KEY POINTS
- 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.
- Three types of standard treatment are used:
- Surgery
- Observation
- Chemotherapy
- New types of treatment are being tested in clinical trials.
- High-dose chemotherapy with stem cell transplant
- Radiation therapy
- Targeted therapy
- Treatment for childhood extracranial germ cell tumors may cause side effects.
- 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:
- Pediatrician.
- Pediatric surgeon.
- Pediatric hematologist.
- Radiation oncologist.
- Endocrinologist.
- Pediatric nurse specialist.
- Rehabilitation specialist.
- Child life professional.
- Psychologist.
- Social worker.
- Geneticist.
- Fertility specialist.
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:
- Resection: Surgery to remove tissue or part or all of an organ.
- 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 on the same side.
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 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). Systemic chemotherapy is used to treat extracranial germ cell tumors.
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 doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. 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 patient completes chemotherapy, 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. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. 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 identify and attack specific cancer cells. Targeted therapy is being studied for the treatment of extracranial germ cell tumors that have come back.
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, such as infertility, trouble hearing and kidney problems.
- Changes in mood, feelings, thinking, learning, or memory.
- Second cancers (new types of cancer), such as leukemia or malignant melanoma.
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.
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, follow-up may include regular physical exams, tumor marker tests, and imaging tests such as CT scan, MRI or chest x-ray.
Treatment of Childhood Mature and Immature Teratomas
Treatment of newly diagnosed mature teratomas includes the following:
- Surgery to remove the tumor followed by observation.
Treatment of newly diagnosed immature teratomas includes the following:
- Surgery to remove the tumor followed by observation for stage I tumors.
- Surgery to remove the tumor for stage I–IV tumors. In young children, surgery is followed by observation; the use of chemotherapy after surgery is controversial. In adolescents and young adults, chemotherapy is given after surgery.
Sometimes a mature or immature teratoma also has malignant cells. A teratoma with malignant cells may need to be treated differently.
Treatment of Malignant Testicular Germ Cell Tumors
Treatment of newly diagnosed malignant testicular germ cell tumors may include the following:
For boys younger than 11 years:
- Surgery (radical inguinal orchiectomy) followed by observation for stage I tumors.
- Surgery (radical inguinal orchiectomy) followed by chemotherapy for stage II–IV tumors and repeat surgery to remove any remaining tumor.
- A clinical trial of a new regimen of surgery followed by observation for stage I tumors or chemotherapy for stage II–IV tumors.
- A clinical trial of a new chemotherapy regimen for stage II–IV tumors.
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. For more information, see Testicular Cancer Treatment.
- Surgery to remove the tumor. Sometimes lymph nodes in the abdomen are also removed.
- A clinical trial of a new regimen of surgery followed by observation for stage I tumors or chemotherapy for stage II–IV tumors.
- A clinical trial of a new chemotherapy regimen.
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.
Treatment of Malignant Ovarian Germ Cell Tumors
Dysgerminomas
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed stage I dysgerminomas of the ovary may include the following:
- Surgery (unilateral salpingo-oophorectomy) followed by observation. Chemotherapy may be given if tumor marker levels do not decrease after surgery or the tumor comes back.
- A clinical trial of a new regimen of surgery followed by observation.
Treatment of newly diagnosed stages II–IV dysgerminomas of the ovary may include the following:
- Surgery (unilateral salpingo-oophorectomy) followed by chemotherapy.
- Chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).
- A clinical trial of a new chemotherapy regimen.
Nongerminomas
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed nongerminomas of the ovary, such as yolk sac tumors, mixed germ cell tumors, choriocarcinoma, and embryonal carcinomas, in young girls may include the following:
- Surgery followed by observation for stage I tumors.
- Surgery followed by chemotherapy for stage I–IV tumors.
- A clinical trial of a new regimen of surgery followed by observation for stage I tumors or chemotherapy for stage II–IV.
Treatment of newly diagnosed nongerminomas of the ovary in adolescents and young women may include the following:
- Surgery and chemotherapy for stage I–IV tumors.
- A clinical trial of a new regimen of surgery followed by observation for stage I or chemotherapy for stage II–IV.
- A clinical trial of a new chemotherapy regimen.
Treatment of newly diagnosed 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.
Treatment of Malignant Extragonadal Extracranial Germ Cell Tumors
Treatment of newly diagnosed childhood malignant extragonadal extracranial germ cell tumors in young children may include the following:
- Surgery and chemotherapy for stage I–IV tumors.
- Biopsy followed by chemotherapy with or without surgery for stage III and IV tumors.
In addition to stage of the disease, treatment of malignant extragonadal extracranial germ cell tumors also depends on where the tumor formed in the body:
- For tumors in the sacrum or coccyx, chemotherapy to shrink the tumor followed by surgery to remove the tumor and coccyx.
- For tumors in the mediastinum, chemotherapy before or after surgery to remove the tumor in the mediastinum.
- For tumors in the abdomen, biopsy followed by chemotherapy to shrink the tumor and surgery to remove the tumor in the abdomen.
- For tumors in the head and neck, surgery to remove the tumor in the head or neck followed by chemotherapy.
Treatment of newly diagnosed childhood malignant extragonadal extracranial germ cell tumors in adolescents and young adults may include the following:
- Surgery.
- Chemotherapy.
- Chemotherapy followed by surgery to remove the tumor.
- A clinical trial of a new regimen of surgery followed by observation for stage I tumors or chemotherapy for stage II–IV tumors.
- A clinical trial of a new chemotherapy regimen.
Treatment of Recurrent Childhood Malignant Extracranial Germ Cell Tumors
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of recurrent childhood extracranial germ cell tumors may include the following:
- Surgery.
- Chemotherapy given before or after surgery, 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 that were stage I at diagnosis.
- High-dose chemotherapy and stem cell transplant.
- Radiation therapy followed by surgery to remove 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.