Question:  What are the treatments for Childhood Extracranial Germ Cell Tumors ?
Answer: 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.    - Some cancer treatments cause side effects months or years after treatment has ended.    - 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        - 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.
                
                
                    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. (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:            -  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.           Even if 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 patients 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). 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.
                    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:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           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.
                
                
                    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.   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 (-hCG) tests are done to see if treatment is working. Continued high levels of AFP or -hCG 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
		            
		                
		                    Mature and Immature Teratomas
		                    Treatment of mature teratomas that are not in the sacrum or coccyx (bottom part of the spine) includes the following:         -  Surgery to remove the tumor followed by observation.        Treatment of immature teratomas that are not in the sacrum or coccyx includes the following:         - Surgery to remove the tumor followed by observation for stage I tumors.    - Surgery to remove the tumor for stage IIIV tumors.         Treatment of immature teratomas that are in the sacrum or coccyx includes the following:         - Surgery (removal of the sacrum and coccyx) followed by observation.        Sometimes a mature or immature teratoma also has malignant cells. The teratoma and malignant cells may need to be treated differently.    Regular follow-up exams with imaging tests and the alpha-fetoprotein (AFP) tumor marker test will be done for at least 3 years.   Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood teratoma. 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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.
		                
		                
		                    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 observation for stage I tumors.     - Surgery (radical inguinal orchiectomy) followed by combination chemotherapy for stage II-IV tumors. A second surgery may be done to remove any tumor remaining after chemotherapy.           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. (See the PDQ summary on Testicular Cancer Treatment for more information.)    Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood malignant testicular 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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.       Malignant Ovarian Germ Cell Tumors        Dysgerminomas     Treatment of stage I dysgerminomas in young girls may include the following:               -  Surgery (unilateral salpingo-oophorectomy) followed by observation. Combination chemotherapy may be given if the tumor comes back.              Treatment of stages IIIV dysgerminomas in young girls may include the following:               - Surgery (unilateral salpingo-oophorectomy) followed by combination chemotherapy.      - Combination chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).                   Nongerminomas     Treatment of stage I nongerminomas in young girls may include the following:               -  Surgery followed by observation.       - Surgery followed by combination chemotherapy.              Treatment of stages IIIV nongerminomas in young girls may include the following:               - Surgery followed by combination chemotherapy. A second surgery may be done to remove any remaining cancer.      -  Biopsy followed by combination chemotherapy to shrink the tumor and sometimes surgery for tumors that cannot be removed by surgery when cancer is diagnosed.                The treatment for adolescents and young adults with ovarian germ cell tumor is much like the treatment for adults. (See the PDQ treatment summary on Ovarian Germ Cell Tumors for more information.)    Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood malignant ovarian 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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.
		                
		                
		                    Malignant Extragonadal Extracranial Germ Cell Tumors
		                    Treatment of childhood malignant extragonadal extracranial germ cell tumors may include the following:         -  Combination 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.    - Combination chemotherapy to shrink the tumor followed by surgery to remove tumors that are in the mediastinum.    -  Biopsy followed by combination chemotherapy to shrink the tumor and surgery to remove tumors that are in the abdomen.    - Surgery to remove the tumor followed by combination chemotherapy for tumors of the head and neck.        Treatment of malignant extragonadal extracranial germ cell tumors in places not already described includes the following:         - Surgery followed by combination chemotherapy.        Check the list of NCI-supported 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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.
		                
		                
		                    Recurrent Childhood Malignant Extracranial Germ Cell Tumors
		                    There is no standard treatment for recurrent childhood malignant extracranial germ cell tumors. Treatment depends on the following:         - The type of treatment given when the cancer was diagnosed.    - How the tumor responded to the initial treatment.        Treatment is usually within a clinical trial and may include the following:         -  Surgery.    - Surgery followed by combination chemotherapy, for most malignant extracranial germ cell tumors including immature teratomas, malignant testicular germ cell tumors, and malignant ovarian germ cell tumors.     - Surgery for tumors that come back in the sacrum or coccyx (bottom part of the spine), if surgery to remove the sacrum and coccyx was not done when the cancer was diagnosed. Chemotherapy may be given before surgery, to shrink the tumor. If any tumor remains after surgery, radiation therapy may also be given.    - Combination chemotherapy for stage I malignant testicular germ cell tumors and stage I ovarian dysgerminomas.    -  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 of combination chemotherapy alone compared with high-dose chemotherapy followed by stem cell transplant.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent childhood malignant 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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.