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In a fetus, germ cells are cells that should become sperm in the testicles or eggs in the ovaries. Sometimes these cells don’t travel to the right part of the body and end up forming a tumor. These tumors can be either benign or malignant, meaning they can spread to other parts of the body. Malignant tumors are cancer.
One way to classify germ cell tumors is based on where they form. Most malignant germ cell tumors are gonadal, meaning they’re in either the ovaries or testes. They can also form in the brain’s pineal gland, near the pituitary gland. Other places they form include the:
- Back
- Coccyx, or tailbone
- Mediastinum, the area between the lungs
- Neck
- Sacrum, a large bone in the lower spine that forms part of the pelvis
Germ cell tumors are also defined by how they look under a microscope and/or the hormones they produce.
Teratomas are usually benign, but some are malignant. Teratomas of the tail bone are the most common germ cell tumor found in children, and are about four times more common in girls than in boys.
Germinomas make the beta-human chorionic gonadotropin hormone. Those that form in the ovaries are called dysgerminomas, while ones in the testes are seminomas. They can also appear outside the ovaries or testes. In these cases, they’re simply called germinomas.
Non-germinomas include:
- Yolk sac tumors, also known as endodermal sinus tumors. They can form in the ovaries, testes or other parts of the body. They are the most common type of testicular cancer in infants and children.
- Embryonal carcinoma. These are malignant and most commonly found in the testicles, but can spread to other parts of the body.
- Gonadoblastomas, which are rare, almost always benign tumors associated with abnormal development of the reproductive organs.
- Polyembryomas. They are a very rare, aggressive type of germ cell tumor that is usually found in the ovaries.
Childhood germ cell tumors risk factors
There are several factors that seem to increase the risk of a child developing a germ cell tumor.
Certain genetic conditions are tied to increased risk for specific types of germ cell tumors:
- Klinefelter syndrome may increase a person’s chances of developing a tumor in the mediastinum, the area between the lungs.
- Swyer syndrome may increase a person’s chance of developing a germ cell tumor in the ovaries or testicles.
- Turner syndrome may increase the risk of ovarian germ cell tumors.
In addition, having an undescended testicle increases the odds of a male developing a testicular germ cell tumor.
A family history of germ cell tumors also increases the chance that someone will develop a germ cell tumor.
In rare cases, childhood germ cell tumors can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
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Childhood Germ Cell Tumor Symptoms
The exact symptoms of a childhood germ cell tumor will depend on where it forms. People with a specific diagnosis can see our pages on childhood brain cancer, ovarian cancer and testicular cancer for specific symptom information.
In general, though, childhood germ cell tumor symptoms can include:
- Lump in abdomen or lower back or testicle
- Pain in the abdomen
- Breast growth (for testicular germ cell tumors)
- In females, no period or unusual bleeding
- Fever
- Constipation
- Headaches
- Shortness of breath
- Chest pain
- Excessive hair growth
- Weakness in legs
- Early entry into puberty
- Diabetes
- Hormonal abnormalities
- Frequent urination
These symptoms do not always mean your child has a childhood germ cell tumor. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.
Did You Know?
Childhood Germ Cell Tumor Diagnosis
There are several ways doctors can diagnose a childhood germ cell tumor. In most cases, the diagnosis will start with a physical exam that finds symptoms such as swelling, lumps and pain. Blood tests can be used to check for tumor markers, including high levels of hormones produced by the specific types of germ cell tumors.
Tumors can also be diagnosed through imaging exams, including :
- Bone scans
- CT scans
- MRI
- Ultrasound
- X-ray
Doctors can also perform a biopsy, where a small piece of a suspected tumor is removed and then analyzed.
Childhood Germ Cell Tumor Staging
Doctors stage cancer based on how far it has progressed. A cancer’s stage helps determine the patient’s treatment and prognosis.
There is no agreed upon staging system for childhood germ cell tumors in the brain. Seminoma testicular cancers are staged using the main testicular cancer staging systems. There are staging system for many other germ cell tumors (source: National Cancer Institute).
Childhood Germ Cell Tumor Stages
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.
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.
Extragonadal germ cell tumors
Instead of staging, extragonadal germ cell tumors are usually placed in prognostic groups.
Good prognosis
A nonseminoma extragonadal germ cell tumor is in the good prognosis group if:
- the tumor is in the back of the abdomen; and
- the tumor has not spread to organs other than the lungs; and
- the levels of tumor markers AFP and β-hCG are normal and LDH is slightly above normal.
A seminoma extragonadal germ cell tumor is in the good prognosis group if:
- the tumor has not spread to organs other than the lungs; and
- the level of AFP is normal; β-hCG and LDH may be at any level.
Intermediate prognosis
A nonseminoma extragonadal germ cell tumor is in the intermediate prognosis group if:
- the tumor is in the back of the abdomen; and
- the tumor has not spread to organs other than the lungs; and
- the level of any one of the tumor markers (AFP, β-hCG, or LDH) is more than slightly above normal.
A seminoma extragonadal germ cell tumor is in the intermediate prognosis group if:
- the tumor has spread to organs other than the lungs; and
- the level of AFP is normal; β-hCG and LDH may be at any level.
