21st Century Pediatric Cancer Sourcebook: Childhood Extracranial Germ Cell Tumors (Gonadal, Extragonadal), Teratomas, Seminomas, Yolk Sac Tumors, Germinomas, Choriocarcinomas
Edition 1.0 - March 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Childhood Extracranial Germ Cell Tumors Treatment
PART TWO
Chapter 1B Late Effects of Treatment for Childhood Cancer - Patient Version
Chapter 2B: Pediatric Supportive Care
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: When Someone You Love Is Being Treated For Cancer
Chapter 15B: Living Beyond Cancer: Finding a New Balance
Chapter 16B: Caring for the Caregiver
Chapter 17B: Young People With Cancer, A Handbook For Parents
Chapter 18B: When Cancer Returns
Chapter 19B: When Someone You Love Has Advanced Cancer / Support for Caregivers
Chapter 20B: Chemotherapy and You
Chapter 21B: Managing Chemotherapy Side Effects - Anemia
Chapter 22B: Managing Chemotherapy Side Effects - Appetite Changes
Chapter 23B: Managing Chemotherapy Side Effects - Bleeding Problems
Chapter 24B: Managing Chemotherapy Side Effects - Constipation
Chapter 25B: Managing Chemotherapy Side Effects - Memory Changes
Chapter 26B: Managing Chemotherapy Side Effects - Mouth and Throat Changes
Chapter 27B: Managing Chemotherapy Side Effects - Nerve Changes
Chapter 28B: Managing Chemotherapy Side Effects - Pain
Chapter 29B: Managing Chemotherapy Side Effects - Skin and Nail Changes
Chapter 30B: Managing Chemotherapy Side Effects - Swelling (Fluid retention)
Chapter 31B: Targeted Cancer Therapies
Chapter 33B : Follow-up Care After Cancer Treatment
Chapter 34B: Radiation Therapy and You
Chapter 36B: Understanding Radiation Therapy, What To Know About External Beam Radiation Therapy
Chapter 37B: Radiation Therapy for Cancer
Chapter 38B: Managing Radiation Therapy Side Effects - What To Do When Your Mouth or Throat Hurts
Chapter 39B: What To Do About Hair Loss (Alopecia)
Chapter 42B: Managing Radiation Therapy Side Effects - Changes When You Urinate
Chapter 43B: Managing Radiation Therapy Side Effects What To Do About Mild Skin Changes
Chapter 45B: General Cancer Information And Resources
Chapter 46B: Cancer And The Environment - What You Need to Know, What You Can Do
Chapter 48B: FDA Warning: Beware of Online Cancer Fraud
Chapter 49B: FDA Office of Oncology Drug Products
Chapter 50B: Understanding the HIPAA Privacy Rule
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Chapter 1A: Childhood Extracranial Germ Cell Tumors
Childhood Extracranial Germ Cell Tumors Treatment
Last Modified: 04/09/2010
Childhood extracranial germ cell tumors form from developing sperm or egg cells that travel to parts of the body other than the brain.
Childhood extracranial germ cell tumors may be benign or malignant.
There are three types of extracranial germ cell tumors.
Mature Teratomas
Immature Teratomas
Malignant Germ Cell Tumors
Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal.
Gonadal Germ Cell Tumors
Extragonadal Extracranial Germ Cell Tumors
The cause of most childhood extracranial germ cell tumors is unknown.
Having certain inherited disorders can increase the risk of developing an extracranial germ cell tumor.
Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body.
Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors.
Certain factors affect prognosis (chance of recovery) and treatment options.
Childhood extracranial germ cell tumors form from developing sperm or egg cells that travel to parts of the body other than the brain.
As a fetus develops, certain cells form sperm in the testicles or eggs in the ovaries. Sometimes these cells travel to other parts of the body and grow into germ cell tumors. This summary is about germ cell tumors that form in parts of the body that are extracranial (outside the brain). Extracranial germ cell tumors are most common in teenagers 15 to 19 years old.
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 mature teratomas, immature teratomas, or malignant germ cell tumors:
Mature Teratomas
Mature teratomas are the most common type of extracranial germ cell tumor. The cells of mature teratomas look very much like normal cells. Mature teratomas are benign and not likely to become cancer.
