 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> in a sample of tissue. The antibody is usually linked to a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types 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__166"><li class="half_rhythm"><div>The type of germ cell tumor.</div></li><li class="half_rhythm"><div>Where the tumor first began to grow.</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 or to other places in the body).</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>Whether the tumor can be completely removed by surgery.</div></li><li class="half_rhythm"><div>The patient's age and general health.</div></li><li class="half_rhythm"><div>Whether the cancer has just been <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> 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 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></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 <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 metastatic tumor is the same type of cancer as the primary tumor. 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 germ cells. The disease is metastatic extracranial germ cell tumor, not liver cancer.</p></div><div id="CDR0000062857__387"><h3>Stages are used to describe the different types of extracranial germ cell tumors.</h3><div id="CDR0000062857__389"><h4>Childhood nonseminoma testicular germ cell tumors</h4><ul id="CDR0000062857__391"><li class="half_rhythm"><div><b>Stage I:</b> 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 and is completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div><b>Stage II:</b> In stage II, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and some cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> remain in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046573/" class="def">scrotum</a> or cancer that can be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> only has spread to the scrotum or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615541/" class="def">spermatic cord</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">Tumor marker</a> levels do not return to normal after surgery or the tumor marker levels increase.</div></li><li class="half_rhythm"><div><b>Stage III:</b> In stage III, 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> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and is not completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. The cancer that remains after surgery can be seen without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>.</div></li><li class="half_rhythm"><div><b>Stage IV:</b> In stage IV, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415317/" class="def">distant</a> parts of the body such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, brain, bone, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>.</div></li></ul></div><div id="CDR0000062857__392"><h4>Childhood ovarian germ cell tumors </h4><p id="CDR0000062857__394">There are two types of stages used for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446560/" class="def">ovarian germ cell tumors</a>. The following stages are from the Children's Oncology Group:</p><ul id="CDR0000062857__395"><li class="half_rhythm"><div><b>Stage I:</b> In stage I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> and can be completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering) of the ovary has not ruptured (broken open).</div></li><li class="half_rhythm"><div><b>Stage II:</b> In stage II, one of the following is true: <dl id="CDR0000062857__396" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The <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>. The remaining cancer can be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> only.</p></dd><dt>-</dt><dd><p class="no_top_margin">The cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and can be seen with a microscope only.</p></dd><dt>-</dt><dd><p class="no_top_margin">The cancer has spread to 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_CDR0000046687/" class="def">ovary</a>.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage III:</b> In stage III, one of the following is true:<dl id="CDR0000062857__397" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The <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>. The remaining cancer can be seen without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and the lymph nodes are 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or larger. Cancer in the lymph nodes can be seen without a microscope.</p></dd><dt>-</dt><dd><p class="no_top_margin">The cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b> In stage IV, 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_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, brain, or bone. </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><b>Stage I:</b> 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.
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<dl id="CDR0000062857__400" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Stage IA: Cancer is found in one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IB: Cancer is found in both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IC: Cancer is found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> and one of the following is true:<ul id="CDR0000062857__219"><li class="half_rhythm"><div>cancer is 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> has ruptured (broken open); 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> that has collected in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; or</div></li><li class="half_rhythm"><div>cancer cells are found 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></p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage II:</b> 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>. Stage II is divided into stage IIA, stage IIB, and stage IIC. <dl id="CDR0000062857__401" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> to the uterus).
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</p></dd><dt>-</dt><dd><p class="no_top_margin">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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</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIC: Cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a> and/or 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> and one of the following is true:<ul id="CDR0000062857__340"><li class="half_rhythm"><div>cancer is found on the outside surface of one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>; 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> has ruptured (broken open); 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> that has collected in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; or</div></li><li class="half_rhythm"><div>cancer cells are found 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_CDR0000463703/" 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></p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage III:</b> In stage III, <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 to other parts of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. Cancer that has spread to the surface of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> is also stage III disease.