Poor prognosis
A nonseminoma extragonadal germ cell tumor is in the poor prognosis group if:
- the tumor is in the chest; or
- the tumor has spread to organs other than the lungs; or
- the level of any one of the tumor markers (AFP, β-hCG, or LDH) is high.
No patients with a seminoma germ cell tumor are classified as having a poor prognosis.
Childhood Germ Cell Tumor Treatment
Our childhood germ cell tumor treatments
Treatment for germ cell tumors depends upon the child’s age and overall health, the types of tissues in the tumor, the tumor’s location, the child’s tolerance for specific types of procedures and the overall prognosis.
Surgery
Treatment for childhood Germ Cell Tumors often includes surgery. In testicular cancer cases, this can include the removal of the affected testicle or testicles. Ovarian cancer patients can have an ovary and fallopian tube removed.
Chemotherapy
Malignant germ cell tumors can spread to other parts of the body before they are diagnosed. Chemotherapy travels all through the body, making it an effective treatment in these cases. Children's Cancer Hospital offers the most up-to-date and advanced chemotherapy options for childhood germ cell tumors.
Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allow Children's Cancer Hospital doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. This is particularly important to growing bodies.
Our treatment approach
At MD Anderson's Children's Cancer Hospital, one of the world's foremost team of experts customizes a treatment plan for your child. This multidisciplinary group is among the few in the nation with specialized experience in treating these rare types of cancers.
Children's Cancer Hospital is committed to providing the most advanced treatments for childhood germ cell tumors with the least impact on your child's body, today and in the future.
Specialized expertise
The team that treats your child for soft tissue sarcoma includes a number of highly trained doctors, including oncologists, surgical oncologists and radiation oncologists. They are supported by a group of dedicated professionals such as advanced practice nurses, physician assistants, therapists and social workers.
Children's Cancer Hospital offers a range of clinical trials for childhood germ cell tumors. We are on the forefront of discovering new and better ways to treat these tumors, and this can translate to better chances for successful treatment for your child.
Why choose MD Anderson for your germ cell tumor treatment?
At MD Anderson's Children's Cancer Hospital, we know your child's health and well being are your number one concern. Our renowned experts customize your child's care for childhood germ cell tumors, utilizing the most advanced treatments and techniques with the least impact on your child's growing body. As part of one of the world's most active cancer centers, Children's Cancer Hospital has remarkable experience and skill in these types of cancer. This can make a difference in your child's outcome.
Customized care
A team of specially trained physicians follows your child throughout treatment, all the way to survivorship. They communicate closely with each other, and with you, to ensure comprehensive, personalized care. They are supported by full complement of health care professionals dedicated to your child's treatment, including nurses, physician assistants, therapists and others.
Children's Cancer Hospital offers clinical trials for innovative new treatments for soft tissue sarcoma. Behind the scenes we are working on groundbreaking basic science research to change the future of pediatric cancer.
Treating the whole child
Children's Cancer Hospital is designed just for children, with a full range of services and amenities that help make the child and family's experience as comfortable as possible. We go beyond medical care to deliver a comprehensive experience that treats the whole child.
And at Children's Cancer Hospital, your child benefits from the resources and expertise of one of the nation's top cancer centers.
What I learned from that time was resilience, faith and love. I realized how strong I was.
When Chase Jones was an 18-year-old baseball player at The University
of North Carolina, he was diagnosed with germinoma, a type of brain tumor. The rest of his team shaved their
heads in support.
Their gesture had a huge impact on
Chase and led him to start the Vs. Cancer Foundation. The organization
empowers sports teams, from little league to the pros, to raise
awareness and money in hopes of ending childhood cancer.
Since it started in 2013, Vs. Cancer has raised more than $1.5 million
for children's hospitals and cancer research. They've worked with The
University of North Carolina, Duke University, Texas A&M
University and the Seattle Mariners, among others.
"Every age, every sport, every form -- college, high school,
youth -- we've given them the platform to make a difference,"
Chase says. "As a cancer survivor, I couldn't be more excited
about that."
Finding hope during pineal region germinoma treatment
One day after baseball practice, Chase walked off the field
with a sharp headache. It was unlike any pain he'd known before. He
never thought it was a brain tumor symptom.
Chase was
diagnosed with stage four pineal region germinoma. This type of tumor
starts in the center of the brain and had metastasized to his
spine.
There were few treatment options for him close to
home. So, after a series of surgeries, chemotherapy and radiation at a
North Carolina hospital, Chase came to the MD Anderson Proton Therapy Center.
Despite being far from his friends and family, Chase felt at home
right away.
"The greatest feeling was walking in
knowing I would walk out cancer-free," he says.
Helping others beat the odds
Today, Chase is 26, cancer-free and helping athletes help kids
with cancer.
"Everybody has been affected by cancer,
and athletes have a platform within their communities. They can do so
much because of the position they're in," Chase says.
Through Vs. Cancer, teams are encouraged to host a creative
fundraising event. Examples include a head shaving event, 100-inning
game, relay race, kickball game, or just adding a yellow ribbon to the
jerseys. Then, teams make a donation.
"It's about
showing athletes that they can make a difference," Chase
says.
"I don't know why I survived cancer. I don't
know why I defied the odds. But because of that, I will be doing this
as long as there are kids battling cancer."
