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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Germ cell tumours arise from the cells meant to become eggs or sperm and can appear in the gonads, lower back, chest or brain. They are among the most curable childhood cancers because they respond to cisplatin chemotherapy and release blood markers that make monitoring easy. The work now is to cure with less: surgery alone for low-risk tumours, gentler platinum drugs, and protecting hearing.
Paediatric and adolescent germ cell tumours (GCTs) are a heterogeneous family (mature and immature teratoma, yolk sac tumour, germinoma or seminoma or dysgerminoma, embryonal carcinoma, choriocarcinoma and mixed tumours) arising in gonadal and extragonadal midline sites: sacrococcygeal region, retroperitoneum, mediastinum and the pineal and suprasellar regions of the brain. Infant tumours are mostly yolk sac tumours and teratomas with a distinct genome; adolescent tumours resemble adult testicular cancer, with 12p gain. Serum AFP and beta-hCG are diagnostic, prognostic and used for surveillance.
Malignant extracranial GCTs are cured in most children with surgery and cisplatin-based chemotherapy (PEb: cisplatin, etoposide, bleomycin in North America; JEb with carboplatin in the United Kingdom). The Malignant Germ Cell International Consortium (MaGIC) pooled COG and CCLG data to build a shared risk classification, which underpins the current joint trial AGCT1531: low-risk tumours are managed with surgery and active surveillance, with chemotherapy only on relapse, and standard-risk patients are randomised between cisplatin and carboplatin to test whether hearing and kidney toxicity can be reduced without losing cure. Cisplatin ototoxicity, the main long-term harm, can be reduced with sodium thiosulfate given after each dose (ACCL0431 and SIOPEL 6, approved for children with localised solid tumours). Salvage for relapse uses high-dose chemotherapy with stem-cell rescue as in adults.
| Setting | Approach | Guideline |
|---|---|---|
| Low-risk malignant extracranial GCT (e.g. stage I testicular, stage I ovarian) | Complete resection followed by active surveillance with serial tumour markers and imaging; chemotherapy only for relapse (AGCT1531 stratum). | not mapped |
| Standard- and high-risk malignant extracranial GCT | Cisplatin, etoposide and bleomycin (PEb) or carboplatin-based JEb, with surgery of residual masses; sodium thiosulfate for otoprotection; high-dose chemotherapy with stem-cell rescue at relapse. | not mapped |
| CNS germinoma | Platinum-based chemotherapy followed by reduced-dose whole-ventricular radiotherapy with tumour boost (SIOP CNS GCT II, ACNS1123). | not mapped |
| CNS non-germinomatous GCT | Intensive platinum-based chemotherapy, second-look surgery for residual disease, then craniospinal or whole-ventricular radiotherapy depending on response and stage. | not mapped |