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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2012/02/18" /><meta name="citation_author" content="PDQ Pediatric Treatment Editorial Board" /><meta name="citation_pmid" content="26389502" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK84259/" /><meta name="citation_keywords" content="childhood central nervous system germ cell tumor" /><meta name="citation_keywords" content="childhood brain tumor" /><meta name="citation_keywords" content="childhood central nervous system germinoma" /><meta name="citation_keywords" content="childhood central nervous system teratoma" /><meta name="citation_keywords" content="childhood central nervous system choriocarcinoma" /><meta name="citation_keywords" content="childhood central nervous system mixed germ cell tumor" /><meta name="citation_keywords" content="childhood central nervous system yolk sac tumor" /><meta name="citation_keywords" content="childhood brain tumor" /><meta name="citation_keywords" content="childhood central nervous system choriocarcinoma" /><meta name="citation_keywords" content="childhood central nervous system germ cell tumor" /><meta name="citation_keywords" content="childhood central nervous system germinoma" /><meta name="citation_keywords" content="childhood central nervous system mixed germ cell tumor" /><meta name="citation_keywords" content="childhood central nervous system teratoma" /><meta name="citation_keywords" content="childhood central nervous system yolk sac tumor" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Pediatric Treatment Editorial Board" /><meta name="DC.Date" content="2012/02/18" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK84259/" /><meta name="description" content="Childhood central nervous system (CNS) germ cell tumors form from germ cells (a type of cell that forms as a fetus develops and later becomes sperm in the testicles or eggs in the ovaries). Learn about the signs, tests to diagnose, and treatment of pediatric germ cell tumors in the brain in this expert-reviewed summary." /><meta name="og:title" content="Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Childhood central nervous system (CNS) germ cell tumors form from germ cells (a type of cell that forms as a fetus develops and later becomes sperm in the testicles or eggs in the ovaries). Learn about the signs, tests to diagnose, and treatment of pediatric germ cell tumors in the brain in this expert-reviewed summary." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK84259/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000719453/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK84259/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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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="#__NBK84259_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK84259_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="_NBK84259_"><span class="title" itemprop="name">Childhood Central Nervous System 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: January 12, 2024.</p><p class="small">Created: <span itemprop="datePublished">February 18, 2012</span>.</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="CDR0000719453__304">This PDQ cancer information summary has current information about the treatment of childhood central nervous system 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="CDR0000719453__305">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="CDR0000719453__1"><h2 id="_CDR0000719453__1_">General Information About Childhood Central Nervous System (CNS) Germ Cell Tumors</h2><div id="CDR0000719453__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000719453__2">Childhood central nervous system (CNS) germ cell tumors form from germ cells.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__126">There are different types of childhood CNS germ cell tumors. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000719453__245">Germinomas</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__253">Nongerminomas</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__318">Teratomas</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000719453__12">Signs and symptoms of childhood CNS germ cell tumors include unusual thirst, frequent urination, or vision changes.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__16">Imaging studies and other tests are used to help diagnose childhood CNS germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__289">A biopsy may be done to be sure of the diagnosis of a CNS germ cell tumor.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__20">Certain factors affect prognosis (chance of recovery).</a></div></li></ul></div><div id="CDR0000719453__2"><h3>Childhood central nervous system (CNS) germ cell tumors form from germ cells.
