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Germ cell tumors can be either benign (noncancerous) or malignant (cancerous). These tumors develop from the cells which produce eggs or sperm. They mainly develop at the testicles or the ovaries, but they can also appear at any part of the body such as the chest, tailbone, or brain, these are known as extragonadal tumors. Germ cell tumors can develop at any age, but they are most common in children, teenagers, and young adults.
Germ cell tumors may be treated with surgery to remove the tumor, chemotherapy with drugs that kill cancer cells, and radiation therapy with powerful energy beams.
Types of germ cell tumors
Germ cell tumors can be benign or malignant. Tumors of both types can grow in size, but only cancerous germ cell tumors can spread to other parts of the body. Cancer that has spread (metastasized) can harm your organs and makes treatment more challenging. The following are the types of germ cell tumor:
- Teratomas: these are tumors that contain many types of tissues such as teeth, hair, muscle, and bone. The most typical type of ovarian germ cell tumors are mature teratomas, also known as dermoid cysts which commonly are benign. Teratomas could be mature and immature, but immature is usually malignant and spread quickly.
- Germinomas: is form of germ cell tumor that develop in the ovaries (also called dysgerminoma) or testes (also called seminoma) or other part of the body such as the brain and spinal cord.
- Yolk sac tumors: also known as endodermal sinus tumors. These tumors include cells like those found in an embryonic development. These tumors spread rapidly to the lymph nodes and other organs since they are malignant. The most common of malignant germ cell tumor diagnoses in children are yolk sac tumors.
- Embryonal cell carcinoma: A rare malignant germ cell tumor called embryonic cell carcinoma. Despite frequently co-existing with other tumor types in mixed germ cell tumors, it may develop solely.
- Polyembryomas: Polyembryomas are tumors that have parts that resemble embryos. Rarely they are rapidly expanding malignant tumors, they frequently coexist with other varieties of germ cell tumors.
- Choriocarcinomas: Cells that develop into the placenta during pregnancy. Choriocarcinoma is a rare malignant germ cell tumor that most frequently affects the uterus (womb) but can also develop in the ovaries or testicles. Both the parent and the fetus are susceptible to its spread.
- Mixed germ cell tumors: these cancerous germ cell tumors include two or more different types.
Symtoms
Germ cell tumor symptoms might vary depending on the size and location of the tumor present in your body.
- Ovaries: germ cell tumors in the ovaries do not always cause symptoms. Mature teratomas may not show symptoms until they are large enough to put pressure on your abdomen. Symptoms may include:
- Pain or discomfort at pelvic.
- Painful and swelling of abdomen
- Painful mass at the ovary
- Nausea
- Bleeding between the periods
- Testicles: The symptoms of a germ cell tumor in the testicles are similar to those of testicular cancer. Symptoms include:
- Firm and solid lump at the testicles that may or may not cause pain when it grows larger.
- Painful scrotum
- Abdominal or groin pain
- Back pain
- Extragonadal: Teratoma can be identified by a tumor on the child’s tailbone or in the middle of their chest. Depending on where the tumor is located, there may be additional extragonadal germ cell tumor symptoms.
- Difficulty in breathing (lungs)
- Difficulty in urination and defecation (pelvis)
- Weakness of the lower extremities (Low back)
- Dull pain and swelling of the abdomen in children
Some cases of germ cell tumors can release reproductive hormones, which in children can lead to early puberty symptoms or abnormal sexual development.
Cause
It is unknown why germ cells develop immaturely and form into a tumor. Normal germ cells form in a developing embryo. These cells eventually develop to the embryo’s testicles or ovaries, where they will develop into egg or sperm cells. Germ cell tumors are made up of immature eggs or sperm cells. The ovaries or testicles may develop a tumor because of the germ cells abnormal division.
Extragonadal tumors are tumors that develop in unusual locations on the body, such as the chest, brain, abdomen, low back, and tailbone.
Risk factors
The following risks may include:
- History: If a family member has a history of germ cell tumor then the person will have a higher risk to develop germ cell tumor.
- Genetic disorder: Turner syndrome and Klinefelter syndrome are two names for genetic disorder where a patient has an extra or missing chromosome.
- Untreated undescended testicle (testicles that haven’t dropped into the scrotum, either one or both).
Diagnosis
A brief history taking and physical examination will be conducted by the doctor, to evaluate for germ cell tumor. The physician may advise to carry out any of the following examinations or procedures:
- Computerized tomography (CT) scan: A CT scan creates a digital, three-dimensional image of the bones and soft tissues by combining several X-ray images of the inside of the body. The site of a tumor might be seen on a CT scan of the chest, abdomen, or pelvis.
- Magnetic Resonance Imaging (MRI): A digital image of the body’s bone and soft tissue is created by an MRI using radio waves and magnets. An MRI can reveal the location of the tumor, just like a CT scan.
- Ultrasound: The internal organ of the body can be visualized by ultrasound using sound waves and can determine a tumor’s solid mass or cystic component helping to distinguish between a cyst and a germ cell tumor.
- Bone scans: A bone scan involves taking X-rays of the bones after the patient taken a particular dye that shows abnormalities. If the bones are being affected by a malignancy, a bone scan can reveal this.
- PET scan: A tracer that is used in a PET scan can be used to locate cancer cells within the body. A PET scan can reveal the spread of cancer.
- Biopsy: A tissue from the tumor is taken out and sent to a laboratory for analysis. Pathologist examines the sample under a microscope to properly diagnose germ cell tumor.
- Blood tests: To measure the levels of enzymes, proteins, or hormones in the blood, the healthcare recommended that the patient undergo some blood test. Certain types of germ cell cancers may be detected by elevated levels of human chorionic gonadotropin (hCG), a-fetoprotein (AFP), and lactate dehydrogenase.
If cases that the tumor has developed and became malignant then the affected organ will be surgically removed.
Treatment
- Surgery: Germ cell tumors are typically treated by surgery. The doctor may perform an ovarian cystectomy to remove the tumor from the affected ovary, or an ovarian and fallopian tube removal (salpingo-oophorectomy).
The doctor will remove the testicle that has the tumor if you have testicular cancer.
A diagnosis for testicular cancer usually includes a radical inguinal orchiectomy, which involves removing your whole testis. The doctor can examine the tissue and administer treatment after removing the testicle.
- Chemotherapy: The majority of germ cell tumor types can be effectively treated with chemotherapy. Drugs are used in chemotherapy to either kill cancer cells or stop them from multiplying. If the tumor cannot be safely removed or if it has migrated to other areas of the body, the patient may be given chemotherapy. Even if the cancer cells are not visible on imaging, chemotherapy may be administered after surgery to remove any cancer cells that may still be present.
- Radiation therapy: High-energy X-rays are directed at cancer cells during radiation therapy to eradicate them. Radiation therapy works best for some forms of germ cell cancers.
