Input: What are the symptoms of Neuroblastoma ?

Output: Signs and symptoms of neuroblastoma include bone pain and a lump in the abdomen, neck, or chest.The most common signs and symptoms of neuroblastoma are caused by the tumor pressing on nearby tissues as it grows or by cancer spreading to the bone. These and other signs and symptoms may be caused by neuroblastoma or by other conditions.   Check with your childs doctor if your child has any of the following:         - Lump in the abdomen, neck, or chest.    - Bulging eyes.    - Dark circles around the eyes ("black eyes").    - Bone pain.    - Swollen stomach and trouble breathing (in infants).    - Painless, bluish lumps under the skin (in infants).    - Weakness or paralysis (loss of ability to move a body part).        Less common signs and symptoms of neuroblastoma include the following:         -  Fever.    - Shortness of breath.    - Feeling tired.    - Easy bruising or bleeding.    -  Petechiae (flat, pinpoint spots under the skin caused by bleeding).    -  High blood pressure.     - Severe watery diarrhea.    -  Horner syndrome (droopy eyelid, smaller pupil, and less sweating on one side of the face).    - Jerky muscle movements.    - Uncontrolled eye movements. </s>


Input: How to diagnose Neuroblastoma ?

Output: Tests that examine many different body tissues and fluids are used to detect (find) and diagnose neuroblastoma. The following tests and procedures may be used:         -   Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.    -   Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.    -   Urine catecholamine studies: A procedure in which a urine sample is checked to measure the amount of certain substances, vanillylmandelic acid (VMA) and homovanillic acid (HVA), that are made when catecholamines break down and are released into the urine. A higher than normal amount of VMA or HVA can be a sign of neuroblastoma.    -   Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.     -   X-ray : An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.     -   MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   mIBG (metaiodobenzylguanidine) scan : A procedure used to find neuroendocrine tumors, such as neuroblastoma. A very small amount of a substance called radioactive mIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumor cells take up the radioactive mIBG and are detected by a scanner. Scans may be taken over 1-3 days. An iodine solution may be given before or during the test to keep the thyroid gland from absorbing too much of the mIBG. This test is also used to find out how well the tumor is responding to treatment. mIBG is used in high doses to treat neuroblastoma.    -   Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.    -  Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. An ultrasound exam is not done if a CT/MRI has been done. </s>


Input: What is the outlook for Neuroblastoma ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:         - Age of the child at the time of diagnosis.    - The child's risk group.    - Whether there are certain changes in the genes.    - Where in the body the tumor started.    - Tumor histology (the shape, function, and structure of the tumor cells).    - Whether there is cancer in the lymph nodes on the same side of the body as the primary cancer or whether there is cancer in the lymph nodes on the opposite side of the body.    - How the tumor responds to treatment.    - How much time passed between diagnosis and when the cancer recurred (for recurrent cancer).        Prognosis and treatment options for neuroblastoma are also affected by tumor biology, which includes:          - The patterns of the tumor cells.    - How different the tumor cells are from normal cells.    - How fast the tumor cells are growing.    - Whether the tumor shows MYCN amplification.    - Whether the tumor has changes in the ALK gene.         The tumor biology is said to be favorable or unfavorable, depending on these factors. A favorable tumor biology means there is a better chance of recovery.   In some children up to 6 months old, neuroblastoma may disappear without treatment. This is called spontaneous regression. The child is closely watched for signs or symptoms of neuroblastoma. If signs or symptoms occur, treatment may be needed. </s>


Input: What are the stages of Neuroblastoma ?

Output:
Key Points
                    - After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - The following stages are used for neuroblastoma:         - Stage 1     - Stage 2     - Stage 3     - Stage 4        - Treatment of neuroblastoma is based on risk groups.

                    After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.
                    The process used to find out the extent or spread of cancer is called staging. The information gathered from the staging process helps determine the stage of the disease. For neuroblastoma, the stage of disease affects whether the cancer is low risk, intermediate risk, or high risk. It also affects the treatment plan. The results of some tests and procedures used to diagnose neuroblastoma may be used for staging. See the General Information section for a description of these tests and procedures.   The following tests and procedures also may be used to determine the stage:         -   Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:                -  Excisional biopsy : The removal of an entire lymph node.      -  Incisional biopsy : The removal of part of a lymph node.      -  Core biopsy : The removal of tissue from a lymph node using a wide needle.       -  Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid from a lymph node using a thin needle.              -   X-ray of the bone: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if neuroblastoma spreads to the liver, the cancer cells in the liver are actually neuroblastoma cells. The disease is metastatic neuroblastoma, not liver cancer.

                    The following stages are used for neuroblastoma:
                    Stage 1    In stage 1, the tumor is in only one area and all of the tumor that can be seen is completely removed during surgery.       Stage 2     Stage 2 is divided into stages 2A and 2B.            -  Stage 2A: The tumor is in only one area and all of the tumor that can be seen cannot be completely removed during surgery.     -  Stage 2B: The tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery. Cancer cells are found in the lymph nodes near the tumor.              Stage 3    In stage 3, one of the following is true:            - the tumor cannot be completely removed during surgery and has spread from one side of the body to the other side and may also have spread to nearby lymph nodes; or     - the tumor is in only one area, on one side of the body, but has spread to lymph nodes on the other side of the body; or     - the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and the tumor cannot be removed by surgery.              Stage 4     Stage 4 is divided into stages 4 and 4S.            - In stage 4, the tumor has spread to distant lymph nodes or other parts of the body.     - In stage 4S:                   - the child is younger than 12 months; and       - the cancer has spread to the skin, liver, and/or bone marrow; and       - the tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery; and/or       - cancer cells may be found in the lymph nodes near the tumor.

