Childhood Extracranial Germ Cell Tumors Treatment (PDQ®)

Last modified: 2018-05-04
Last downloaded: 2018-06-16

   

General Information About Childhood Extracranial Germ Cell Tumors

   

Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain.

A germ cell is a type of cell that forms as a fetus (unborn baby) develops. These cells later become sperm in the testicles or eggs in the ovaries. Sometimes while the fetus is forming, germ cells travel to parts of the body where they should not be and grow into a germ cell tumor. The tumor may form before or after birth.

This summary is about germ cell tumors that form in parts of the body that are extracranial (outside the brain). Extracranial germ cell tumors usually form in the following areas of the body:

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).

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).

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).

Extracranial germ cell tumors are most common in adolescents.

See the PDQ summary on Childhood Central Nervous System Germ Cell Tumors Treatment for information on intracranial (inside the brain) germ cell tumors.

   

Childhood extracranial germ cell tumors may be benign or malignant.

Extracranial germ cell tumors may be benign (noncancer) or malignant (cancer).

   

There are three types of extracranial germ cell tumors.

Extracranial germ cell tumors are grouped into teratomas, malignant germ cell tumors, and mixed germ cell tumors:

Teratomas 

There are two main types of teratomas:

  • Mature teratomas. These tumors are the most common type of extracranial germ cell tumor. Mature teratomas are benign tumors and not likely to become cancer. They usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or in the testicles or ovaries at the start of puberty. The cells of mature teratomas look almost like normal cells under a microscope. Some mature teratomas release enzymes or hormones that cause signs and symptoms of disease.
  • Immature teratomas. These tumors usually occur in the sacrum or coccyx in newborns or the ovaries at the start of puberty. They have cells that look very different from normal cells under a microscope. Immature teratomas may be cancer and spread to other parts of the body. They often have several different types of tissue in them, such as hair, muscle, and bone. Some immature teratomas release enzymes or hormones that cause signs and symptoms of disease.

Malignant Germ Cell Tumors 

Malignant germ cell tumors are cancer. There are two main types of malignant germ cell tumors:

  • Seminomatous germ cell tumors. These tumors make a hormone called beta-human chorionic gonadotropin (β-hCG). There are three types of seminomatous germ cell tumors:
    • Seminomas form in the testicle in boys.
    • Dysgerminomas form in the ovary in girls.
    • Germinomas form in areas of the body that are not the ovary or testicle, such as the mediastinum.
  • Non-seminomatous germ cell tumors. There are five types of non-seminomatous germ cell tumors:
    • Yolk sac tumors make a hormone called alpha-fetoprotein (AFP). They can form in the ovary, testicle, or other areas of the body.
    • Choriocarcinomas make a hormone called beta-human chorionic gonadotropin (β-hCG). They can form in the ovary, testicle, or other areas of the body.
    • Embryonalcarcinomas may make a hormone called β-hCG and/or a hormone called AFP. They can form in the testicle or other areas of the body, but not in the ovary.
    • Gonadoblastomas.
    • Teratoma and yolk sac tumors.

Mixed Germ Cell Tumors 

Mixed germ cell tumors are made up of at least two types of malignant germ cell tumor. They can form in the ovary, testicle, or other areas of the body.

   

Childhood extracranial germ cell tumors are grouped as gonadal or extracranial extragonadal.

Malignant extracranial germ cell tumors are tumors that form outside the brain. They are gonadal or extragonadal.

Gonadal Germ Cell Tumors 

Gonadal germ cell tumors form in the testicles in boys or ovaries in girls.

  • Testicular germ cell tumors. Testicular germ cell tumors are divided into two main types, seminoma and nonseminoma.
    • Seminomas make a hormone called beta-human chorionic gonadotropin (β-hCG).
    • Nonseminomas are usually large and cause signs or symptoms. They tend to grow and spread more quickly than seminomas.

    Testicular germ cell tumors usually occur before the age of 4 years or in adolescents and young adults. Testicular germ cell tumors in adolescents (aged 11 years and older) and young adults are different from those that form in early childhood.