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</h3><p id="CDR0000719453__295"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046382/" class="def">Germ cells</a> are the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046563/" class="def">reproductive cells</a> in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046400/" class="def">fetus</a>. 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 unfertilized eggs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>. Sometimes the germ cells travel to or from other parts of the fetus as it develops and later become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a>. Most germ cell tumors form in the testes or ovaries. Germ cell tumors that form in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045643/" class="def">CNS</a> (central nervous system) germ cell tumors.</p><p id="CDR0000719453__243">CNS germ cell tumors occur most often in people aged 10 to 19 years and more often in males than in females. The most common places for one or more CNS germ cell tumors to form is in the brain near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046226/" class="def">pineal gland</a> and in an area of the brain that includes the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046229/" class="def">pituitary gland</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> just above it. Sometimes germ cell tumors form in other areas of the brain.</p><div id="CDR0000719453__242" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20inside%20of%20the%20brain%2C%20showing%20the%20pineal%20and%20pituitary%20glands%2C%20optic%20nerve%2C%20ventricles%20(with%20cerebrospinal%20fluid%20shown%20in%20blue)%2C%20and%20other%20parts%20of%20the%20brain&p=BOOKS&id=599361_CDR0000689771.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK84259.18/bin/CDR0000689771.jpg" alt="Drawing of the inside of the brain showing ventricles (fluid-filled spaces), choroid plexus, hypothalamus, pineal gland, pituitary gland, optic nerve, brain stem, cerebellum, cerebrum, medulla, pons, and spinal cord." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.</p></div></div><p id="CDR0000719453__3164">The cause of most childhood CNS germ cell tumors is not known.</p><p id="CDR0000719453__296">This summary is about germ cell tumors that start in the central nervous system (brain and spinal cord). Germ cell tumors may also form in other parts of the body. For information on germ cell tumors that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443318/" class="def">extracranial</a> (outside the brain), see <a href="/books/n/pdqcis/CDR0000062857/">Childhood Extracranial Germ Cell Tumors Treatment</a>. </p><p id="CDR0000719453__263">Treatment of CNS germ cell tumors may be different for children and adults. See the following PDQ summaries for information about treatment for adults:</p><ul id="CDR0000719453__278"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000062697/">Adult Central Nervous System Tumors Treatment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000271920/">Extragonadal Germ Cell Tumors Treatment</a>
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</div></li></ul></div><div id="CDR0000719453__126"><h3>There are different types of childhood CNS germ cell tumors. </h3><p id="CDR0000719453__244">Different types of CNS germ cell tumors can form from the germ cells that later become sperm or unfertilized eggs. The type of CNS germ cell tumor that is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> depends on what the cells look like under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> and results of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory tests</a> that check <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor marker</a> levels.</p><p id="CDR0000719453__328">This summary is about the treatment of several types of CNS germ cell tumors.</p><div id="CDR0000719453__245"><h4>Germinomas</h4><p id="CDR0000719453__247"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800814/" class="def">Germinomas</a> are the most common type of CNS germ cell tumor and have a good <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>. Tumor marker levels are not used to diagnose germinomas.</p></div><div id="CDR0000719453__253"><h4>Nongerminomas</h4><p id="CDR0000719453__255">Some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800816/" class="def">nongerminomas</a> make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a> (beta-hCG). Types of nongerminomas include the following:</p><ul id="CDR0000719453__256"><li class="half_rhythm"><div><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> make the hormone AFP.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000791306/" class="def">Yolk sac tumors</a> make the hormone AFP.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">Choriocarcinomas</a> make the hormone beta-hCG.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000791309/" class="def">Mixed germ cell tumors</a> are made of more than one kind of germ cell. They may make AFP and beta-hCG.</div></li></ul></div><div id="CDR0000719453__318"><h4>Teratomas</h4><p id="CDR0000719453__315">CNS <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratomas</a> are described as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature</a>, based on how normal the cells look under a microscope. Mature teratomas look almost like normal cells under a microscope and are made of different kinds of tissue, such as hair, muscle, and bone. Immature teratomas look very different from normal cells under a microscope and are made of cells that look like fetal cells. Some immature teratomas are a mix of mature and immature cells. Tumor marker levels are not used to diagnose teratomas.</p></div></div><div id="CDR0000719453__12"><h3>Signs and symptoms of childhood CNS germ cell tumors include unusual thirst, frequent urination, or vision changes.</h3><p id="CDR0000719453__284"><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> depend on the following:</p><ul id="CDR0000719453__285"><li class="half_rhythm"><div>Where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has formed.</div></li><li class="half_rhythm"><div>The size of the tumor.</div></li><li class="half_rhythm"><div>Whether the tumor or the body make too much of certain hormones.</div></li></ul><p id="CDR0000719453__14">Signs and symptoms may be caused by childhood CNS germ cell tumors or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. Check with your child's doctor if your child has any of the following:</p><ul id="CDR0000719453__15"><li class="half_rhythm"><div>Being very thirsty.</div></li><li class="half_rhythm"><div>Making large amounts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a> that is clear or almost clear.</div></li><li class="half_rhythm"><div>Frequent urination.</div></li><li class="half_rhythm"><div>Bed wetting or getting up at night to urinate.