Immature Teratomas
Immature teratomas have cells that look very different from normal cells. They are more likely to become cancer.
Malignant Germ Cell Tumors
Malignant germ cell tumors are cancer. There are three types of malignant germ cell tumors:
Yolk sac tumors: Tumors that make a hormone called alpha-fetoprotein (AFP).
Germinomas: Tumors that make a hormone called beta-human chorionic gonadotropin (β-hCG).
Choriocarcinomas: Tumors that make a hormone called beta-human chorionic gonadotropin (β-hCG).
Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal.
Malignant extracranial germ cell tumors are grouped into gonadal and extragonadal.
Gonadal Germ Cell Tumors
Gonadal germ cell tumors form in the testicles or ovaries.
Testicular Germ Cell Tumors
Testicular germ cell tumors usually occur before the age of 4 years or in teenagers and young adults.
Testicular germ cell tumors in teenagers and young adults are different from those that form in early childhood. They are more like testicular cancer in adults. Testicular germ cell tumors are divided into two main types, nonseminoma and seminoma.
Nonseminoma: These tumors are usually large and cause symptoms. They tend to grow and spread more quickly than seminomas.
Seminoma: These tumors make a hormone called beta-human chorionic gonadotropin (β-hCG). They are more sensitive to radiation therapy than nonseminomas.
Boys older than 14 years with testicular germ cell tumors are treated in pediatric cancer centers, but the treatment is similar to that used in adults.
Ovarian Germ Cell Tumors
Ovarian germ cell tumors form in egg-making cells in an ovary. These tumors are more common in teenage girls and young women. Most ovarian germ cell tumors are benign teratomas.
Extragonadal Extracranial Germ Cell Tumors
Extragonadal germ cell tumors form in areas other than the testicles or ovaries.
Most germ cell tumors that are not in the testicles, ovaries, or brain, 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, 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, teenagers, and young adults, 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 developing 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. People who think they may be at risk should discuss this with their doctor. Possible risk factors for extracranial germ cell tumors include the following:
Having certain genetic syndromes may increase the risk of developing childhood germ cell tumors:
Klinefelter syndrome may increase the risk of developing germ cell tumors in the mediastinum.
Swyer syndrome may increase the risk of developing germ cell tumors in the testes or ovaries.
Having an undescended testicle may increase the risk of developing a testicular germ cell tumor.
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 symptoms. A doctor should be consulted if any of these problems occur.
Most tumors of the sacrum and coccyx can be seen as a lump.
A testicular tumor may cause a painless lump in the testicles.
An ovarian germ cell tumor may cause:
Pain or a lump in the abdomen.
Fever.
Constipation.
No menstruation.
Unusual vaginal bleeding.
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:
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 in the organ or tissue that makes it.
Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
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.
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.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. In some cases, the tumor is removed during surgery and then a biopsy is done.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
The type of germ cell tumor.
Where the tumor first began to grow.
The stage of the cancer (whether it has spread to nearby areas or to other places in the body).
Whether the tumor can be completely removed by surgery.
The patient's age and general health.
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.
Stages of Childhood Extracranial Germ Cell Tumors
Key Points for This Section
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.
There are three ways that cancer spreads in the body.
The following stages are commonly used for most childhood extracranial germ cell tumors:
Stage I extracranial germ cell tumors
Stage II extracranial germ cell tumors
Stage III extracranial germ cell tumors
Stage IV extracranial germ cell tumors
The following stages may be used for childhood extracranial germ cell tumors in the ovary:
Stage I ovarian germ cell tumors
Stage II ovarian germ cell tumors
Stage III ovarian germ cell tumors
Stage IV ovarian 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. This procedure is also called nuclear magnetic resonance imaging.
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 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 tumor may also be used in staging.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are commonly used for most childhood extracranial germ cell tumors:
Stage I extracranial germ cell tumors
In stage I, the cancer is in one place and can be completely removed by surgery.