  • Ovarian germ cell tumors. Ovarian germ cell tumors are more common in adolescent girls and young women. Most ovarian germ cell tumors are benign teratoma (dermoid cysts). Sometimes immature teratomas, dysgerminomas, yolk sac tumors, and mixed germ cell tumors (cancer) occur.

Extragonadal Extracranial Germ Cell Tumors 

Extragonadal extracranial germ cell tumors form in areas other than the brain, testicles, or ovaries.

Most extragonadal extracranial germ cell tumors form along the midline of the body. This includes the following:

  • Sacrum (the large, triangle-shaped bone in the lower spine that forms part of the pelvis).
  • Coccyx (the small bone at the bottom of the spine, also called the tailbone).
  • Mediastinum (the area between the lungs).
  • Back of the abdomen.
  • Neck.

In younger children (aged younger than 11 years), extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are teratomas in the sacrum or coccyx.

In older children, adolescents, and young adults (aged 11 years and older), extragonadal extracranial germ cell tumors are often in the mediastinum.

   

The cause of most childhood extracranial germ cell tumors is unknown.

   

Having certain inherited disorders can increase the risk of an extracranial germ cell tumor.

Anything that increases your risk of getting a disease is called a risk factor. 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.

Possible risk factors for extracranial germ cell tumors include the following:

   

Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body.

Different tumors may cause the following signs and symptoms. Other conditions may cause these same signs and symptoms. Check with a doctor if your child has any of the following:

   

Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors.

The following tests and procedures may be used:

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.

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.

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.

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.

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).

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).

  • Physical exam and history: 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.
  • Serum tumor marker test : A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers.

    Most malignant germ cell tumors release tumor markers. The following tumor markers are used to detect extracranial germ cell tumors:

    • Alpha-fetoprotein (AFP).
    • Beta-human chorionic gonadotropin (β-hCG).
    For testicular germ cell tumors, blood levels of the tumor markers help show if the tumor is a seminoma or nonseminoma.
  • Blood chemistry studies : 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.
  • Chest x-ray : An x-ray 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.
  • CT scan (CAT scan): 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 injected into a vein 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.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.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, 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).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.
  • Ultrasound exam: 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 sonogram. The picture can be printed to be looked at later.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).
  • Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Sometimes an incisional biopsy or needle biopsy is done. Sometimes the tumor is removed during surgery and then a biopsy is done.

    The following tests may be done on the sample of tissue that is removed:

   

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The patient's age and general health.
  • The stage of the cancer (whether it has spread to nearby areas, lymph nodes, or to other places in the body).
  • Where the tumor first began to grow.
  • How well the tumor responds to treatment (lower AFP and β-hCG levels).
  • The type of germ cell tumor.
  • Whether the tumor can be completely removed by surgery.
  • Whether the cancer has just been diagnosed or has recurred (come back).

The prognosis for childhood extracranial germ cell tumors, especially ovarian germ cell tumors, is good.


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Stages of Childhood Extracranial Germ Cell Tumors

   

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.

The process used to find out if cancer has spread from where the tumor started to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. In some cases, staging may follow surgery to remove the tumor.

The following procedures may be used:

  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain or lymph nodes. This procedure is also called nuclear magnetic resonance imaging.
  • CT scan (CAT scan): 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 x-ray machine. A dye may be injected into a vein 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.
  • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive 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 scanner.
  • Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
  • Paracentesis : The removal of fluid from the space between the lining of the abdomen and the organs in the abdomen, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

The results from tests and procedures used to detect and diagnose childhood extracranial germ cell tumors may also be used in staging.

   

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
   

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if an extracranial germ cell tumor spreads to the liver, the cancer cells in the liver are actually cancerous germ cells. The disease is metastatic extracranial germ cell tumor, not liver cancer.

   

Stages are used to describe the different types of extracranial germ cell tumors.