                    Treatment of neuroblastoma is based on risk groups.
                    For many types of cancer, stages are used to plan treatment. For neuroblastoma, treatment depends on risk groups. The stage of neuroblastoma is one factor used to determine risk group. Other factors are the age of the child, tumor histology, and tumor biology.   There are three risk groups: low risk, intermediate risk, and high risk.         - Low-risk and intermediate-risk neuroblastoma have a good chance of being cured.    - High-risk neuroblastoma may be hard to cure. </s>


Input: What are the treatments for Neuroblastoma ?

Output:
Key Points
                    - There are different types of treatment for patients with neuroblastoma.     - Children with neuroblastoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer, especially neuroblastoma.    - Children who are treated for neuroblastoma may have late effects, including an increased risk of second cancers.     - Seven types of standard treatment are used:         - Observation     - Surgery      - Radiation therapy      - Iodine 131-mIBG therapy     - Chemotherapy      - High-dose chemotherapy and radiation therapy with stem cell rescue      - Targeted therapy        - New types of treatment are being tested in clinical trials.         - Immunotherapy     - Other drug therapy        - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with neuroblastoma.
                    Different types of treatment are available for patients with neuroblastoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.    Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

                    Children with neuroblastoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer, especially neuroblastoma.
                    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with neuroblastoma and who specialize in certain areas of medicine. These may include the following specialists:         -  Pediatric surgeon.    - Pediatric radiation oncologist..    -  Endocrinologist.    -  Neurologist.    - Pediatric neuropathologist..    -  Neuroradiologist.    -  Pediatrician.    -  Pediatric nurse specialist.    -  Social worker.    -  Child life professional.    -  Psychologist.

                    Children who are treated for neuroblastoma may have late effects, including an increased risk of second cancers.
                    Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include:         - Physical problems.    - Changes in mood, feelings, thinking, learning, or memory.    -  Second cancers (new types of cancer).          Some late effects may be treated or controlled. It is important that parents of children who are treated for neuroblastoma talk with their doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

                    Seven types of standard treatment are used:
                    Observation     Observation is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change.       Surgery      Surgery is used to treat neuroblastoma unless it has spread to other parts of the body. Depending on where the tumor is, as much of the tumor as is safely possible will be removed. If the tumor cannot be removed, a biopsy may be done instead.        Radiation therapy      Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:             -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type of cancer being treated and the child's risk group. External radiation therapy is used to treat neuroblastoma.       Iodine 131-mIBG therapy     Iodine 131-mIBG therapy is a treatment with radioactive iodine. The radioactive iodine is given through an intravenous (IV) line and enters the bloodstream which carries radiation directly to tumor cells. Radioactive iodine collects in neuroblastoma cells and kills them with the radiation that is given off. Iodine 131-mIBG therapy is sometimes used to treat high-risk neuroblastoma that comes back after initial treatment.       Chemotherapy      Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of cancer being treated and the child's risk group.    The use of two or more anticancer drugs is called combination chemotherapy.    See Drugs Approved for Neuroblastoma for more information.       High-dose chemotherapy and radiation therapy with stem cell rescue      High-dose chemotherapy and radiation therapy with stem cell rescue is a way of giving high doses of chemotherapy and radiation therapy and replacing blood -forming cells destroyed by cancer treatment for high-risk neuroblastoma. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.     Maintenance therapy is given after high-dose chemotherapy and radiation therapy with stem cell rescue to kill any cancer cells that may regrow and cause the disease to come back. Maintenance therapy is given for 6 months and includes the following treatments:            -  Isotretinoin: A vitamin -like drug that slows the cancer's ability to make more cancer cells and changes how these cells look and act. This drug is taken by mouth.     -  Dinutuximab: A type of monoclonal antibody therapy that uses an antibody made in the laboratory from a single type of immune system cell. Dinutuximab identifies and attaches to a substance, called GD2, on the surface of neuroblastoma cells. Once dinutuximab attaches to the GD2, a signal is sent to the immune system that a foreign substance has been found and needs to be killed. Then the body's immune system kills the neuroblastoma cell. Dinutuximab is given by infusion. It is a type of targeted therapy.     -  Granulocyte-macrophage colony-stimulating factor (GM-CSF): A cytokine that helps make more immune system cells, especially granulocytes and macrophages (white blood cells), which can attack and kill cancer cells.     -  Interleukin-2 (IL-2): A type of immunotherapy that boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.           See Drugs Approved for Neuroblastoma for more information.       Targeted therapy    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack cancer cells with less harm to normal cells. There are different types of targeted therapy:            -  Tyrosine kinase inhibitors are small-molecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide. Crizotinib is used to treat neuroblastoma that has come back after treatment.     -  Antibody-drug conjugates are made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to specific proteins or receptors found on certain cells, including cancer cells. The drug enters these cells and kills them without harming other cells. Lorvotuzumab mertansine is an antibody-drug conjugate being studied to treat neuroblastoma that has come back after treatment.