Stage II extracranial germ cell tumors
In stage II, the cancer has spread to nearby tissues or lymph nodes and is not completely removed by surgery. The cancer remaining after surgery can be seen with a microscope only.
Stage III extracranial germ cell tumors
In stage III, the cancer:
has spread to nearby tissues and lymph nodes.
is found in fluid in the abdomen or around the lungs.
is not completely removed by surgery. The remaining cancer can be seen without a microscope.
Stage IV extracranial germ cell tumors
In stage IV, the cancer has spread to other places in the body, such as the lung, liver, brain, bone, and distant lymph nodes.
The following stages may be used for childhood extracranial germ cell tumors in the ovary:
Stage I ovarian germ cell tumors
In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.
Stage IA: Cancer is found in a single ovary.
Stage IB: Cancer is found in both ovaries.
Stage IC: Cancer is found in one or both ovaries and one of the following is true:
cancer is found on the outside surface of one or both ovaries; or
the capsule (outer covering) of the tumor has ruptured (broken open); or
cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
Stage II ovarian germ cell tumors
In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.
Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
Stage IIB: Cancer has spread to other tissue within the pelvis such as the bladder, rectum, or vagina.
Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
Stage III ovarian germ cell tumors
In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:
Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).
Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.
Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.
Cancer that has spread to the surface of the liver is also considered stage III disease.
Stage IV ovarian germ cell tumors
In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body.
Cancer that has spread to tissues in the liver is also considered stage IV disease.
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 occur within three years of surgery. About half of the teratomas that recur in the sacrum or coccyx are malignant, so follow-up is important.
Treatment Option Overview
Key Points for This Section
There are different types of treatment for children with extracranial germ cell tumors.
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.
Some cancer treatments cause side effects months or years after treatment has ended.
Three types of standard treatment are used:
Surgery
Watchful waiting
Chemotherapy
New types of treatment are being tested in clinical trials.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
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:
Pediatric surgeon. * Pediatric hematologist. * Radiation oncologist. * Endocrinologist. * Pediatric nurse specialist. * Rehabilitation specialist. * Psychologist. * Social worker. * Geneticist.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or 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.
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. The following types of surgery may be used:
Resection: Surgery to remove tissue or part or all of an organ. If cancer is in the coccyx, the entire coccyx is removed.
Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors may not be able to be completely removed.
Radical inguinal orchiectomy: Surgery to remove one or both testicles through an incision (cut) in the groin.
Unilateral salpingo-oophorectomy: Surgery to remove one ovary and one fallopian tube.
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until 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 spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. 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.
Information about clinical trials is available from the NCI Web site 4.
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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
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. This is sometimes called re-staging.
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 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 are done to see if treatment is working. Continued high levels of AFP may mean the cancer is still growing. For at least 3 years after surgery, follow-up will include regular physical exams, imaging tests, and tumor marker tests.
Treatment Options for Childhood Extracranial Germ Cell Tumors
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Mature and Immature Teratomas
Treatment of mature and immature teratomas in the sacrum or coccyx is usually surgery followed by watchful waiting. Most teratomas can be removed completely. If the tumor is in the coccyx, the entire coccyx is removed. Chemotherapy may be given if the tumor comes back.
Treatment of mature and immature teratomas that are not in the sacrum or coccyx is usually surgery followed by watchful waiting. A second surgery may be done to remove any remaining cancer.
Regular follow-up exams with imaging tests and the alpha-fetoprotein (AFP) tumor marker test will be done for at least 3 years.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood teratoma 5. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Malignant Gonadal Germ Cell Tumors
Malignant Testicular Germ Cell Tumors
Treatment of malignant testicular germ cell tumors may include the following:
For boys younger than 15 years:
Surgery (radical inguinal orchiectomy) followed by watchful waiting for stage I tumors. Chemotherapy may be given if the tumor comes back.
Surgery (radical inguinal orchiectomy) followed by combination chemotherapy for stage II-IV tumors.
A clinical trial of lower doses and fewer cycles of chemotherapy after surgery.
For boys 15 years and older:
Malignant testicular germ cell tumors in boys 15 years and older are treated differently than they are in young boys. Surgery may include removal of lymph nodes in the abdomen. Treatment depends on whether the tumor is a seminoma (which is sensitive to radiation therapy) or a nonseminoma.
