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Home > Health Library > Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Treatment - Patient Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
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.
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), retroperitoneum (the back wall of the abdomen), and the head and neck.
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).
Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal extracranial tumors.
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 gonads (testicles and ovaries).
Testicular germ cell tumors usually occur before the age of 4 years or in adolescents and young adults. Testicular germ cell tumors in adolescents (11 years and older) and young adults are different from those that form in early childhood.
Extragonadal extracranial germ cell tumors
Extragonadal extracranial germ cell tumors form in areas of the body other than the brain or gonads (testicles and ovaries).
Most extragonadal extracranial germ cell tumors form along the midline of the body. This includes the following:
In children younger than 11 years, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are benign teratomas in the sacrum or coccyx.
In older children, adolescents, and young adults (11 years and older), extragonadal extracranial germ cell tumors are often in the mediastinum.
There are three types of extracranial germ cell tumors.
Extracranial germ cell tumors are also grouped into teratomas, malignant germ cell tumors, and mixed germ cell tumors:
There are two main types of teratomas:
Malignant germ cell tumors
Malignant germ cell tumors are cancer. There are two main types of malignant germ cell 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.
The cause of most childhood extracranial germ cell tumors is unknown.
Having certain inherited disorders can increase the risk of extracranial germ cell tumors.
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 where the tumor formed 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 diagnose childhood extracranial germ cell tumors.
The following tests and procedures may be used:
Some malignant germ cell tumors release tumor markers. The following tumor markers may be used to detect extracranial germ cell tumors:
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 and treatment options depend on the following:
The prognosis for childhood extracranial germ cell tumors, especially ovarian germ cell tumors, is good.
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:
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:
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.
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 younger than 11 years
The following stages are from the Children's Oncology Group.
In stage I, the cancer is found in the testicle only. The testicle and spermatic cord are completely removed by surgery and all of the following are true:
In stage II, the testicle and spermatic cord are removed by surgery and one of the following is true:
Cancer has not spread to the lymph nodes.
In stage III, one of the following is true:
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 11 years and older
In males older than 15 years, there are only stage I tumors and metastatic tumors. See the PDQ summary on Testicular Cancer Treatment for more information about staging used for testicular germ cell tumors in patients 11 years and older.
Ovarian germ cell tumors
Two staging systems are used for ovarian germ cell tumors: Children's Oncology Group and the International Federation of Gynecology and Obstetrics (FIGO).
In stage I, the tumor in the ovary is completely removed by surgery and all of the following are true:
In stage II, the tumor in the ovary is completely removed by surgery and a biopsy is done before surgery and one of the following is true:
Cancer cells are not found in fluid taken from the abdomen. Cancer is not seen in lymph nodes or tissue that lines the abdomen and cancer is not found in tissue samples taken during a biopsy.
In stage III, there is tumor in the ovary and one of the following is true:
In stage III-X, the tumor can be described as stage I or stage II, except:
In stage IV, one of the following is true:
The following stages are from the International Federation of Gynecology and Obstetrics (FIGO).
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.
In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis, or primary peritoneal cancer is found. Stage II is divided into stage IIA and stage IIB.
In stage III, cancer is found in one or both ovaries or primary peritoneal cancer is found. Cancer has spread outside the pelvis to other parts of the abdomen and/or to lymph nodes at the back of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.
Stage IV is divided into stage IVA and IVB.
In stage I, the tumor is completely removed by surgery and all of the following are true:
In stage II, cancer is not completely removed by surgery and one of the following is true:
Cancer cells are not found in fluid taken from the abdomen. There is no sign of cancer in lymph nodes in the abdomen, pelvis, or chest on a CT scan or MRI.
In stage IV, the cancer has spread to other parts of the body, such as the liver, lung, bone, or brain.
Childhood extracranial germ cell tumors usually do not come back after treatment.
Recurrent childhood extracranial germ cell tumor is cancer that has 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 3 years of surgery. About half of the teratomas that recur in the sacrum or coccyx are malignant, so follow-up is important.
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:
Three types of standard treatment are used:
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 surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
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 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 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 is a type of treatment that uses drugs or other substances to identify and 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.
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:
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).
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.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed mature teratomas includes the following:
Treatment of newly diagnosed immature teratomas includes the following:
Sometimes a mature or immature teratoma also has malignant cells. 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.
Treatment of newly diagnosed malignant testicular 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. (See the PDQ summary on Testicular Cancer Treatment for more information.)
Treatment of newly diagnosed stage I dysgerminomas of the ovary may include the following:
Treatment of newly diagnosed stages II–IV dysgerminomas of the ovary may include the following:
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:
Treatment of newly diagnosed nongerminomas of the ovary in adolescents and young women may include the following:
Treatment of newly diagnosed nongerminomas of the ovary that cannot be removed by primary surgery without risk to nearby tissue may include the following:
Treatment of newly diagnosed childhood malignant extragonadal extracranial germ cell tumors in young children may include the following:
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:
Treatment of newly diagnosed childhood malignant extragonadal extracranial germ cell tumors in adolescents and young adults may include the following:
Treatment of recurrent childhood extracranial germ cell tumors may include the following:
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:
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This PDQ cancer information summary has current information about the treatment of childhood extracranial germ cell tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Extracranial Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/extracranial-germ-cell/patient/germ-cell-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389180]
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Last Revised: 2020-12-08
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