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Stage III is divided into stage IIIA, stage IIIB, and stage IIIC: <div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062857218" co-legend-rid="figlgndCDR0000062857218"><a href="/books/NBK65737.2/figure/CDR0000062857__218/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062857218" rid-ob="figobCDR0000062857218"><img class="small-thumb" src="/books/NBK65737.2/bin/CDR0000415526.gif" src-large="/books/NBK65737.2/bin/CDR0000415526.jpg" alt="Pea, peanut, walnut, and lime show tumor sizes" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062857218"><h4 id="CDR0000062857__218"><a href="/books/NBK65737.2/figure/CDR0000062857__218/?report=objectonly" target="object" rid-ob="figobCDR0000062857218">Figure</a></h4><p class="float-caption no_bottom_margin">Pea, peanut, walnut, and lime show tumor sizes. </p></div></div><dl id="CDR0000062857__402" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Stage IIIA: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> only, but cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that can only be seen 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> (<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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>) or to the small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a>.
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</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIIB: Cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> and is 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIIC: Cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> and is larger than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044224/" class="def">diameter</a> and/or has spread to <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>.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b> In stage IV, <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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046283/" class="def">metastasized</a> (spread) beyond the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> to other parts of the body.
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Cancer that has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> is also stage IV disease.</div></li></ul></div><div id="CDR0000062857__403"><h4>Childhood extragonadal extracranial germ cell tumors</h4><ul id="CDR0000062857__405"><li class="half_rhythm"><div><b>Stage I:</b> In stage I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is in one place and can be completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> 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> (bottom part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>), the sacrum and coccyx are completely removed by surgery. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">Tumor marker</a> levels return to normal after surgery. </div></li><li class="half_rhythm"><div><b>Stage II:</b> In stage II, 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_CDR0000455334/" class="def">capsule</a> (outer covering) and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. The cancer is not completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> and the cancer remaining after surgery can be seen with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> only. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">Tumor marker</a> levels do not return to normal after surgery or increase.</div></li><li class="half_rhythm"><div><b>Stage III:</b> In stage III, one of the following is true:<dl id="CDR0000062857__406" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The <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>. The cancer remaining after surgery can be seen without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and is larger than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> in diameter.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b> In stage IV, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to distant parts of the body, including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, brain, bone, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>.</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 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">Some cancer treatments cause side effects months or years after treatment has ended.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__55">Three types of standard treatment are used:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062857__79">New types of treatment are being tested in clinical trials. </a></div></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 standard (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>Some cancer treatments cause side effects months or years after treatment has ended.</h3><p id="CDR0000062857__260">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> from cancer treatment that begin during or 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.
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</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.
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</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).
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</div></li></ul><p id="CDR0000062857__283">For example, late effects of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> 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> include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>, loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> control, and scars.</p><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">Surgery to completely remove the tumor 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">Even if 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 cells 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"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045981/" class="def">Observation</a> 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>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one anticancer drug. 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.</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="http://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__353"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> is a way of giving high doses of chemotherapy and replacing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>-forming cells destroyed by the cancer treatment. <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 chemotherapy is completed, 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__354"><h4>Hyperthermia therapy</h4><p id="CDR0000062857__356"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046263/" class="def">Hyperthermia therapy</a> is a
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treatment in which body tissue is heated above normal temperature to damage and