Malignant Ovarian Germ Cell Tumors
Treatment of childhood malignant ovarian germ cell tumors in young girls may include the following:
Surgery (unilateral salpingo-oophorectomy) followed by watchful waiting for stage I dysgerminoma or immature teratoma tumors. Chemotherapy may be given if the tumor comes back.
Surgery (unilateral salpingo-oophorectomy) followed by combination chemotherapy for stages II-IV tumors.
Chemotherapy to make the tumor smaller, followed by surgery (unilateral salpingo-oophorectomy).
Surgery (tumor debulking) followed by chemotherapy.
A clinical trial of lower doses and fewer cycles of chemotherapy after surgery.
A clinical trial of surgery (unilateral salpingo-oophorectomy) followed by watchful waiting for stage I tumors that are not a dysgerminoma or immature teratoma.
The treatment for adolescents and young adults with ovarian germ cell tumor is similar to the treatment for adults.
Malignant Extragonadal Germ Cell Tumors
Treatment of childhood extragonadal malignant germ cell tumors may include the following:
Surgery to remove tumors in the mediastinum (the area between the lungs).
Surgery followed by combination chemotherapy.
Combination chemotherapy followed by surgery.
Chemotherapy only.
A clinical trial of lower doses and fewer cycles of chemotherapy.
A clinical trial of a new chemotherapy regimen.
A clinical trial of surgery followed by watchful waiting.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood extragonadal germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent Childhood Malignant Extracranial Germ Cell Tumors
There is no standard treatment for recurrent childhood malignant extracranial germ cell tumors. Treatment is usually within in a clinical trial and may include the following:
Surgery followed by combination chemotherapy, for malignant testicular germ cell tumors that recur after being treated with surgery and watchful waiting.
Surgery for tumors that come back in the sacrum or coccyx. Chemotherapy may be given before surgery, to shrink the tumor. If any of the tumor remains after surgery, radiation therapy may be added.
Surgery followed by chemotherapy, for malignant ovarian germ cell tumors that recur after being treated with surgery and watchful waiting.
A clinical trial of combination chemotherapy.
Glossary Terms
abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
alpha-fetoprotein (AL-fuh-FEE-toh-PROH-teen)
A protein normally produced by a fetus. AFP levels are usually undetectable in the blood of healthy adult men or women (who are not pregnant). An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. Also called AFP.
antibody (AN-tee-BAH-dee)
A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.
antigen (AN-tih-jen)
Any substance that causes the body to make a specific immune response.
benign (beh-NINE)
Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. Also called nonmalignant.
beta-human chorionic gonadotropin (BAY-tuh-HYOO-mun KOR-ee-AH-nik goh-NA-doh-TROH-pin)
A hormone normally found in the blood and urine during pregnancy. It may also be produced by some tumor cells. An increased level of beta-human chorionic gonadotropin may be a sign of cancer of the testis, uterus, ovary, liver, stomach, pancreas, or lung. Beta-human chorionic gonadotropin may also be produced in response to certain conditions that are not cancer. Beta-human chorionic gonadotropin is being studied in the treatment of Kaposi sarcoma. Also called ß-hCG.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray
An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
choriocarcinoma (KOR-ee-oh-KAR-sih-NOH-muh)
A malignant, fast-growing tumor that develops from trophoblastic cells (cells that help an embryo attach to the uterus and help form the placenta). Almost all choriocarcinomas form in the uterus after fertilization of an egg by a sperm, but a small number form in a testis or an ovary. Choriocarcinomas spread through the blood to other organs, especially the lungs. They are a type of gestational trophoblastic disease. Also called chorioblastoma, chorioepithelioma, and chorionic carcinoma.
chromosome (KROH-muh-some)
Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes.
coccyx (KOK-six)
The small bone at the bottom of the spine. It is made up of 3-5 fused bones. Also called tailbone.
constipation (KAHN-stih-PAY-shun)
A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
contrast material
A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan
A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cytogenetics (SY-toh-jeh-NEH-tix)