</div></li><li class="half_rhythm"><div>Trouble moving the eyes, trouble seeing clearly, or seeing double.</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440113/" class="def">puberty</a>.</div></li><li class="half_rhythm"><div>Headaches.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li><li class="half_rhythm"><div>Having problems with school work.</div></li></ul></div><div id="CDR0000719453__16"><h3>Imaging studies and other tests are used to help diagnose childhood CNS germ cell tumors.</h3><p id="CDR0000719453__18">In addition to asking about your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">personal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642015/" class="def">family health history</a> and doing a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>, your child's doctor may perform the following tests and procedures:</p><ul id="CDR0000719453__238"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322871/" class="def">Neurological exam</a></b>: A series of questions and tests to check the brain, spinal cord, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerve</a> function. The exam checks a person's mental status, coordination, and ability to walk normally, and how well the muscles, reflexes, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000792756/" class="def">senses</a> work. This may also be called a neuro exam or a neurologic exam.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Visual field exam</b>: An exam to check a person's field of vision (the total area in which objects can be seen). This test measures both central vision (how much a person can see when looking straight ahead) and peripheral vision (how much a person can see in all other directions while staring straight ahead). The eyes are tested one at a time. The eye not being tested is covered.</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) with and without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597153/" class="def">gadolinium</a></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 brain and spinal cord. A substance called gadolinium is <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>. The gadolinium may collect around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the lining around the spinal cord to remove a sample of the CSF. The sample of CSF is checked under a microscope for signs of tumor cells and tested for tumor markers. The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> in the sample may also be tested. This procedure is also called an LP or spinal tap.<div id="CDR0000719453__281" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Lumbar%20puncture&p=BOOKS&id=599361_CDR0000503953.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK84259.18/bin/CDR0000503953.jpg" alt="Lumbar puncture; drawing shows a patient lying in a curled position on a table and a spinal needle (a long, thin needle) being inserted into the lower back. Inset shows a close-up of the spinal needle inserted into the cerebrospinal fluid (CSF) in the lower part of the spinal column." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000732562/" class="def">Tumor marker tests</a></b>: A procedure in which a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> or cerebrospinal fluid (CSF) is checked to measure the amounts of certain substances released into the blood or CSF normally by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and tissues, or at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormally</a> high levels by tumor cells in the body. Certain substances are linked to specific types of cancer when found at increased levels in the blood or CSF. These are called tumor markers. </div><div class="half_rhythm">The following tumor markers are used to diagnose some CNS germ cell tumors:<dl id="CDR0000719453__237" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">Alpha-fetoprotein</a> (AFP).</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">Beta-human chorionic gonadotropin</a> (beta-hCG).</p></dd></dl>
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</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>Blood hormone studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain hormones 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 in the organ or tissue that makes it. The blood will be checked for the levels of hormones made by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046229/" class="def">pituitary gland</a> and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">glands</a>.</div></li></ul></div><div id="CDR0000719453__289"><h3>A biopsy may be done to be sure of the diagnosis of a CNS germ cell tumor.</h3><p id="CDR0000719453__291">If doctors think your child may have a CNS germ cell tumor, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> may be done. For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">brain tumors</a>, the biopsy can be done by removing part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> or making a small hole in the skull and using a needle or surgical device to remove a sample of tissue. Sometimes, when a needle is used, it is guided by a computer to remove the tissue sample. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor may remove as much tumor as safely possible during the same <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. The piece of skull is usually put back in place after the procedure. </p><div id="CDR0000719453__292" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Craniotomy&p=BOOKS&id=599361_CDR0000691155.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK84259.18/bin/CDR0000691155.jpg" alt="Drawing of a craniotomy showing a section of the scalp that has been pulled back to remove a piece of the skull; the dura covering the brain has been opened to expose the brain. The layer of muscle under the scalp is also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Craniotomy. An opening is made in the skull and a piece of the skull is removed to show part of the brain.</p></div></div><p id="CDR0000719453__293">The following test may be done on the sample of tissue that is removed:</p><ul id="CDR0000719453__294"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A laboratory test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient's tissue. The antibodies are usually linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.</div></li></ul><p id="CDR0000719453__320">Sometimes the diagnosis can be made based on the results of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046361/" class="def">imaging</a> and tumor marker tests and a biopsy is not needed. </p></div><div id="CDR0000719453__20"><h3>Certain factors affect prognosis (chance of recovery).</h3><p id="CDR0000719453__22">The prognosis depends on the following:
