Germ Cell Tumors

Note: This section has health/medical information. It was not written by a health care professional. The medical references are:

NCI web site sections on the germ cell tumors, accessed 2009
Childhood Cancer: A Parents Guide to Solid Tumor Cancers, 2th ed., by Honna Janes-Hodder and Nancy Keene, 2002

Recommended web site: Extracranial germ cell tumors on cancer.gov

Germ cell tumors originate in sperm (testicles) or egg (ovary) cells, and can migrate to other parts of the body, or they can remain in the tissue of origin. Germ cell tumors of the ovary are uncommon but aggressive tumors seen most often in young women or preteen and adolescent girls, and are generally curable if found and treated early. Use of combination chemotherapy after initial surgery has dramatically improved the prognosis for many of these tumors.

Ovarian germ cell tumors can be difficult to diagnose early. Often there are no symptoms in the early stages. Because young girls have yet to have a gynecologic examination, the only symptoms may be a swelling or hard distended abdomen without weight gain (with or with out pain).

Tests that may be used to indicate this type of tumor are an ultrasound or CT scan. (Also for older patients the first step would be an internal - pelvic -exam).

Prognosis and choice of treatment depend on the type of tumor and stage of the tumor (whether it affects one ovary, both, or has spread to other places).

Classification of Germ Cell Tumors

The classifications of germ cell tumors include dysgerminoma, endodermal sinus tumor, embryonal carcinoma, polyembryoma, choriocarcinoma, teratoma, solid cystic, monodermal, and mixed forms. Please see the cancer.gov site for the most up-to-date information.

Stages of ovarian germ cell tumor

Once ovarian germ cell tumor has been found, surgery and staging is the first course of action. Staging determines if the cancer has spread from the ovaries to other parts of the body. The operation is called a laparotomy.

The cancerous tumor is removed and other organs are checked to see if they contain cancer. A biopsy is taken to determine the type of tumor.

The following stages are used for ovarian germ cell tumor:

Stage I: Cancer is found only in one or both of the ovaries.
Stage II: Cancer is found in one or both ovaries and/or has spread to the uterus, and/or the fallopian tubes, and/or other body parts within the pelvis.
Stage III: Cancer is found in one or both ovaries and has spread to lymph nodes or to other body parts inside the abdomen, such as the surface of the liver or intestine.
Stage IV: Cancer is found in one or both ovaries and has spread outside the abdomen or has spread to the inside of the liver.
Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the ovary that is left or in another place.

Markers

Many of these tumors have a marker that shows up in the blood that indicates the tumors presence. Levels of alphafetoprotein (AFP) and human chorionic gonadotropin (HCG) should be obtained as soon as the diagnosis is established. The levels should decrease after surgery, a failure to do so would indicate a remaining tumor. Monitoring these levels can also indicate a recurrence.

Treatments

Surgery and chemotherapy is the most common treatment for ovarian germ cell tumor.

If the tumor is ovarian, one or both ovaries may be removed along with fallopian tubes and sometimes the uterus. All efforts are made to preserve fertility whenever possible. Some stage one tumors can be treated with surgery alone. Depending on the stage and type of tumor, radiation or chemotherapy are also used.

Chemotherapy combinations containing cisplatin, etoposide, and bleomycin (BEP) are now preferred because of a lower relapse rate and shorter treatment time. Other treatment plans may include VAC or PVB (cisplatin/vinblastine/bleomycin) chemotherapy.

Ped-Onc Resources for Germ Cell Tumors

The following ped-onc resource lists have appropriate sections for parents of children with brain tumors:

childhood cancer e-mail lists - the ped-onc list is appropriate for parents of children with germ cell tumors
support organizations - brain tumors

books and printed materials - especially note "Childhood Cancer, A Parent's Guide to Solid Tumor Cancers" by Janes-Hodder and Keene
young people with germ cell tumors - germ cell tumors are listed on the "other" cancer pages

Links to More Information

The following web sites provide good, general information on germ cell cancers and their treatment.

Cancer.gov site has excellent coverage on germ cell tumors.
Ovarian germ cell page. This is an excellent site, much information although it does not focus on childhood ovarian germ cell cancers.

General Disclaimer

These pages are intended for informational purposes only and are not intended to render medical advice. The information provided on Ped Onc Resource Center should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you suspect your child has a health problem, you should consult your health care provider.

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