Testicular germ cell tumors (in patients aged younger than 11 years) 

The following stages are from the Children's Oncology Group:

  • Stage I: In stage I,
    • the cancer is found in the testicle only. The testicle and spermatic cord are completely removed by surgery;
    • the capsule (outer covering of the tumor) did not rupture (break open) on its own or during surgery and a needle biopsy or incisional biopsy was not done;
    • all lymph nodes are smaller than 1 centimeter in their shortest diameter as imaged by CT scan or MRI.
  • Stage II: In stage II,
    • the testicle and spermatic cord are removed by surgery.
    • the capsule (outer covering of the tumor) ruptured (broke open) on its own or during surgery or a needle biopsy or incisional biopsy was done;
    • cancer that can only be seen with a microscope remains in the scrotum or in the spermatic cord near the scrotum; tumor marker levels do not either return to normal or decrease after surgery;
    • the cancer has not spread to the lymph nodes.
  • Stage III: In stage III,
    • the cancer has spread to one or more lymph nodes at the back of the abdomen;
    • lymph nodes are at least 2 centimeters wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest diameter and either have not changed or are growing when CT scan or MRI is repeated within 4–6 weeks.
  • Stage IV: In stage IV,
    • the cancer has spread to other parts of the body, such as the liver, lung, bone, and brain.

Testicular germ cell tumors (in patients aged 11 years and older) 

See the PDQ summary on Testicular Cancer Treatment for more information about staging used for testicular germ cell tumors in patients aged 11 years and older.

Childhood ovarian germ cell tumors 

Two staging systems are used for childhood ovarian germ cell tumors.

The following stages are from the Children's Oncology Group:

  • Stage I: In stage I,
    • the tumor in the ovary is completely removed by surgery;
    • the capsule (outer covering of the tumor) did not rupture (break open) during surgery and a biopsy was not done before surgery;
    • there is no sign that the cancer has spread through the capsule;
    • no cancer cells are found in fluid taken from the abdomen;
    • no cancer is seen in tissue that lines the abdomen or found in tissue samples taken during a biopsy;
    • lymph nodes are smaller than 1 centimeter in their shortest diameter on CT scan or MRI or no cancer is found in lymph node tissue samples taken during a biopsy.
  • Stage II: In stage II,
    • the tumor in the ovary is completely removed by surgery and a biopsy was done before surgery;
    • cancer has spread through all or part of the capsule (outer covering of the tumor);
    • the tumor is larger than 10 centimeters and is removed by laparoscopic surgery;
    • the tumor is removed by being broken up into small pieces and it is not known if cancer has spread through the capsule;
    • no cancer cells are found in fluid in the abdomen;
    • no cancer is seen in lymph nodes or tissue that lines the abdomen or found in tissue samples taken during a biopsy.
  • Stage III: In stage III,
    • lymph nodes are at least 2 centimeters wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest diameter and either have not changed or are growing when CT scan or MRI is repeated 4–6 weeks after surgery;
    • the tumor is not completely removed by surgery or a biopsy was done before surgery;
    • cancer cells are found in fluid in the abdomen, including immature teratoma;
    • cancer is found in lymph nodes, including immature teratoma;
    • cancer is found in tissue that lines the abdomen, including immature teratoma.
  • Stage III-X: Stage III-X includes patients whose tumors would be described as stage I or stage II, except:
    • cells lining the abdomen are not collected;
    • lymph nodes larger than 1 cm in their shortest diameter are not biopsied;
    • tissue from the lining of the abdomen is not collected for biopsy;
    • staging is to be completed during a second surgery.
  • Stage IV: In stage IV,
    • the cancer has spread to the liver or outside the abdomen to other areas of the body, such as the bone, lung, or brain.
    • cancer cells are found in the fluid in the lung.

The following stages are from the International Federation of Gynecology and Obstetrics (FIGO):

Tumor sizes. The size of a tumor may be compared to the size of a pea (1 cm), peanut (2 cm), grape (3 cm), walnut (4 cm), lime (5 cm), egg (6 cm), peach (7 cm), or grapefruit (10 cm).

Tumor sizes. The size of a tumor may be compared to the size of a pea (1 cm), peanut (2 cm), grape (3 cm), walnut (4 cm), lime (5 cm), egg (6 cm), peach (7 cm), or grapefruit (10 cm).