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</p><ul id="CDR0000719453__23"><li class="half_rhythm"><div>The type of germ cell tumor.</div></li><li class="half_rhythm"><div>The type and level of any tumor markers.</div></li><li class="half_rhythm"><div>Where the tumor is in the brain or in the spinal cord.</div></li><li class="half_rhythm"><div>
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Whether the cancer has spread within the brain and spinal cord or to other parts of the body.
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</div></li><li class="half_rhythm"><div>Whether the tumor is newly diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after treatment. </div></li></ul></div></div><div id="CDR0000719453__26"><h2 id="_CDR0000719453__26_">Stages of Childhood CNS Germ Cell Tumors</h2><div id="CDR0000719453__26.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000719453__27">Childhood central nervous system (CNS) germ cell tumors rarely spread outside of the brain and spinal cord.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__3162">Sometimes childhood central nervous system germ cell tumors come back after treatment.</a></div></li></ul></div><div id="CDR0000719453__27"><h3>Childhood central nervous system (CNS) germ cell tumors rarely spread outside of the brain and spinal cord.</h3><p id="CDR0000719453__273">The process used to find out how much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> there is and whether the cancer has spread is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. There is no standard <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689095/" class="def">staging system</a> for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a>.</p><p id="CDR0000719453__321"> The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774686/" class="def">treatment plan</a> depends on the following:</p><ul id="CDR0000719453__297"><li class="half_rhythm"><div>The type of germ cell tumor.</div></li><li class="half_rhythm"><div>Whether the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> or to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> or bone.</div></li><li class="half_rhythm"><div>The results of <a href="#CDR0000719453__16">tests and procedures</a> done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> childhood CNS germ cell tumors.
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</div></li><li class="half_rhythm"><div>Whether the tumor is newly diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after treatment.</div></li></ul></div><div id="CDR0000719453__3162"><h3>Sometimes childhood central nervous system germ cell tumors come back after treatment.</h3><p id="CDR0000719453__331">The tumors usually recur (come back) where they first formed. The tumors may also come back in other places and/or in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046295/" class="def">meninges</a> (thin layers of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> that cover and protect the brain and spinal cord).</p></div></div><div id="CDR0000719453__52"><h2 id="_CDR0000719453__52_">Treatment Option Overview</h2><div id="CDR0000719453__52.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000719453__53">There are different types of treatment for children with central nervous system (CNS) germ cell tumors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__58">Children with CNS germ cell tumors should have their treatment planned
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by a team of health care providers who are experts in treating
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cancer in children. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__67">Four types of treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000719453__73">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__76">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__69">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__79">High-dose chemotherapy with stem cell rescue</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000719453__85">New types of treatment are being tested in clinical
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trials.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__62">Treatment for childhood CNS germ cell tumors may cause side effects.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__94">Patients may want to think about taking part in a
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clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__96">Patients can enter clinical trials before, during, or
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after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000719453__98">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000719453__53"><h3>There are different types of treatment for children with central nervous system (CNS) germ cell tumors.</h3><p id="CDR0000719453__56">
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Different types of
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treatment are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a>. Some
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treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and
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some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical
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trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current
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treatments or obtain information on new treatments for people
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is
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better than the standard treatment, the new treatment may
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become the standard treatment.</p><p id="CDR0000719453__57">Because cancer in children is rare, taking part in a clinical
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trial should be considered. Some clinical trials are open only
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to patients who have not started treatment.</p></div><div id="CDR0000719453__58"><h3>Children with CNS germ cell tumors should have their treatment planned
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by a team of health care providers who are experts in treating
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cancer in children. </h3><p id="CDR0000719453__60">Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a> and/or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">radiation oncologist</a>. A pediatric oncologist is a doctor who specializes in treating children with cancer. A radiation oncologist specializes in treating cancer with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>. These doctors work with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046245/" class="def">pediatric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who