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kill cancer cells or to make cancer cells more sensitive to the effects of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> and certain anticancer drugs.</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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </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, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP) tests and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a> (β-hCG) tests are done to see if treatment is working. Continued high levels of AFP or β-hCG may mean the cancer is still growing. For at least 3 years after surgery, follow-up will include regular physical exams, imaging tests, and tumor marker tests.</p></div></div><div id="CDR0000062857__159"><h2 id="_CDR0000062857__159_">Treatment Options for Childhood Extracranial Germ Cell Tumors</h2><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> that are not 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> (bottom part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</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> that are not in the sacrum or coccyx 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 and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> for stage II–IV tumors. It is not known if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> will help the patient live longer.</div></li></ul><p id="CDR0000062857__375">Treatment of immature teratomas that are in the sacrum or coccyx includes the following:</p><ul id="CDR0000062857__376"><li class="half_rhythm"><div>Surgery (removal of the sacrum and coccyx) followed by observation.</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>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratoma</a> and malignant cells may need to be treated differently. </p><p id="CDR0000062857__282">Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000732562/" class="def">tumor marker test</a> will be done for at least 3 years.</p><p id="CDR0000062857__TrialSearch_93_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43494&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">childhood teratoma</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</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 15 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">combination chemotherapy</a> for stage II-IV tumors. A second surgery may be done to remove any tumor remaining after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li></ul><p id="CDR0000062857__292">For boys 15 years and older:</p><p id="CDR0000062857__153">Malignant testicular germ cell tumors in boys 15 years and older are treated differently than they are in young boys. Surgery may include removal of <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>. (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><p id="CDR0000062857__TrialSearch_96_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43495&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">childhood malignant testicular germ cell tumor</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</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> in young girls 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">Combination chemotherapy</a> may be given if the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> comes back.</div></li></ul><p id="CDR0000062857__361">Treatment of stages II–IV dysgerminomas in young girls may include the following:</p><ul id="CDR0000062857__362"><li class="half_rhythm"><div>Surgery (unilateral salpingo-oophorectomy) followed by combination chemotherapy.</div></li><li class="half_rhythm"><div>Combination chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).</div></li></ul></div><div id="CDR0000062857__363"><h5>Nongerminomas</h5><p id="CDR0000062857__349">Treatment of stage I nongerminomas 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>. </div></li><li class="half_rhythm"><div>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>.</div></li></ul><p id="CDR0000062857__365">Treatment of stages II–IV nongerminomas in young girls may include the following:</p><ul id="CDR0000062857__350"><li class="half_rhythm"><div>Surgery followed by combination chemotherapy. A second surgery may be done to remove any remaining <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a> followed by combination chemotherapy to shrink the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and sometimes surgery for tumors that cannot be removed by surgery when cancer is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>.</div></li></ul><p id="CDR0000062857__183">The treatment for adolescents and young adults with ovarian germ cell tumor is
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much like the treatment for adults. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> treatment summary on <a href="/books/n/pdqcis/CDR0000062967/">Ovarian Germ Cell Tumors</a> for more information.)</p><p id="CDR0000062857__TrialSearch_99_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43496&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">childhood malignant ovarian germ cell tumor</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000661950/" class="def">extragonadal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443318/" class="def">extracranial</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a> may include the following:</p><ul id="CDR0000062857__105"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> to shrink 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_CDR0000045570/" class="def">surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443329/" class="def">sacrum</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443343/" class="def">coccyx</a> (bottom part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>) for tumors that are in the sacrum or coccyx.</div></li><li class="half_rhythm"><div>Combination chemotherapy to shrink the tumor followed by surgery to remove tumors that are in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046288/" class="def">mediastinum</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a> followed by combination chemotherapy to shrink the tumor and surgery to remove tumors that are in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</div></li><li class="half_rhythm"><div>Surgery to remove the tumor followed by combination chemotherapy for tumors of the head and neck.</div></li></ul><p id="CDR0000062857__377">Treatment of malignant extragonadal extracranial germ cell tumors in places not already described includes the following:</p><ul id="CDR0000062857__378"><li class="half_rhythm"><div>Surgery followed by combination chemotherapy.</div></li></ul><p id="CDR0000062857__TrialSearch_103_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43497&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">childhood extragonadal germ cell tumor</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062857__107"><h3>Recurrent Childhood Malignant Extracranial Germ Cell Tumors </h3><p id="CDR0000062857__108">There is no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood <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_CDR0000444992/" class="def">extracranial germ cell tumors</a>. Treatment depends on the following:</p><ul id="CDR0000062857__379"><li class="half_rhythm"><div>The type of treatment given when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> was <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>.