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Extragonadal germ cell tumor treatment will ultimately depend on the type and location of the tumor. Radiation, chemotherapy, and surgery are most commonly used, but which is used and when all depends on the location and type. If this cancer is left untreated it will continue to grow. Depending on the originating location, it may eventually spread to the bones (especially the spine), lungs, liver, and other areas of the body. The sooner treatment is started, the better the patient's prognosis in most cases.
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This is the mid-chest area. High-dose radiation is the usual treatment for seminomas in this area. Sometimes, chemotherapy will be used in addition to radiation. Chemotherapy is used to treat nonseminomas.
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This is the head. The pineal tumor will be surgically removed. Both a seminoma and nonseminoma are often treated with radiation. However, some hospitals will suggest combining low-dose radiation and chemotherapy due to the fact that high-dose radiation can result in brain damage in certain parts of the brain. The combination of radiation and chemotherapy is especially used for nonseminomas.
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This is the lower back area and retroperitoneal tumors. Before the tumor is surgically removed, chemotherapy is used to shrink it as much as possible. If the entire tumor cannot be removed surgically, the patient may have to be administered a second round of chemotherapy, followed by a second surgery to try and remove whatever remains of the tumor.
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What Chemotherapies are Used?
There are a variety of chemotherapies that can be used during extragonadal germ cell tumor treatment. Cisplatin, etoposide, bleomycin, vinblastine, and ifosfamide have all been used to treat these tumors. Ifosfamide is an alkylating agent. Bleomycin is a glycopeptide antibiotic. Etoposide causes DNA breakage and inhibits topoisomerase II. Cisplatin is exerts an antineoplastic effect and is a platinum-containing compound. Vinblastine inhibits microtubule formation and is a vinca alkaloid.
All of the above chemotherapies can cause a variety of side effects. Common side effects include nausea and vomiting, fatigue, hair loss, and diarrhea. Other problems that chemotherapies may cause include:
- Bruising or bleeding
- Nerve and muscle problems
- Fertility and sexual problems
- Low white blood cell count
- Dry skin and/or rashes
- Difficulty breathing, lung problems, and/or excessive coughing
When a patient begins chemotherapy, they are often given medications to help counteract some of the common side effects, such as the nausea, vomiting, constipation, and diarrhea.
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What Factors Affect Prognosis?
Regardless of treatment, certain factors can affect a patient's prognosis and survivability. Such factors include:
- Whether the tumor is a seminoma or nonseminoma
- The blood levels of B-hCg, LDH, and AFP
- How well the tumor responds to initial treatment
- The location and size of the tumor
- Whether the tumor has spread
- Whether the tumor was first diagnosed or recurring
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WebMD. (2010). Extragonadal Germ Cell Tumors Treatment – General Information About Extragonadal Germ Cell Tumors: http://www.webmd.com/cancer/tc/extragonadal-germ-cell-tumors-treatment-patient-information-nci-pdq-general-information-about
Aetna InteliHealth. (2007). Extragonadal Germ Cell Tumors. Retrieved on September 12, 2010 from Aetna InteliHealth: http://www.intelihealth.com/IH/ihtIH/E/9339/24580.html
Sachdeva, K. MD, et al. (2008). Extragonadal Germ Cell Tumors. Retrieved on September 12, 2010 from eMedicine Medscape: http://emedicine.medscape.com/article/278174-overview