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are experts in treating children with CNS germ cell tumors and who specialize
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in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may include the following
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000719453__61"><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>Pediatric <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046269/" class="def">neurosurgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046267/" class="def">Neurologist</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>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000631048/" class="def">Ophthalmologist.</a>
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</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_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_CDR0000809738/" class="def">Fertility specialists</a>.</div></li></ul></div><div id="CDR0000719453__67"><h3>Four types of treatment are used:</h3><div id="CDR0000719453__73"><h4>Radiation therapy</h4><p id="CDR0000719453__75">
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Radiation therapy is a cancer treatment that
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uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill
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cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or keep them from growing. </p><p id="CDR0000719453__329"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a
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machine outside the body to send radiation toward the area of the body with cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. This type of radiation therapy may include the following:</p><ul id="CDR0000719453__330"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046701/" class="def">Stereotactic radiosurgery</a>: Stereotactic radiosurgery is a type of external radiation therapy. A rigid head frame is attached to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> to keep the head still during the radiation treatment. A machine aims a single large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of radiation directly at the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>. This procedure does not involve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.</div></li></ul><p id="CDR0000719453__267">Radiation therapy to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a> can affect growth and development in young children. Certain ways of giving radiation therapy can lessen the damage to healthy brain tissue. For children younger than 3 years, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may be given instead. This can delay or reduce the need for radiation therapy.</p></div><div id="CDR0000719453__76"><h4>Chemotherapy</h4><p id="CDR0000719453__78">
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Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>
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to stop the growth of cancer cells, either by killing the
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cells or by stopping them from dividing. When chemotherapy
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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
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drugs enter the bloodstream and can reach cancer cells
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throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>).</p></div><div id="CDR0000719453__69"><h4>Surgery</h4><p id="CDR0000719453__276">Whether surgery to remove the tumor can be done depends on where the tumor is in the brain. Surgery to remove the tumor may cause severe, long-term <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a>.</p><p id="CDR0000719453__269">Surgery may be done to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratomas</a> and may be used for germ cell tumors that come back. After the doctor removes all the cancer that can be seen
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at the time of the surgery, some patients may be given
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chemotherapy or radiation therapy 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="CDR0000719453__79"><h4>High-dose chemotherapy with stem cell rescue</h4><p id="CDR0000719453__326">High doses of chemotherapy are given to kill cancer cells. Healthy cells, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>-forming cells, are also destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> is a treatment to replace the blood-forming cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> of the patient and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. These reinfused stem cells grow into (and restore) the body's blood cells.</p></div></div><div id="CDR0000719453__85"><h3>New types of treatment are being tested in clinical
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trials.</h3><p id="CDR0000719453__87">Information about clinical trials is available from the
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<a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000719453__62"><h3>Treatment for childhood CNS germ cell tumors may cause side effects.
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</h3><p id="CDR0000719453__62_md_76">To learn more about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, visit <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a>.</p><p id="CDR0000719453__64"> Side effects from cancer treatment that begin after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer
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treatment may include the following:</p><ul id="CDR0000719453__65"><li class="half_rhythm"><div>Physical problems including the following:<ul id="CDR0000719453__3165"><li class="half_rhythm"><div>Vision problems.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458098/" class="def">Endocrine</a> problems, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683346/" class="def">diabetes insipidus</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">Blood vessel</a> problems, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439425/" class="def">stroke</a>.</div></li></ul></div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or
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memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer).</div></li></ul><p id="CDR0000719453__66">Some late effects may be treated or controlled. Talk with your child's doctors about the possible late
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effects caused by some treatments. For more information, see <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment
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for Childhood Cancer</a>.