Childhood extragonadal extracranial germ cell tumors 

The following stages are from the Children's Oncology Group:

  • Stage I: In stage I,
    • the tumor is completely removed by surgery and no cancer cells are found in the area where the tumor was removed;
    • the capsule (outer covering of the tumor) did not rupture (break open) on its own or during surgery and a biopsy was not done;
    • cancer cells are not found in fluid in the abdominal cavity, if the tumor is in the abdomen;
    • lymph nodes are smaller than 1 centimeter when imaged by CT scan or MRI in the abdomen, pelvis, and chest.
  • Stage II: In stage II,
    • cancer is not completely removed by surgery and cancer that can only be seen with a microscope remains after surgery;
    • the capsule (outer covering of the tumor) ruptured (broke open) on its own or during surgery or a biopsy was done;
    • cancer cells are not found in fluid in the abdominal cavity;
    • there is no sign of cancer in lymph nodes in the abdomen, pelvis, or chest when imaged by CT scan or MRI.
  • Stage III: In stage III,
    • cancer is not completely removed by surgery and cancer that can be seen with the eye remains after surgery or only a biopsy was done;
    • lymph nodes are at least 2 centimeters wide or are larger than 1 centimeter but smaller than 2 centimeters in their shortest diameter and either have not changed or are growing when CT scan or MRI is repeated within 4–6 weeks;
  • Stage IV: In stage IV,
    • the cancer has spread to other parts of the body, such as the liver, lung, bone, or brain.

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Recurrent Childhood Extracranial Germ Cell Tumors

Recurrent childhood extracranial germ cell tumor is cancer that has recurred (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body.

The number of patients who have tumors that come back is small. Most recurrent germ cell tumors come back within three years of surgery. About half of the teratomas that recur in the sacrum or coccyx are malignant, so follow-up is important.


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Treatment Option Overview

   

There are different types of treatment for children with extracranial germ cell tumors.

Different types of treatments are available for children with extracranial germ cell tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

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.

   

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.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with extracranial germ cell tumors and who specialize in certain areas of medicine. These may include the following specialists:

   

Treatment for childhood extracranial germ cell tumors may cause side effects.

For information about side effects that begin during treatment for cancer, see our Side Effects page.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:

  • Physical problems.
  • Changes in mood, feelings, thinking, learning, or memory.
  • Second cancers (new types of cancer).

For example, late effects of surgery to remove tumors in the sacrum or coccyx include constipation, loss of bowel and bladder control, and scars.

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 PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

   

Three types of standard treatment are used:

Surgery 

Surgery to completely remove the tumor is done whenever possible. If the tumor is very large, chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. A goal of surgery is to keep reproductive function. The following types of surgery may be used:

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Observation 

Observation is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. For childhood extracranial germ cell tumors, this includes physical exams, imaging tests, and tumor marker tests.

Chemotherapy 

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

   

New types of treatment are being tested in clinical trials.

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 NCI website.

High-dose chemotherapy with stem cell transplant 

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Radiation therapy 

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

The way the radiation therapy is given depends on the type of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back.

Targeted therapy 

Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Targeted therapy is being studied for the treatment of extracranial germ cell tumors that have come back.

   

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial 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 standard treatment.

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.

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.

   

Patients can enter clinical trials before, during, or after starting their cancer treatment.

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 side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

   

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage 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.

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). These tests are sometimes called follow-up tests or check-ups.

For childhood extracranial germ cell tumors, alpha-fetoprotein (AFP) tests and beta-human chorionic gonadotropin (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 and tumor marker tests. Imaging tests may include:

  • CT scan or MRI (when treatment is completed).
  • Guided imaging of the site where the cancer started (every 3 months for the first year and every six months for the second year). Since seminomas and dysgerminomas may come back later, imaging may be scheduled over a longer period of time.
  • Chest x-ray (once a year).

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Treatment Options for Childhood Extracranial Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Mature and Immature Teratomas

Treatment of mature teratomas includes the following:

Treatment of immature teratomas includes the following:

  • Surgery to remove the tumor followed by observation for stage I tumors.
  • Surgery to remove the tumor followed by observation for stage II–IV tumors.