                    New types of treatment are being tested in clinical trials.
                    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.     Immunotherapy     Immunotherapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or biological therapy.     Vaccine therapy uses a substance to stimulate the immune system to destroy a tumor. Vaccine therapy is being studied to treat neuroblastoma that has come back after treatment.       Other drug therapy     Lenalidomide is a type of angiogenesis inhibitor. It prevents the growth of new blood vessels that are needed by a tumor to grow.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

		            Treatment Options for Neuroblastoma

		                    Low-Risk Neuroblastoma
		                    Treatment of low-risk neuroblastoma may include the following:         -  Surgery followed by observation.     -  Chemotherapy with or without surgery, for children with symptoms, children whose tumor has continued to grow and cannot be removed by surgery, or children with unfavorable tumor biology.    - Observation alone for infants younger than 6 months who have small adrenal tumors.    - Observation alone for infants who do not have signs or symptoms of neuroblastoma.    -  Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy or surgery.    - A clinical trial of treatment based on the tumor's response to treatment and tumor biology.

		                    Intermediate-Risk Neuroblastoma
		                    Treatment of intermediate-risk neuroblastoma may include the following:         -  Chemotherapy for children with symptoms or to shrink a tumor that cannot be removed by surgery. Surgery may be done after chemotherapy.    - Surgery alone for infants.    -  Observation alone for certain infants.    -  Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy or surgery.    - Radiation therapy for tumors that do not respond to other treatment.    - A clinical trial of treatment based on the tumor's response to treatment and tumor biology.

		                    High-Risk Neuroblastoma
		                    Treatment of high-risk neuroblastoma may include the following:         - A regimen of combination chemotherapy, surgery, stem cell rescue, radiation therapy, and monoclonal antibody therapy (dinutuximab) with interleukin-2 (IL-2), granulocyte-macrophage colony-stimulating factor (GM-CSF), and isotretinoin.

		                    Stage 4S Neuroblastoma
		                    There is no standard treatment for stage 4S neuroblastoma but treatment options include the following:         -  Observation with supportive care for certain children who have favorable tumor biology and do not have signs or symptoms.    -  Chemotherapy, for children who have signs or symptoms of neuroblastoma or unfavorable tumor biology, or for very young infants.    - A clinical trial of treatment based on the tumor's response to treatment and tumor biology.

		                    Recurrent Neuroblastoma
		                    Patients First Treated for Low-Risk Neuroblastoma     Treatment for recurrent neuroblastoma that is found only in the area where the cancer first formed may include the following:            -  Surgery followed by observation or chemotherapy.     - Chemotherapy that may be followed by surgery.           Treatment for recurrent neuroblastoma that has spread to other parts of the body may include the following:            - Observation.     - Chemotherapy.     - Surgery followed by chemotherapy.     - Treatment as for newly diagnosed high-risk neuroblastoma for children older than 1 year.                Patients First Treated for Intermediate-Risk Neuroblastoma     Treatment for recurrent neuroblastoma that is found only in the area where the cancer first formed may include the following:            -  Surgery that may be followed by chemotherapy.     - Treatment as for newly diagnosed high-risk neuroblastoma for neuroblastoma that has spread to other parts of the body.           Recurrent neuroblastoma that has spread to other parts of the body is treated the same way as newly diagnosed high-risk neuroblastoma.         Patients First Treated for High-Risk Neuroblastoma     Treatment for recurrent neuroblastoma may include the following:            -  Combination chemotherapy.     -  Iodine 131-mIBG therapy to relieve symptoms and improve quality of life. It may be given alone or in combination with other therapy, or before stem cell rescue.     - A second course of high-dose chemotherapy and stem cell rescue.     -  Tyrosine kinase inhibitor therapy (crizotinib) for patients with changes in the  ALK  gene.           Because there is no standard treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma, patients may want to consider a clinical trial. For information about clinical trials, please see the NCI website.         Patients with Recurrent CNS Neuroblastoma      Treatment for neuroblastoma that recurs (comes back) in the central nervous system (CNS; brain and spinal cord) may include the following:            -  Surgery to remove the tumor in the CNS followed by radiation therapy.     - A clinical trial of a new therapy.                Treatments Being Studied for Progressive/Recurrent Neuroblastoma     Some of the treatments being studied in clinical trials for neuroblastoma that recurs (comes back) or progresses (grows, spreads, or does not respond to treatment) include the following:            -  Combination chemotherapy and monoclonal antibody therapy (dinutuximab).     -   Lenalidomide and monoclonal antibody therapy (dinutuximab) with or without isotretinoin.     -  Iodine 131-mIBG given alone or with other anticancer drugs.     -  Immunotherapy (vaccine therapy).     -  Tyrosine kinase inhibitor (crizotinib) and combination chemotherapy.     -  Targeted therapy with an antibody-drug conjugate (lorvotuzumab mertansine). </s>


Input: what research (or clinical trials) is being done for Neuroblastoma ?

Output:
New types of treatment are being tested in clinical trials.
                    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.     Immunotherapy     Immunotherapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or biological therapy.     Vaccine therapy uses a substance to stimulate the immune system to destroy a tumor. Vaccine therapy is being studied to treat neuroblastoma that has come back after treatment.       Other drug therapy     Lenalidomide is a type of angiogenesis inhibitor. It prevents the growth of new blood vessels that are needed by a tumor to grow.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. </s>


Input: What is (are) Childhood Extracranial Germ Cell Tumors ?

Output:
Key Points
                    - Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain.    - Childhood extracranial germ cell tumors may be benign or malignant.    - There are three types of extracranial germ cell tumors.         - Mature Teratomas      - Immature Teratomas      - Malignant Germ Cell Tumors        - Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal.          - Gonadal Germ Cell Tumors     - Extragonadal Extracranial Germ Cell Tumors        - The cause of most childhood extracranial germ cell tumors is unknown.    - Having certain inherited disorders can increase the risk of an extracranial germ cell tumor.    - Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body.    - Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain.
                    A germ cell is a type of cell that forms as a fetus (unborn baby) develops. These cells later become sperm in the testicles or eggs in the ovaries. Sometimes while the fetus is forming, germ cells travel to parts of the body where they should not be and grow into a germ cell tumor. The tumor may form before or after birth.   This summary is about germ cell tumors that form in parts of the body that are extracranial (outside the brain). Extracranial germ cell tumors usually form in the following areas of the body:          - Testicles.    - Ovaries.    -  Sacrum or coccyx (bottom part of the spine).    - Retroperitoneum (the back wall of the abdomen).    -  Mediastinum (area between the lungs).               Extracranial germ cell tumors are most common in adolescents 15 to 19 years of age.   See the PDQ summary on Childhood Central Nervous System Germ Cell Tumors Treatment for information on intracranial (inside the brain) germ cell tumors.

                    Childhood extracranial germ cell tumors may be benign or malignant.
                    Extracranial germ cell tumors may be benign (noncancer) or malignant (cancer).

                    There are three types of extracranial germ cell tumors.
                    Extracranial germ cell tumors are grouped into mature teratomas, immature teratomas, and malignant germ cell tumors:      Mature Teratomas     Mature teratomas are the most common type of extracranial germ cell tumor. Mature teratomas are benign tumors and not likely to become cancer. They usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or in the ovaries of girls at the start of puberty. The cells of mature teratomas look almost like normal cells under a microscope. Some mature teratomas release enzymes or hormones that cause signs and symptoms of disease.       Immature Teratomas     Immature teratomas also usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or the ovaries of girls at the start of puberty. Immature teratomas have cells that look very different from normal cells under a microscope. Immature teratomas may be cancer. They often have several different types of tissue in them, such as hair, muscle, and bone. Some immature teratomas release enzymes or hormones that cause signs and symptoms of disease.       Malignant Germ Cell Tumors     Malignant germ cell tumors are cancer. There are two main types of malignant germ cell tumors:            - Germinomas: Tumors that make a hormone called beta-human chorionic gonadotropin (-hCG). There are three types of germinomas.                  -  Dysgerminomas form in the ovary in girls.       -  Seminomas form in the testicle in boys.       - Germinomas form in areas of the body that are not the ovary or testicle.                - Nongerminomas: There are four types of nongerminomas.                  - Yolk sac tumors make a hormone called alpha-fetoprotein (AFP). They can form in the ovary, testicle, or other areas of the body.       -  Choriocarcinomas make a hormone called beta-human chorionic gonadotropin (-hCG). They can form in the ovary, testicle, or other areas of the body.       -  Embryonal carcinomas may make a hormone called -hCG and/or a hormone called AFP. They can form in the testicle or other parts of the body, but not in the ovary.       - Mixed germ cell tumors are made up of both malignant germ cell tumor and teratoma. They can form in the ovary, testicle, or other areas of the body.

                    Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal.
                    Malignant extracranial germ cell tumors are gonadal or extragonadal.     Gonadal Germ Cell Tumors    Gonadal germ cell tumors form in the testicles in boys or ovaries in girls.          Testicular Germ Cell Tumors        Testicular germ cell tumors are divided into two main types, seminoma and nonseminoma.               - Seminomas make a hormone called beta-human chorionic gonadotropin (-hCG).      - Nonseminomas are usually large and cause signs or symptoms. They tend to grow and spread more quickly than seminomas.              Testicular germ cell tumors usually occur before the age of 4 years or in adolescents and young adults. Testicular germ cell tumors in adolescents and young adults are different from those that form in early childhood.     Boys older than 14 years with testicular germ cell tumors are treated in pediatric cancer centers, but the treatment is much like the treatment used in adults. (See the PDQ summary on Testicular Cancer Treatment for more information.)             Ovarian Germ Cell Tumors        Ovarian germ cell tumors are more common in adolescent girls and young women. Most ovarian germ cell tumors are benign teratomas. Sometimes immature teratomas, dysgerminomas, yolk sac tumors, and mixed germ cell tumors (cancer) occur. (See the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.)          Extragonadal Extracranial Germ Cell Tumors    Extragonadal extracranial germ cell tumors form in areas other than the brain, testicles, or ovaries.    Most extragonadal extracranial germ cell tumors form along the midline of the body. This includes the following:             - Sacrum (the large, triangle-shaped bone in the lower spine that forms part of the pelvis).     -  Coccyx (the small bone at the bottom of the spine, also called the tailbone).     -  Mediastinum (the area between the lungs).     -  Back of the abdomen.     -  Neck.           In younger children, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are teratomas in the sacrum or coccyx.    In older children, adolescents, and young adults, extragonadal extracranial germ cell tumors are often in the mediastinum. </s>


Input: What causes Childhood Extracranial Germ Cell Tumors ?

Output: The cause of most childhood extracranial germ cell tumors is unknown. </s>


Input: Who is at risk for Childhood Extracranial Germ Cell Tumors? ?

Output: Having certain inherited disorders can increase the risk of an extracranial germ cell tumor. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your childs doctor if you think your child may be at risk.    Possible risk factors for extracranial germ cell tumors include the following:         - Having certain genetic syndromes:               -  Klinefelter syndrome may increase the risk of germ cell tumors in the mediastinum.      - Swyer syndrome may increase the risk of germ cell tumors in the testicles or ovaries.      - Turner syndrome may increase the risk of germ cell tumors in the ovaries.             - Having an undescended testicle may increase the risk of developing a testicular germ cell tumor. </s>


Input: What are the symptoms of Childhood Extracranial Germ Cell Tumors ?

Output: Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body. Different tumors may cause the following signs and symptoms. Other conditions may cause these same signs and symptoms. Check with a doctor if your child has any of the following:         - A lump in the abdomen or lower back.    -  A painless lump in the testicle.    - Pain in the abdomen.    -  Fever.    -  Constipation.    - In females, no menstrual periods.    - In females, unusual vaginal bleeding. </s>


Input: How to diagnose Childhood Extracranial Germ Cell Tumors ?

Output: Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors. The following tests and procedures may be used:         -   Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The testicles may be checked for lumps, swelling, or pain. A history of the patient's health habits and past illnesses and treatments will also be taken.     -   Serum tumor marker test : A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers.  Most malignant germ cell tumors release tumor markers. The following tumor markers are used to detect extracranial germ cell tumors:                - Alpha-fetoprotein (AFP).      - Beta-human chorionic gonadotropin (-hCG).          For testicular germ cell tumors, blood levels of the tumor markers help show if the tumor is a seminoma or nonseminoma.    -   Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.    -   Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.    -   Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. In some cases, the tumor is removed during surgery and then a biopsy is done. The following tests may be done on the sample of tissue that is removed:               -  Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.       -  Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer. </s>


Input: What is the outlook for Childhood Extracranial Germ Cell Tumors ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:         - The type of germ cell tumor.    - Where the tumor first began to grow.    - The stage of the cancer (whether it has spread to nearby areas or to other places in the body).    - How well the tumor responds to treatment (lower AFP and -hCG levels).    - Whether the tumor can be completely removed by surgery.    - The patient's age and general health.    - Whether the cancer has just been diagnosed or has recurred (come back).        The prognosis for childhood extracranial germ cell tumors, especially ovarian germ cell tumors, is good. </s>


Input: What are the stages of Childhood Extracranial Germ Cell Tumors ?

Output:
Key Points
                    - After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas or to other parts of the body.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - Stages are used to describe the different types of extracranial germ cell tumors.         - Childhood nonseminoma testicular germ cell tumors     - Childhood ovarian germ cell tumors      - Childhood extragonadal extracranial germ cell tumors

                    After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas or to other parts of the body.
                    The process used to find out if cancer has spread from where the tumor started to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. In some cases, staging may follow surgery to remove the tumor.    The following procedures may be used:         -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the lymph nodes. This procedure is also called nuclear magnetic resonance imaging.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.    -   Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.    -   Paracentesis : The removal of fluid from the space between the lining of the abdomen and the organs in the abdomen, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.        The results from tests and procedures used to detect and diagnose childhood extracranial germ cell tumors may also be used in staging.

                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if an extracranial germ cell tumor spreads to the liver, the cancer cells in the liver are actually cancerous germ cells. The disease is metastatic extracranial germ cell tumor, not liver cancer.

                    Stages are used to describe the different types of extracranial germ cell tumors.
                    Childhood nonseminoma testicular germ cell tumors            -  Stage I: In stage I, the cancer is found in the testicle only and is completely removed by surgery.     -  Stage II: In stage II, the cancer is removed by surgery and some cancer cells remain in the scrotum or cancer that can be seen with a microscope only has spread to the scrotum or spermatic cord. Tumor marker levels do not return to normal after surgery or the tumor marker levels increase.     -  Stage III: In stage III, the cancer has spread to one or more lymph nodes in the abdomen and is not completely removed by surgery. The cancer that remains after surgery can be seen without a microscope.     -  Stage IV: In stage IV, the cancer has spread to distant parts of the body such as the liver, brain, bone, or lung.              Childhood ovarian germ cell tumors     There are two types of stages used for childhood ovarian germ cell tumors. The following stages are from the Children's Oncology Group:            -  Stage I: In stage I, the cancer is in the ovary and can be completely removed by surgery and the capsule (outer covering) of the ovary has not ruptured (broken open).     -  Stage II: In stage II, one of the following is true:                   - The cancer is not completely removed by surgery. The remaining cancer can be seen with a microscope only.       - The cancer has spread to the lymph nodes and can be seen with a microscope only.       - The cancer has spread to the capsule (outer covering) of the ovary.                -  Stage III: In stage III, one of the following is true:                  - The cancer is not completely removed by surgery. The remaining cancer can be seen without a microscope.       - The cancer has spread to lymph nodes and the lymph nodes are 2 centimeters or larger. Cancer in the lymph nodes can be seen without a microscope.       - The cancer is found in fluid in the abdomen.                -  Stage IV: In stage IV, the cancer has spread to the lung, liver, brain, or bone.            The following stages are from the International Federation of Gynecology and Obstetrics (FIGO):            -  Stage I: In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC.                   - Stage IA: Cancer is found in one ovary.       - Stage IB: Cancer is found in both ovaries.       - Stage IC: Cancer is found in one or both ovaries and one of the following is true:                           - cancer is found on the outside surface of one or both ovaries; or          - the capsule (outer covering) of the tumor has ruptured (broken open); or           - cancer cells are found in fluid that has collected in the abdomen; or          - cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).                                 -  Stage II: In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.                   - Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).        - Stage IIB: Cancer has spread to other tissue within the pelvis such as the bladder, rectum, or vagina.        - Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and one of the following is true:                           - cancer is found on the outside surface of one or both ovaries; or          - the capsule (outer covering) of the tumor has ruptured (broken open); or           - cancer cells are found in fluid that has collected in the abdomen; or          - cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).                                 -  Stage III: In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Cancer that has spread to the surface of the liver is also stage III disease. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC:                   - Stage IIIA: The tumor is found in the pelvis only, but cancer cells that can only be seen with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen) or to the small bowel.        - Stage IIIB: Cancer has spread to the peritoneum and is 2 centimeters or smaller in diameter.       - Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.                -  Stage IV: In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer that has spread to tissues in the liver is also stage IV disease.              Childhood extragonadal extracranial germ cell tumors            -  Stage I: In stage I, the cancer is in one place and can be completely removed by surgery. For tumors in the sacrum or coccyx (bottom part of the spine), the sacrum and coccyx are completely removed by surgery. Tumor marker levels return to normal after surgery.      -  Stage II: In stage II, the cancer has spread to the capsule (outer covering) and/or lymph nodes. The cancer is not completely removed by surgery and the cancer remaining after surgery can be seen with a microscope only. Tumor marker levels do not return to normal after surgery or increase.     -  Stage III: In stage III, one of the following is true:                  - The cancer is not completely removed by surgery. The cancer remaining after surgery can be seen without a microscope.       - The cancer has spread to lymph nodes and is larger than 2 centimeters in diameter.                -  Stage IV: In stage IV, the cancer has spread to distant parts of the body, including the liver, brain, bone, or lung. </s>


Input: What are the treatments for Childhood Extracranial Germ Cell Tumors ?

Output:
Key Points
                    - There are different types of treatment for children with extracranial germ cell tumors.    - Children with extracranial germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.    - Some cancer treatments cause side effects months or years after treatment has ended.    - Three types of standard treatment are used:         - Surgery     - Observation     - Chemotherapy        - New types of treatment are being tested in clinical trials.          - High-dose chemotherapy with stem cell transplant     - Radiation therapy        - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for children with extracranial germ cell tumors.
                    Different types of treatments are available for children with extracranial germ cell tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.   Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

                    Children with extracranial germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
                    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with extracranial germ cell tumors and who specialize in certain areas of medicine. These may include the following specialists:         -  Pediatrician.    -  Pediatric surgeon.    -  Pediatric hematologist.    -  Radiation oncologist.    -  Endocrinologist.    -  Pediatric nurse specialist.    -  Rehabilitation specialist.    -  Child life professional.    -  Psychologist.    -  Social worker.    -  Geneticist.

                    Some cancer treatments cause side effects months or years after treatment has ended.
                    Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:         - Physical problems.     - Changes in mood, feelings, thinking, learning, or memory.     -  Second cancers (new types of cancer).         For example, late effects of surgery to remove tumors in the sacrum or coccyx include constipation, loss of bowel and bladder control, and scars.   Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

                    Three types of standard treatment are used:
                    Surgery    Surgery to completely remove the tumor is done whenever possible. If the tumor is very large, chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. A goal of surgery is to keep reproductive function. The following types of surgery may be used:            -  Resection: Surgery to remove tissue or part or all of an organ.     - Radical inguinal orchiectomy: Surgery to remove one or both testicles through an incision (cut) in the groin.     -  Unilateral salpingo-oophorectomy: Surgery to remove one ovary and one fallopian tube on the same side.           Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.       Observation     Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. For childhood extracranial germ cell tumors, this includes physical exams, imaging tests, and tumor marker tests.       Chemotherapy    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.     The way the chemotherapy is given depends on the type and stage of the cancer being treated.

                    New types of treatment are being tested in clinical trials.
                    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.     High-dose chemotherapy with stem cell transplant     High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.   For childhood extracranial germ cell tumors, alpha-fetoprotein (AFP) tests and beta-human chorionic gonadotropin (-hCG) tests are done to see if treatment is working. Continued high levels of AFP or -hCG may mean the cancer is still growing. For at least 3 years after surgery, follow-up will include regular physical exams, imaging tests, and tumor marker tests.

		            Treatment Options for Childhood Extracranial Germ Cell Tumors

		                    Mature and Immature Teratomas
		                    Treatment of mature teratomas that are not in the sacrum or coccyx (bottom part of the spine) includes the following:         -  Surgery to remove the tumor followed by observation.        Treatment of immature teratomas that are not in the sacrum or coccyx includes the following:         - Surgery to remove the tumor followed by observation for stage I tumors.    - Surgery to remove the tumor for stage IIIV tumors.         Treatment of immature teratomas that are in the sacrum or coccyx includes the following:         - Surgery (removal of the sacrum and coccyx) followed by observation.        Sometimes a mature or immature teratoma also has malignant cells. The teratoma and malignant cells may need to be treated differently.    Regular follow-up exams with imaging tests and the alpha-fetoprotein (AFP) tumor marker test will be done for at least 3 years.   Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood teratoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.

		                    Malignant Gonadal Germ Cell Tumors
		                    Malignant Testicular Germ Cell Tumors     Treatment of malignant testicular germ cell tumors may include the following:    For boys younger than 15 years:            -  Surgery (radical inguinal orchiectomy) followed by observation for stage I tumors.     - Surgery (radical inguinal orchiectomy) followed by combination chemotherapy for stage II-IV tumors. A second surgery may be done to remove any tumor remaining after chemotherapy.           For boys 15 years and older:    Malignant testicular germ cell tumors in boys 15 years and older are treated differently than they are in young boys. Surgery may include removal of lymph nodes in the abdomen. (See the PDQ summary on Testicular Cancer Treatment for more information.)    Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood malignant testicular germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.       Malignant Ovarian Germ Cell Tumors        Dysgerminomas     Treatment of stage I dysgerminomas in young girls may include the following:               -  Surgery (unilateral salpingo-oophorectomy) followed by observation. Combination chemotherapy may be given if the tumor comes back.              Treatment of stages IIIV dysgerminomas in young girls may include the following:               - Surgery (unilateral salpingo-oophorectomy) followed by combination chemotherapy.      - Combination chemotherapy to shrink the tumor, followed by surgery (unilateral salpingo-oophorectomy).                   Nongerminomas     Treatment of stage I nongerminomas in young girls may include the following:               -  Surgery followed by observation.       - Surgery followed by combination chemotherapy.              Treatment of stages IIIV nongerminomas in young girls may include the following:               - Surgery followed by combination chemotherapy. A second surgery may be done to remove any remaining cancer.      -  Biopsy followed by combination chemotherapy to shrink the tumor and sometimes surgery for tumors that cannot be removed by surgery when cancer is diagnosed.                The treatment for adolescents and young adults with ovarian germ cell tumor is much like the treatment for adults. (See the PDQ treatment summary on Ovarian Germ Cell Tumors for more information.)    Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood malignant ovarian germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.

		                    Malignant Extragonadal Extracranial Germ Cell Tumors
		                    Treatment of childhood malignant extragonadal extracranial germ cell tumors may include the following:         -  Combination chemotherapy to shrink the tumor followed by surgery to remove the sacrum and coccyx (bottom part of the spine) for tumors that are in the sacrum or coccyx.    - Combination chemotherapy to shrink the tumor followed by surgery to remove tumors that are in the mediastinum.    -  Biopsy followed by combination chemotherapy to shrink the tumor and surgery to remove tumors that are in the abdomen.    - Surgery to remove the tumor followed by combination chemotherapy for tumors of the head and neck.        Treatment of malignant extragonadal extracranial germ cell tumors in places not already described includes the following:         - Surgery followed by combination chemotherapy.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood extragonadal germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.

		                    Recurrent Childhood Malignant Extracranial Germ Cell Tumors
		                    There is no standard treatment for recurrent childhood malignant extracranial germ cell tumors. Treatment depends on the following:         - The type of treatment given when the cancer was diagnosed.    - How the tumor responded to the initial treatment.        Treatment is usually within a clinical trial and may include the following:         -  Surgery.    - Surgery followed by combination chemotherapy, for most malignant extracranial germ cell tumors including immature teratomas, malignant testicular germ cell tumors, and malignant ovarian germ cell tumors.     - Surgery for tumors that come back in the sacrum or coccyx (bottom part of the spine), if surgery to remove the sacrum and coccyx was not done when the cancer was diagnosed. Chemotherapy may be given before surgery, to shrink the tumor. If any tumor remains after surgery, radiation therapy may also be given.    - Combination chemotherapy for stage I malignant testicular germ cell tumors and stage I ovarian dysgerminomas.    -  High-dose chemotherapy and stem cell transplant.    - Radiation therapy followed by surgery to remove the tumor in the brain for cancer that has spread to the brain.    - A clinical trial of combination chemotherapy alone compared with high-dose chemotherapy followed by stem cell transplant.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent childhood malignant germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. </s>


Input: what research (or clinical trials) is being done for Childhood Extracranial Germ Cell Tumors ?

Output:
New types of treatment are being tested in clinical trials.
                    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.     High-dose chemotherapy with stem cell transplant     High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. </s>


Input: What is (are) Small Cell Lung Cancer ?

Output:
Key Points
                    - Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.    - There are two main types of small cell lung cancer.     - Smoking is the major risk factor for small cell lung cancer.    - Signs and symptoms of small cell lung cancer include coughing, shortness of breath, and chest pain.    - Tests and procedures that examine the lungs are used to detect (find), diagnose, and stage small cell lung cancer.    - Certain factors affect prognosis (chance of recovery) and treatment options.    - For most patients with small cell lung cancer, current treatments do not cure the cancer.

                    Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
                    The lungs are a pair of cone-shaped breathing organs that are found in the chest. The lungs bring oxygen into the body when you breathe in and take out carbon dioxide when you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung, which is slightly larger, has three. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also affected by lung cancer. Small tubes called bronchioles and tiny air sacs called alveoli make up the inside of the lungs.     There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.    This summary is about small cell lung cancer and its treatment. See the following PDQ summaries for more information about lung cancer:          -  Non-Small Cell Lung Cancer Treatment     -  Unusual Cancers of Childhood Treatment     -  Lung Cancer Prevention     -  Lung Cancer Screening

                    There are two main types of small cell lung cancer.
                    These two types include many different types of cells. The cancer cells of each type grow and spread in different ways. The types of small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:         - Small cell carcinoma (oat cell cancer).     - Combined small cell carcinoma.

                    For most patients with small cell lung cancer, current treatments do not cure the cancer.
                    If lung cancer is found, patients should think about taking part in one of the many clinical trials being done to improve treatment. Clinical trials are taking place in most parts of the country for patients with all stages of small cell lung cancer. Information about ongoing clinical trials is available from the NCI website. </s>


Input: Who is at risk for Small Cell Lung Cancer? ?

Output: Smoking is the major risk factor for small cell lung cancer. Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for lung cancer.    Risk factors for lung cancer include the following:            -  Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.      -  Being exposed to secondhand smoke.     - Being exposed to radiation from any of the following:                  -  Radiation therapy to the breast or chest.       -  Radon in the home or workplace.       -  Imaging tests such as CT scans.       - Atomic bomb radiation.                 -  Being exposed to asbestos, chromium, nickel, beryllium, arsenic, soot, or tar in the workplace.     -  Living where there is air pollution.     -  Having a family history of lung cancer.     -  Being infected with the human immunodeficiency virus (HIV).     -  Taking beta carotene supplements and being a heavy smoker.           Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.     When smoking is combined with other risk factors, the risk of lung cancer is increased. </s>


Input: What are the symptoms of Small Cell Lung Cancer ?

Output: Signs and symptoms of small cell lung cancer include coughing, shortness of breath, and chest pain. These and other signs and symptoms may be caused by small cell lung cancer or by other conditions. Check with your doctor if you have any of the following:         - Chest discomfort or pain.    - A cough that doesnt go away or gets worse over time.     - Trouble breathing.    - Wheezing.    -  Blood in sputum (mucus coughed up from the lungs).     - Hoarseness.    - Trouble swallowing.    - Loss of appetite.    - Weight loss for no known reason.    - Feeling very tired.     - Swelling in the face and/or veins in the neck. </s>


Input: How to diagnose Small Cell Lung Cancer ?

Output: Tests and procedures that examine the lungs are used to detect (find), diagnose, and stage small cell lung cancer. The following tests and procedures may be used:         -   Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.    -   Laboratory tests : Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.    -   Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   CT scan (CAT scan) of the brain, chest, and abdomen : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.     -   Sputum cytology : A microscope is used to check for cancer cells in the sputum (mucus coughed up from the lungs).     -   Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The different ways a biopsy can be done include the following:                -  Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung, using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to find the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.      -  Bronchoscopy : A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.       -  Thoracoscopy : A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes cant be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.      -  Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.      -  Mediastinoscopy : A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.             -   Light and electron microscopy : A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.    -   Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer. </s>


Input: What are the stages of Small Cell Lung Cancer ?

Output:
Key Points
                    - After small cell lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the chest or to other parts of the body.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - The following stages are used for small cell lung cancer:          - Limited-Stage Small Cell Lung Cancer     - Extensive-Stage Small Cell Lung Cancer

                    After small cell lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the chest or to other parts of the body.
                    The process used to find out if cancer has spread within the chest or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose small cell lung cancer are also used to stage the disease. (See the General Information section.)    Other tests and procedures that may be used in the staging process include the following:         -   MRI (magnetic resonance imaging) of the brain: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the brain, chest or upper abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.    -   Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if small cell lung cancer spreads to the brain, the cancer cells in the brain are actually lung cancer cells. The disease is metastatic small cell lung cancer, not brain cancer.

                    The following stages are used for small cell lung cancer:
                    Limited-Stage Small Cell Lung Cancer    In limited-stage, cancer is in the lung where it started and may have spread to the area between the lungs or to the lymph nodes above the collarbone.        Extensive-Stage Small Cell Lung Cancer    In extensive-stage, cancer has spread beyond the lung or the area between the lungs or the lymph nodes above the collarbone to other places in the body. </s>


Input: What are the treatments for Small Cell Lung Cancer ?

Output:
Key Points
                    - There are different types of treatment for patients with small cell lung cancer.     - Five types of standard treatment are used:         - Surgery      - Chemotherapy      - Radiation therapy      - Laser therapy     - Endoscopic stent placement        - New types of treatment are being tested in clinical trials.     - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with small cell lung cancer.
                    Different types of treatment are available for patients with small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

                    Five types of standard treatment are used:
                    Surgery      Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used. During surgery, the doctor will also remove lymph nodes to find out if they have cancer in them. Sometimes, surgery may be used to remove a sample of lung tissue to find out the exact type of lung cancer.     Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.       Chemotherapy     Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.    See Drugs Approved for Small Cell Lung Cancer for more information.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat small cell lung cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life. Radiation therapy to the brain to lessen the risk that cancer will spread to the brain may also be given.       Laser therapy     Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.       Endoscopic stent placement     An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. An endoscopic stent can be used to open an airway blocked by abnormal tissue.

                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

		            Treatment Options by Stage

		                    Limited-Stage Small Cell Lung Cancer
		                    Treatment of limited-stage small cell lung cancer may include the following:         -  Combination chemotherapy and radiation therapy to the chest. Radiation therapy to the brain may later be given to patients with complete responses.    - Combination chemotherapy alone for patients who cannot be given radiation therapy.    -  Surgery followed by chemotherapy.    - Surgery followed by chemotherapy and radiation therapy.    - Radiation therapy to the brain may be given to patients who have had a complete response, to prevent the spread of cancer to the brain.    -  Clinical trials of new chemotherapy, surgery, and radiation treatments.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with limited stage small cell lung cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.

		                    Extensive-Stage Small Cell Lung Cancer
		                    Treatment of extensive-stage small cell lung cancer may include the following:         -  Combination chemotherapy.     -  Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.    - Radiation therapy to the chest may be given to patients who respond to chemotherapy.    - Radiation therapy to the brain may be given to patients who have had a complete response, to prevent the spread of cancer to the brain.    -  Clinical trials of new chemotherapy treatments.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with extensive stage small cell lung cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. </s>