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</p></div><div id="CDR0000719453__94"><h3>Patients may want to think about taking part in a
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clinical trial.</h3><p id="CDR0000719453__94_md_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="CDR0000719453__94_md_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="CDR0000719453__94_md_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="CDR0000719453__96"><h3>Patients can enter clinical trials before, during, or
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after starting their cancer treatment.</h3><p id="CDR0000719453__96_md_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 recurring (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="CDR0000719453__96_md_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000719453__98"><h3>Follow-up tests may be needed.</h3><p id="CDR0000719453__98_md_98">As your child goes through treatment, they will have follow-up tests or check-ups. Some of the tests that were done to diagnose the cancer may be repeated 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="CDR0000719453__98_md_99">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 condition has changed or if the cancer has recurred (come back).</p><p id="CDR0000719453__271">Children whose cancer affected their <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046229/" class="def">pituitary gland</a> when the cancer was diagnosed will usually need to have their blood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormone</a> levels checked. If the blood hormone level is low, replacement hormone medicine is given. </p><p id="CDR0000719453__298">Children who had a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor marker</a> level (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a>) when the cancer was diagnosed usually need to have their blood tumor marker level checked. If the tumor marker level increases after initial treatment, the tumor may have recurred. </p></div></div><div id="CDR0000719453__101"><h2 id="_CDR0000719453__101_">Treatment of Childhood CNS Germinomas</h2><p id="CDR0000719453__316">For information about the treatments listed below, see the <a href="#CDR0000719453__67">Treatment Option Overview</a> section.</p><p id="CDR0000719453__102">Treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800814/" class="def">germinomas</a> may include:</p><ul id="CDR0000719453__103"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>Radiation therapy to the whole <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a> including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045939/" class="def">ventricles</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a>-filled spaces of the brain) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. A higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> is given to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> than the area around the tumor.</div></li><li class="half_rhythm"><div>Radiation therapy to the ventricles and the tumor.</div></li></ul></div><div id="CDR0000719453__107"><h2 id="_CDR0000719453__107_">Treatment of Childhood CNS Nongerminomas</h2><p id="CDR0000719453__3160">For information about the treatments listed below, see the <a href="#CDR0000719453__67">Treatment Option Overview</a> section.</p><p id="CDR0000719453__108">It is not clear what treatment is best for newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800816/" class="def">nongerminomas</a>.</p><p id="CDR0000719453__323">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">choriocarcinoma</a>, <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">carcinoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000791306/" class="def">yolk sac tumor</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000791309/" class="def">mixed germ cell tumor</a> may include:</p><ul id="CDR0000719453__109"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>. If a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638197/" class="def">mass</a> remains after chemotherapy that continues to grow and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor marker</a> levels are normal (called growing teratoma syndrome), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> may be needed to check if the mass is part teratoma, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045690/" class="def">fibrosis</a>, or a growing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>.<ul id="CDR0000719453__324"><li class="half_rhythm"><div>If the mass is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature teratoma</a> or fibrosis, radiation therapy is given.</div></li><li class="half_rhythm"><div>If the mass is a growing tumor, other treatments may be given.</div></li></ul></div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of chemotherapy with radiation therapy to treat patients with CNS nongerminomas that have not spread. </div></li></ul></div><div id="CDR0000719453__104"><h2 id="_CDR0000719453__104_">Treatment of Childhood CNS Teratomas</h2><p id="CDR0000719453__3161">For information about the treatments listed below, see the <a href="#CDR0000719453__67">Treatment Option Overview</a> section.</p><p id="CDR0000719453__105">Treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443575/" class="def">mature</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443576/" class="def">immature</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044248/" class="def">teratomas</a> may include:</p><ul id="CDR0000719453__106"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove as much of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> as possible. </div></li></ul></div><div id="CDR0000719453__110"><h2 id="_CDR0000719453__110_">Treatment of Recurrent Childhood CNS Germ Cell Tumors</h2><p id="CDR0000719453__111">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (CNS) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">germ cell tumors</a> may include:</p><ul id="CDR0000719453__112"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800814/" class="def">germinomas</a>.