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    Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Childhood Extracranial GCTs

    As with other childhood solid tumors, stage directly impacts the outcome of patients with malignant germ cell tumors (GCTs).[1,2,3] The most commonly used staging systems in the United States are as follows:[4]

    • Nonseminoma Testicular GCT Staging (Children's Oncology Group [COG]).
    • Ovarian GCT Staging (COG).
    • Ovarian GCT Staging (International Federation of Gynecology and Obstetrics [FIGO]).
    • Extragonadal Extracranial GCT Staging (COG).

    Nonseminoma Testicular GCT Staging From the COG

    • Stage I: Limited to testis; complete resection by high inguinal orchiectomy or transscrotal resection with no tumor spillage. There must be no evidence of disease beyond the testis by radiologic scans or pathology.
    • Stage II: Transscrotal orchiectomy with spillage of tumor; microscopic disease in scrotum or high in spermatic cord (>0.5 cm). Tumor markers fail to normalize or increase.
    • Stage III: Gross residual disease; retroperitoneal lymph node involvement (>2 cm in boys younger than 10 years).
    • Stage IV: Distant metastases, including liver, brain, bone, and lung.

    Retroperitoneal lymph node dissection has not been required in pediatric germ cell trials to stage disease in males younger than 15 years. Data on adolescent males with testicular GCTs are limited. Retroperitoneal lymph node dissection is used for both staging and treatment in adult testicular GCT trials.[5] (Refer to the PDQ summary on Testicular Cancer Treatment for more information about the staging of adult testicular GCTs.)

    Ovarian GCT Staging From the COG

    • Stage I: Localized disease; completely resected without microscopic disease in the resected margins or evidence of capsular rupture. Negative peritoneal cytology.
    • Stage II: Microscopic residual disease, capsular invasion, or microscopic lymph node involvement.
    • Stage III: Gross residual disease, gross lymph node involvement (>2 cm), or cytologic evidence of tumor cells in ascites.
    • Stage IV: Disseminated disease involving lungs, liver, brain, or bone.

    Ovarian GCT Staging From the FIGO

    Another ovarian GCT staging system used frequently by gynecologic oncologists is the FIGO staging system, which is based on an adequate staging operation at the time of diagnosis.[6] (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.) This system has also been used by some pediatric centers [2] and is as follows:

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