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Childhood Germ Cell Tumors Diagnosis

There are several ways doctors can diagnose a childhood germ cell tumor. In most cases, the diagnosis will start with a physical exam that finds symptoms such as swelling, lumps and pain. Blood tests can be used to check for tumor markers, including high levels of hormones produced by the specific types of germ cell tumors.

Tumors can also be diagnosed through imaging exams, including :

  • Bone scans
  • CT scans
  • MRI
  • Ultrasound
  • X-ray

Doctors can also perform a biopsy, where a small piece of a suspected tumor is removed and then analyzed.

Childhood germ cell tumor staging

Doctors stage cancer based on how far it has progressed. A cancer’s stage helps determine the patient’s treatment and prognosis.

There is no agreed upon staging system for childhood germ cell tumors in the brain. Seminoma testicular cancers are staged using the main testicular cancer staging systems. There are staging system for many other germ cell tumors (source: National Cancer Institute).

Childhood germ cell tumor stages

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.

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.

Extragonadal germ cell tumors

Instead of staging, extragonadal germ cell tumors are usually placed in prognostic groups.  

Good prognosis

A nonseminoma extragonadal germ cell tumor is in the good prognosis group if:

  • the tumor is in the back of the abdomen; and
  • the tumor has not spread to organs other than the lungs; and
  • the levels of tumor markers AFP and β-hCG are normal and LDH is slightly above normal.

A seminoma extragonadal germ cell tumor is in the good prognosis group if:

  • the tumor has not spread to organs other than the lungs; and
  • the level of AFP is normal; β-hCG and LDH may be at any level.

Intermediate prognosis

A nonseminoma extragonadal germ cell tumor is in the intermediate prognosis group if:

  • the tumor is in the back of the abdomen; and
  • the tumor has not spread to organs other than the lungs; and
  • the level of any one of the tumor markers (AFP, β-hCG, or LDH) is more than slightly above normal.

A seminoma extragonadal germ cell tumor is in the intermediate prognosis group if:

  • the tumor has spread to organs other than the lungs; and
  • the level of AFP is normal; β-hCG and LDH may be at any level.

Poor prognosis

A nonseminoma extragonadal germ cell tumor is in the poor prognosis group if:

  • the tumor is in the chest; or
  • the tumor has spread to organs other than the lungs; or
  • the level of any one of the tumor markers (AFP, β-hCG, or LDH) is high.

No patients with a seminoma germ cell tumor are classified as having a poor prognosis.

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