Sometimes a mature or immature teratoma also has malignantcells. A teratoma with malignant cells may need to be treated differently.

Use our clinical trial search 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. General information about clinical trials is also available.

Malignant Gonadal Germ Cell Tumors

Malignant Testicular Germ Cell Tumors

Treatment of malignanttesticular germ cell tumors may include the following:

For boys younger than 11 years:

For boys 11 years and older:

Malignant testicular germ cell tumors in boys 11 years and older are treated differently than they are in young boys. Surgery may include removal of lymph nodes in the abdomen. (See the PDQ summary on Testicular Cancer Treatment for more information.)

Use our clinical trial search 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. General information about clinical trials is also available.

Malignant Ovarian Germ Cell Tumors

Dysgerminomas

Treatment of stage I dysgerminomas of the ovary in young girls may include the following:

Treatment of stages II–IV dysgerminomas of the ovary in young girls may include the following:

  • Surgery (unilateral salpingo-oophorectomy) followed by chemotherapy.
  • Chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).

Nongerminomas

Treatment of nongerminomas of the ovary in young girls may include the following:

Treatment of nongerminomas of the ovary in adolescents and young women may include the following:

  • Surgery and observation for stage I tumors.
  • Surgery and chemotherapy for stage I and stage II-IV tumors.

Treatment of nongerminomas of the ovary that cannot be removed by primary surgery without risk to nearby tissue may include the following:

  • Biopsy followed by chemotherapy and surgery.

Use our clinical trial search 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. General information about clinical trials is also available.

Malignant Extragonadal Extracranial Germ Cell Tumors

Treatment of childhood malignantextragonadal extracranial germ cell tumors in children younger than 11 years may include the following:

  • Surgery and chemotherapy for stages I-IV.
  • Biopsy followed by chemotherapy and possibly surgery for stages III and IV.

In addition to stage of the disease, treatment of malignant extragonadal extracranial germ cell tumors also depend on the site of the disease:

  • Chemotherapy to shrink the tumor followed by surgery to remove the sacrum and coccyx (bottom part of the spine) for tumors that are in the sacrum or coccyx.
  • Chemotherapy to shrink the tumor followed by surgery to remove tumors that are in the mediastinum.
  • Biopsy followed by chemotherapy to shrink the tumor and surgery to remove tumors that are in the abdomen.
  • Surgery to remove the tumor followed by chemotherapy for tumors of the head and neck.

Treatment of childhood malignant extragonadal extracranial germ cell tumors in children aged 11 years and older may include the following:

  • Surgery.
  • Chemotherapy.
  • Chemotherapy followed by surgery to remove any tumor remaining after chemotherapy.
  • A clinical trial of a new treatment.

Use our clinical trial search 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. General information about clinical trials is also available.

Recurrent Childhood Malignant Extracranial Germ Cell Tumors

There is no standard treatment for recurrent childhood malignantextracranial germ cell tumors. Treatment depends on the following:

Treatment is usually within a clinical trial and may include the following:

  • Surgery.
  • Surgery with chemotherapy given before or after, for most malignant extracranial germ cell tumors including immature teratomas, malignant testicular germ cell tumors, and malignant ovarian germ cell tumors.
  • Chemotherapy for recurrent malignant testicular germ cell tumors and recurrent nongerminomas of the ovary.
  • High-dose chemotherapy and stem cell transplant.
  • Radiation therapy followed by surgery to remove the tumor in the brain for cancer that has spread to the brain.
  • A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
  • A clinical trial of chemotherapy alone compared with high-dose chemotherapy followed by stem cell transplant.

Use our clinical trial search 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. General information about clinical trials is also available.


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To Learn More About Childhood Cancer

For more information from the National Cancer Institute about childhood extracranial germ cell tumors, see the following.

For more childhood cancer information and other general cancer resources, see the following:


Back to Top Source: The National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries ( http://www.cancer.gov/cancertopics/pdq)