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Germ cell tumors are formed by germ cells, a type of reproductive cell. They are the cells that become eggs in females or sperm in males. Germ cells develop as a baby grows inside the mother. Sometimes, germ cells can form tumors, called germ cell tumors. Germ cell tumors may be benign (not cancer) or malignant (cancer).
Germ cell tumors can occur in the:
Extracranial germ cell tumors are germ cell tumors that form outside of the brain. They are often found in reproductive organs (ovaries or testicles). These are called gonadal germ cell tumors.
Germ cell tumors that form outside of the ovaries and testicles are called extragonadal germ cell tumors. These tumors usually grow along the center of the body.
Germ cell tumors can develop at any age. In pediatric patients, they occur most often in young children and in teens. They account for about 3% of childhood cancers.
Surgery is the main treatment for germ cell tumor. In some cases, germ cell tumor can be treated with surgery alone. Chemotherapy may be used with surgery. If surgery can completely remove the tumor, children have an excellent chance of cure.
Signs and symptoms of a germ cell tumor depend on the tumor size and location.
Symptoms may include:
Germ cell tumors are most common in young children and in teens. An increase in germ cell tumors is seen in adolescents between 15–20 years old.
The cause of germ cell tumors is largely unknown. Certain inherited syndromes can increase the risk of germ cell tumor. These include Klinefelter syndrome, Swyer syndrome, and Turner syndrome.
In boys, having an undescended testicle can increase risk for gonadal germ cell tumor in that testicle.
Germ cell tumors in young children are usually benign. Malignant tumors are less common in younger children.
Extragonadal tumors in young children most often occur in the lower spine or tailbone. In some cases, part of the tumor may be seen outside the body. If a germ cell tumor develops before birth, there is a risk for preterm delivery. It can also cause problems during birth including tumor rupture and bleeding. Some tumors may be found on routine ultrasound imaging during pregnancy.
Germ cell tumors in teens and young adults are usually gonadal. These occur within the testes or ovary. They may be benign or malignant. Extragonadal tumors in older children and adolescents often occur in the mediastinum (chest).
Doctors use several types of tests to diagnose germ cell tumor. Tests may include:
Germ cell tumors are classified by how the cells look under a microscope.
Types of germ cell tumors include:
Staging of germ cell tumor is based on:
In general, there are 4 stages of germ cell tumor.
|Stage 1||The tumor is completely removed with surgery.|
|Stage 2||The tumor is removed by surgery, but microscopic cells are left behind.|
|Stage 3||Surgery could not completely remove the tumor, or there is spread of disease to nearby tissues or lymph nodes.|
|Stage 4||The tumor has spread to other parts of the body such as liver or lungs.|
Each type of germ cell tumor has guidelines used for staging.
Find more information on germ cell tumor including Stages of Childhood Extracranial Germ Cell Tumor.
Treatment for germ cell tumor depends on several factors including:
The main treatments for germ cell tumors are surgery and chemotherapy.
Radiation therapy is not usually used because surgery and chemotherapy are most effective. However, germ cell tumors can be treated with radiation, especially if the tumor has come back or is harder to treat.
Surgery to remove the tumor is a main treatment for germ cell tumors. When possible, the goal is complete removal of the tumor. In some cases, if the tumor can be fully removed, your child may not need other treatment.
Germ cell tumor often needs special care during surgery. Germ cell tumors can grow near vital organs. They can also break apart easily. If parts of the tumor break off (tumor spill), then the cancer is a higher stage.
Chemotherapy may be used alone or with surgery to treat germ cell tumors. The type of chemotherapy depends on several factors including:
Chemotherapy before surgery may be used to shrink the tumor. That can make it is easier to remove. Chemotherapy also may be used after surgery to kill any remaining cancer cells.
High-dose chemotherapy with stem cell transplant may be a treatment option for disease that comes back. Patients with germ cell tumor that has spread or come back after treatment may consider treatment as part of a clinical trial.
The prognosis for germ cell tumor is quite good when the cancer can be fully removed by surgery. With proper treatment, children with stage 1 or 2 disease have a cure rate of more than 90%. For more advanced disease (stages 3 or 4), survival rates are about 80–85%. But many factors influence the chance of cure.
Factors that influence outlook for germ cell tumor include:
About 1 in 5 patients have spread of disease (metastasis) at diagnosis. The most common places for germ cell tumor to spread are the lung, liver, and lymph nodes. Less often, germ cell tumor may spread to the brain or bone.
For most children with germ cell tumor, the chance of cure is good. After treatment, imaging tests and monitoring of tumor markers are used to watch for return of the germ cell tumor.
Talk to your care team about the treatments your child received and how to manage any side effects. Long-term problems depend on the specific type of germ cell tumor and the type of treatment. Children with gonadal germ cell tumors may have problems with fertility (having children) or hormone function.
Childhood cancer survivors treated with chemotherapy or radiation should be monitored at least once a year for long-term side effects or late effects of therapy. It is important to have regular physical checkups and screenings by a primary physician familiar with late effects and survivorship issues.
Adopting healthy habits such as eating a balanced diet and being active can help survivors protect their health.
Your care team may prepare a survivorship care plan. This plan is a complete record of treatment, medical concerns, and suggested screenings and health care.
Reviewed: March 2023