Germ cell tumours can appear at any age. They develop from cells that produce eggs or sperm so germ cell tumours can affect the ovaries or testes. However, it is possible for a germ cell tumour to develop in other parts of the body.
As a baby develops during pregnancy, the cells producing eggs or sperm normally move to the ovaries or testes. Sometimes, they can settle in other parts of the body where they can develop into tumours. The most common places for this to happen are the bottom of the spine, brain, chest, and abdomen.
Germ cell tumours are sometimes given different names based on what they look like under the microscope. These include yolk-sac tumours, germinomas, embryonal carcinomas, mature teratomas and immature teratomas.
They may be non-cancerous (benign) or cancerous (malignant). Malignant tumours have the ability to grow and spread to other parts of the body.
Benign tumours do not spread but may cause problems by pressing on nearby tissue and organs.
Immature teratomas fall between benign and malignant. These can occur at many different sites, (most commonly in the abdomen) and can spread locally, but rarely outside their original area. They can usually be removed with an operation.
Watch expert Dr James Nicholson, Consultant Paediatric Oncologist and CCLG member, explain more about germ cell tumours.
Causes
The exact causes of germ cell tumours are not known and research is ongoing. It is not infectious and cannot be passed on to another person. It is important to remember that nothing you have done has caused your child’s cancer.
Signs and symptoms
The symptoms depend on where the tumour develops. Usually, it starts with a lump that can either be felt or which causes other symptoms.
How germ cell tumours are diagnosed
A variety of different tests and investigations may be needed to diagnose a germ cell tumour. Any tests and investigations that your child needs will be explained to you.
A small piece of the tumour will be removed and looked at under a microscope to find out if it is a cancer or not. Thisis called a biopsy. It’s a small operation, performed under a general anaesthetic. If the main tumour can be removed at the same time, this may happen as part of the same operation.
A CT or MRI scan may be used to see the exact position of a tumour within the body and whether the cancer has spread to other parts of the body.
Germ cell tumours often produce proteins called tumour markers that can be measured in the blood. The ones that are produced by germ cell tumours are alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). Your child will have blood tests to check these tumour markers during diagnosis. The doctors will continue to check these during treatment and after treatment is over.
If your child has a germ cell tumour in the brain these markers may also be detected in the fluid around the brain and spine called cerebro-spinal fluid (CSF). This can be tested by doing a lumbar puncture.
Sometimes, a germ cell tumour can be diagnosed with tumour markers and scan results so that a biopsy isn’t necessary. This happens if surgery is not needed for treatment or a biopsy may be particularly difficult.For example, if the tumour is in the brain.
Staging
The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors to decide on the most appropriate treatment.
A general staging system is described below:
- Stage 1 - the tumour is small, has not spread and has been completely removed.
- Stages 2 and 3 - the tumour is larger and may not be completely removed with surgery, or may have spread to nearby organs.
- Stage 4 - the tumour has spread to other distant parts of the body.
Treatment
Germ cell tumours outside the brain
The treatment your child will have usually depends on a number of factors, including the size, position and stage of the tumour. It usually includes either surgery, chemotherapy, or a combination of the two.
A benign tumour can be cured if it is removed by surgery. It may mean removing a testicle or an ovary if this is where the tumour started.
If the tumour is malignant and can be completely removed with surgery, chemotherapy is not always needed, especially if it began in the testes or ovary. If the tumour cannot be removed easily or has spread, your child will be given chemotherapy.
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. Germ cell tumours are generally very sensitive to chemotherapy. It is usually given as injections and drips (infusions) into a vein. The combination of chemotherapy drugs and the length of treatment will depend on the position of the tumour, your child’s age, the tumour marker levels and whether or not the tumour has spread.
Germ cell tumours within the brain
Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed.
Radiotherapy is the use of high-energy rays to destroy cancer cells. Germ cell tumours in the brain do not usually need to be removed with surgery. Depending on the type and stage of the tumour, radiotherapy is given either to part of the brain or the whole brain and the spine.
Clinical trials
Many children have their treatment as part of a clinical research trial. Clinical trials are carried out to try to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Clinical trials mean there are now better results for curing children’s cancers compared with just a few years ago.
Your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child. You may decide not to take part, or you can withdraw from a trial at any stage. You will then receive the best standard treatment available.
National treatment guidelines
Sometimes, clinical trials are not available for your child’s tumour. In these cases, your doctors will offer the most appropriate treatment, using guidelines which have been agreed by experts across the UK. Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.
Follow-up care
Your child will continue to have regular blood tests during and after treatment, to check their levels of AFP and HCG. If the levels rise, this indicates that the tumour might have come back and further treatment is needed. Your child may also have regular scans after finishing treatment.
If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.
This information is about germ cell tumours in children, aged 0-14 years.
Find out about ovarian and testicular cancer in teenagers and young adults (15 - 24 years)