Key Points
                    - 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.    - Cancer may spread from where it began to other parts of the body.    - Stages are used to describe the different types of extracranial germ cell tumors.         - Childhood nonseminoma testicular germ cell tumors     - Childhood ovarian germ cell tumors      - Childhood extragonadal 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 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.
                    Childhood nonseminoma testicular germ cell tumors            -  Stage I: In stage I, the cancer is found in the testicle only and is completely removed by surgery.     -  Stage II: In stage II, the cancer is removed by surgery and some cancer cells remain in the scrotum or cancer that can be seen with a microscope only has spread to the scrotum or spermatic cord. Tumor marker levels do not return to normal after surgery or the tumor marker levels increase.     -  Stage III: In stage III, the cancer has spread to one or more lymph nodes in the abdomen and is not completely removed by surgery. The cancer that remains after surgery can be seen without a microscope.     -  Stage IV: In stage IV, the cancer has spread to distant parts of the body such as the liver, brain, bone, or lung.              Childhood ovarian germ cell tumors     There are two types of stages used for childhood ovarian germ cell tumors. The following stages are from the Children's Oncology Group:            -  Stage I: In stage I, the cancer is in the ovary and can be completely removed by surgery and the capsule (outer covering) of the ovary has not ruptured (broken open).     -  Stage II: In stage II, one of the following is true:                   - The cancer is not completely removed by surgery. The remaining cancer can be seen with a microscope only.       - The cancer has spread to the lymph nodes and can be seen with a microscope only.       - The cancer has spread to the capsule (outer covering) of the ovary.                -  Stage III: In stage III, one of the following is true:                  - The cancer is not completely removed by surgery. The remaining cancer can be seen without a microscope.       - The cancer has spread to lymph nodes and the lymph nodes are 2 centimeters or larger. Cancer in the lymph nodes can be seen without a microscope.       - The cancer is found in fluid in the abdomen.                -  Stage IV: In stage IV, the cancer has spread to the lung, liver, brain, or bone.            The following stages are from the International Federation of Gynecology and Obstetrics (FIGO):            -  Stage I: 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 one 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 fluid that has collected in the abdomen; or          - cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).                                 -  Stage II: 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 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 fluid that has collected in the abdomen; or          - cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).                                 -  Stage III: In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Cancer that has spread to the surface of the liver is also stage III disease. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC:                   - Stage IIIA: The tumor is found in the pelvis only, but cancer cells that can only be seen with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen) or to the small bowel.        - Stage IIIB: Cancer has spread to the peritoneum and 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.                -  Stage IV: 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 stage IV disease.              Childhood extragonadal extracranial germ cell tumors            -  Stage I: In stage I, the cancer is in one place and can be completely removed by surgery. For tumors in the sacrum or coccyx (bottom part of the spine), the sacrum and coccyx are completely removed by surgery. Tumor marker levels return to normal after surgery.      -  Stage II: In stage II, the cancer has spread to the capsule (outer covering) and/or lymph nodes. The cancer is not completely removed by surgery and the cancer remaining after surgery can be seen with a microscope only. Tumor marker levels do not return to normal after surgery or increase.     -  Stage III: In stage III, one of the following is true:                  - The cancer is not completely removed by surgery. The cancer remaining after surgery can be seen without a microscope.       - The cancer has spread to lymph nodes and is larger than 2 centimeters in diameter.                -  Stage IV: In stage IV, the cancer has spread to distant parts of the body, including the liver, brain, bone, or lung.