</div></li><li class="half_rhythm"><div><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_CDR0000666718/" class="def">stem cell rescue</a> using the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a>, with or without more radiation therapy, for germinomas and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000800816/" class="def">nongerminomas</a>.</div></li></ul></div><div id="CDR0000719453__275"><h2 id="_CDR0000719453__275_">Current Clinical Trials</h2><p id="CDR0000719453__TrialSearch_275_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000719453__119"><h2 id="_CDR0000719453__119_">To Learn More About Childhood CNS Germ Cell Tumors</h2><p id="CDR0000719453__120">For more information about childhood central nervous system germ cell tumors, see the following:</p><ul id="CDR0000719453__279"><li class="half_rhythm"><div>
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<a href="https://www.pbtc.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Pediatric Brain Tumor Consortium (PBTC)</a>
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</div></li></ul><p id="CDR0000719453__119_md_44">For more childhood cancer information and other general cancer resources, visit:</p><ul id="CDR0000719453__119_md_45"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000719453__AboutThis_1"><h2 id="_CDR0000719453__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000719453__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000719453__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000719453__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="CDR0000719453__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000719453__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood central nervous system 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="CDR0000719453__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000719453__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000719453__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000719453__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000719453__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="CDR0000719453__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000719453__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000719453__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="CDR0000719453__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000719453__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Central Nervous System Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/brain/patient/child-cns-germ-cell-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/brain/patient/child-cns-germ-cell-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389502]</p><p id="CDR0000719453__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000719453__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000719453__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000719453__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000719453__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div 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/NBK84259.18/?report=reader">PubReader</a></li><li><a href="/books/NBK84259.18/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK84259" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK84259" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Central Nervous System Germ Cell Tumors Treatment (PDQ®): Patient Version. 2024 Jan 12. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK84259.19/">NBK84259.19</a></span> November 6, 2024</li><li><span class="bk_col_itm">NBK84259.18</span> January 12, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK84259.17/">NBK84259.17</a></span> September 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href="/books/NBK84259.7/">NBK84259.7</a></span> August 18, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK84259.6/">NBK84259.6</a></span> August 29, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK84259.5/">NBK84259.5</a></span> June 10, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK84259.4/">NBK84259.4</a></span> May 25, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK84259.3/">NBK84259.3</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK84259.2/">NBK84259.2</a></span> September 22, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK84259.1/">NBK84259.1</a></span> August 26, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this 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="#CDR0000719453__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Central Nervous System (CNS) Germ Cell Tumors</a></li><li><a href="#CDR0000719453__26" ref="log$=inpage&link_id=inpage">Stages of Childhood CNS Germ Cell Tumors</a></li><li><a href="#CDR0000719453__52" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000719453__101" ref="log$=inpage&link_id=inpage">Treatment of Childhood CNS Germinomas</a></li><li><a href="#CDR0000719453__107" ref="log$=inpage&link_id=inpage">Treatment of Childhood CNS Nongerminomas</a></li><li><a href="#CDR0000719453__104" ref="log$=inpage&link_id=inpage">Treatment of Childhood CNS Teratomas</a></li><li><a href="#CDR0000719453__110" ref="log$=inpage&link_id=inpage">Treatment of Recurrent Childhood CNS Germ Cell Tumors</a></li><li><a href="#CDR0000719453__275" ref="log$=inpage&link_id=inpage">Current Clinical Trials</a></li><li><a href="#CDR0000719453__119" ref="log$=inpage&link_id=inpage">To Learn More About Childhood CNS Germ Cell Tumors</a></li><li><a href="#CDR0000719453__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK82800/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389180" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389363" ref="ordinalpos=1&linkpos=2&log$=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> Ovarian 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> Ovarian Germ Cell Tumors Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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