</div></li><li class="half_rhythm"><div>How the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responded</a> to the initial treatment.</div></li></ul><p id="CDR0000062857__380">Treatment is usually within a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> and 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>Surgery followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>, for most malignant 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>Surgery for tumors that come back 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> (bottom part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>), if surgery to remove the sacrum and coccyx was not done when the cancer was diagnosed. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> may be given before surgery, to shrink the tumor. If any tumor remains after surgery, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> may also be given.</div></li><li class="half_rhythm"><div>Combination chemotherapy for stage I malignant testicular germ cell tumors and stage I <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044984/" class="def">ovarian</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000672835/" class="def">dysgerminomas</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>Radiation therapy followed by surgery to remove the tumor in the brain for cancer that has spread to the brain.</div></li></ul><p id="CDR0000062857__TrialSearch_107_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43498&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent childhood malignant germ cell tumor</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</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 extracranial germ cell tumors, see the following.</p><ul id="CDR0000062857__343"><li class="half_rhythm"><div><a href="http://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="http://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="http://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="http://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="http://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="http://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="http://www.cancer.gov/about-cancer/diagnosis-staging/staging/staging-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a></div></li><li class="half_rhythm"><div><a href="http://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="http://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="http://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__160"><h2 id="_CDR0000062857__160_">Changes to This Summary (10/01/2015)</h2><p id="CDR0000062857__161">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.</p><p id="CDR0000062857__162">Images were added to this summary.</p></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="http://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 ("Date Last Modified") 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="http://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 are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 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">National Cancer Institute: PDQ® Childhood Extracranial Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/extracranial-germ-cell/patient/germ-cell-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/extracranial-germ-cell/patient/germ-cell-treatment-pdq</a>. Accessed <MM/DD/YYYY>.</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="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 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="http://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="http://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="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div><div id="CDR0000062857__GetMore_3"><h2 id="_CDR0000062857__GetMore_3_">Get More Information From NCI</h2><p id="CDR0000062857__GetMore_15"><i><b>Call 1-800-4-CANCER</b></i></p><p id="CDR0000062857__GetMore_16">For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.</p><p id="CDR0000062857__GetMore_25"><i><b>Chat online
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</b></i></p><p id="CDR0000062857__GetMore_26">The <a href="https://livehelp.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's LiveHelp®</a> online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI websites and answer questions about cancer.
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</p><p id="CDR0000062857__GetMore_27"><i><b>Write to us</b></i></p><p id="CDR0000062857__GetMore_28">For more information from the NCI, please write to this address:</p><ul id="CDR0000062857__GetMore_29" class="simple-list"><li class="half_rhythm"><div>NCI Public Inquiries Office</div></li><li class="half_rhythm"><div>9609 Medical Center Dr. </div></li><li class="half_rhythm"><div>Room 2E532 MSC 9760</div></li><li class="half_rhythm"><div>Bethesda, MD 20892-9760</div></li></ul><p id="CDR0000062857__GetMore_17"><i><b>Search the NCI websites</b></i></p><p id="CDR0000062857__GetMore_18">The <a href="http://www.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a> provides online access to information on cancer, clinical trials, and other websites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen web pages that are most closely related to the search term entered.</p><p id="CDR0000062857__GetMore_30">There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.</p><p id="CDR0000062857__GetMore_19"><i><b>Find Publications</b></i></p><p id="CDR0000062857__GetMore_20">The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the <a href="https://pubs.cancer.gov/ncipl" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI Publications Locator</a>. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).</p></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/NBK65737.2/?report=reader">PubReader</a></li><li><a href="/books/NBK65737.2/?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. 2015 Oct 1. In: PDQ Cancer Information Summaries [Internet]. 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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$=inpage&link_id=inpage">Treatment Options for Childhood Extracranial Germ Cell Tumors</a></li><li><a href="#CDR0000062857__192" 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389213" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Extragonadal Germ Cell Tumors Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Extragonadal Germ Cell Tumors Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389502" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31593394" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Mesothelioma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span 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