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 system in the United States is described below. Retroperitoneal lymph node dissection has not been required in pediatric germ cell trials to stage 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. (Refer to the PDQ summary on Testicular Cancer Treatment for more information about the staging of adult testicular GCTs.)
Nonseminoma Testicular GCT Staging From Children's Oncology Group
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Stage I: Limited to testis, complete resection by high inguinal orchiectomy or transscrotally with no tumor spillage. There must be no evidence of disease beyond the testis by radiologic scans or pathology. Tumor markers must normalize in appropriate half-life after resection.
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 < age 10 years).
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 FIGO
Another staging system used frequently by gynecologic oncologists is the International Federation of Gynecologic Oncologists (FIGO) staging system, which is based on an adequate staging operation at the time of diagnosis. (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.) This system has also been used by some pediatric centers, and is as follows: