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Germ cell tumors (GCTs) of the brain and spinal cord are rare. They are most often diagnosed in children and young adults.
These tumors usually develop in 1 of 2 brain regions: pineal or suprasellar. They can also develop in the spinal cord. The pineal region of the brain contains the pineal gland. The suprasellar region is located near the pituitary gland. Germ cell tumors of the brain and spinal cord do not usually spread throughout the body.
Signs and symptoms of a GST depend on the tumor size and location.
As the tumor grows, it may cause cerebral spinal fluid (CSF) to build up in the brain. This is hydrocephalus. It causes increased pressure in the brain.
Pressure on the brain tissue can cause many symptoms of GCT in the pineal region.
Depending on the region affected, symptoms may vary.
Pineal region tumor symptoms:
Supracellar region symptoms:
The cause is unknown for most germ cell tumors of the brain and spinal cord. About 90% of these tumors occur in patients younger than age 20. Most of the tumors occur in early teens. Germ cell tumors are 2–3 times more common in males than females.
Germ cell brain tumors of the brain and spinal cord are often classified as germinoma or nongerminomatous germ cell tumor (NGGCT). The tumor types include:
Germinomas are the most common type of germ cell tumor. Children with germinoma have a 90% chance of cure.
In the pineal region, GCTs occur mostly in males and are usually germinomas.
In the suprasellar region, males and females both get GCTs equally. NGGCTs and germinomas arise with equal frequency.
If a pathologist finds cancer cells in the biopsy sample, the lab will do more lab tests on the sample. These may include flow cytometry, immunophenotyping, and cytogenetic analysis.
These tumors rarely spread to other parts of the body beyond the central nervous system (brain and spinal cord). A germ cell tumor of the brain can spread to other parts of the central nervous system, including the spine and cerebrospinal fluid.
GTCs in the brain or spinal cord are described as newly diagnosed or recurrent.
Treatment for germ cell tumors of the brain and spinal cord depends on several factors. These include:
The main treatments for germ cell tumors of the brain and spinal cord are:
For recurrent disease, patients may get high-dose chemotherapy with stem cell rescue.
Surgery is not often used to treat germinoma. However, as non-germinomas are harder to treat, surgery may be used to remove as much of the tumor as possible. The patient may need more chemotherapy and radiation therapy.
In some cases, doctors place a ventriculoperitoneal (VP) shunt or external shunt in the brain to prevent fluid from building up. Too much fluid can increase pressure on the brain, causing harm. A shunt is a small tube that drains cerebrospinal fluid so that it can be removed from the brain and reduce pressure. This can relieve many symptoms caused by brain tumors. The shunt may be temporary or permanent.
Your care team is the best source of information about your child's prognosis. The prognosis depends on several factors. These include:
Germinomas in children usually respond well to treatment. The survival rate is about 90% in the United States.
Certain types of germ cell tumors of the brain and spinal cord have a better prognosis than others. Many factors also affect treatment and prognosis. Here is a general guide based on the tumor type:
|Germinoma with syncytiotrophoblastic giant cells
Mixed tumors (germinoma or teratoma)
Teratoma with malignant transformation
Coping with a cancer diagnosis and treatment can be stressful for the patient and the family. You may want to talk to a social worker or a psychologist.
Learn more about how to talk to your child about cancer.
The impact of a brain tumor on a child’s quality of life varies widely. Some children with brain tumors show few lasting effects after treatment. Other children may have long-term problems.
Some problems are the result of injury to the brain from the tumor and/or surgery. Other changes may be due to long-term or late effects of chemotherapy and/or radiation.
Patients treated for brain tumors of the brain and spinal cord should be watched for changes or problems, including:
Psychological services can help with emotional, social, developmental, and cognitive needs. School support is often needed after treatment for a brain tumor. Tell your care team if you need help to support your school-aged child during their illness.
Certain tests before and after treatment can help show education needs. The child’s care team can help parents plan for neuropsychological testing and academic accommodations, and work concerns for older patients.
Lifestyle habits can help your child’s brain and overall health. Some things your child can do are:
After completing treatment, your child will need follow-up care to watch for recurrence and any late effects. These are health problems that happen months or years after the end of their treatment. Your child should:
Your child's doctor may also order imaging tests and exams to watch for recurrence (known as monitoring).
Patients with germ cell tumors of the brain and spinal cord are at risk for long-term problems in endocrine function. This could include diabetes insipidus and problems with pituitary gland function. Low pituitary function can lead to problems such as:
Hormone levels are important, so patients may need medicines that include hormone replacement.
Reviewed: May 2023