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).[1-3] The most commonly used staging systems in the United States are as follows:
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. (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. (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:
|aAdapted from FIGO Committee on Gynecologic Oncology.|
|bIn order to evaluate the impact on prognosis of the different criteria for allotting cases to stage Ic or IIc, it is valuable to know whether rupture of the capsule was spontaneous, or caused by the surgeon; and whether the source of malignant cells detected was peritoneal washings or ascites.|
|I||Growth limited to the ovaries.|
|Ia||Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact.|
|Ib||Growth limited to both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact.|
|Icb||Tumor either stage Ia or Ib, but with tumor on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings.|
|II||Growth involving one or both ovaries with pelvic extension.|
|IIa||Extension and/or metastases to the uterus and/or tubes.|
|IIb||Extension to other pelvic tissues.|
|IIcb||Tumor either stage IIa or IIb, but with tumor on surface of one or both ovaries, or with capsule(s) ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings.|
|III||Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastases equals stage III. Tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum.|
|IIIa||Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery.|
|IIIb||Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative.|
|IIIc||Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive regional lymph nodes.|
|IV||Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allot a case to stage IV. Parenchymal liver metastasis equals stage IV.|
Extragonadal Extracranial GCT Staging From the COG
- Stage I: Localized disease; complete resection with no microscopic disease at margins or in regional lymph nodes. Tumor markers must normalize in appropriate half-life after resection. Complete coccygectomy for sacrococcygeal site.
- Stage II: Microscopic residual disease, capsular invasion, and/or microscopic lymph node involvement. Tumor markers fail to normalize or increase.
- Stage III: Gross residual disease and gross lymph node involvement (>2 cm).
- Stage IV: Distant metastases, including liver, brain, bone, or lung.
- Ablin AR, Krailo MD, Ramsay NK, et al.: Results of treatment of malignant germ cell tumors in 93 children: a report from the Childrens Cancer Study Group. J Clin Oncol 9 (10): 1782-92, 1991. [PUBMED Abstract]
- Mann JR, Pearson D, Barrett A, et al.: Results of the United Kingdom Children's Cancer Study Group's malignant germ cell tumor studies. Cancer 63 (9): 1657-67, 1989. [PUBMED Abstract]
- Marina N, Fontanesi J, Kun L, et al.: Treatment of childhood germ cell tumors. Review of the St. Jude experience from 1979 to 1988. Cancer 70 (10): 2568-75, 1992. [PUBMED Abstract]
- Brodeur GM, Howarth CB, Pratt CB, et al.: Malignant germ cell tumors in 57 children and adolescents. Cancer 48 (8): 1890-8, 1981. [PUBMED Abstract]
- de Wit R, Fizazi K: Controversies in the management of clinical stage I testis cancer. J Clin Oncol 24 (35): 5482-92, 2006. [PUBMED Abstract]
- Cannistra SA: Cancer of the ovary. N Engl J Med 329 (21): 1550-9, 1993. [PUBMED Abstract]
- FIGO Committee on Gynecologic Oncology: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 105 (1): 3-4, 2009. [PUBMED Abstract]