What are germ cell tumors?

All germ cell tumors are the result of abnormal development of germ cells. They may be benign (when examined under a microscope the cells are found to be not cancerous) or malignant (when examined under a microscope the cells are found to be cancerous). There are several theories about the origin of these tumors. The best evidence suggests that most are due to abnormal growth of fetal germ cells that arise from the fetal yolk sac that start forming while the fetus is still growing in the mother’s womb. Normal migration of these germ cells may cause gonadal tumors, whereas abnormal migration produces extragonadal tumors, or tumors outside the gonads, such as in the belly, spine or brain.

Malignant germ cell tumors include several types of cancer, such as immature teratoma, yolk sac tumor and choriocarcinoma. They can destroy the testes or ovaries and can spread to other parts of the body.

Most germ cell tumors are not malignant but may require treatment because of the size or location of the tumor. Benign germ cell tumors include certain kinds of teratomas.

In children, germ cell tumors are found in the following areas:

  • Sacrococcygeal (tailbone area): 40%
  • Ovary: 25%
  • Testicle: 12%
  • Brain: 5%
  • Other (including the neck and chest): 18%

What are symptoms of germ cell tumors?
The signs and symptoms of germ cell tumors differ depending on where they are located. Symptoms may include:

  • Abdominal pain
  • Constipation
  • Mass protruding from area around lower back and buttocks
  • Painless mass in the scrotum
  • Shortness of breath

How are germ cell tumors diagnosed?
Germ cell tumors are usually found when a child comes to the doctor because of pain or a mass. Germ cell tumors within the brain may result in visual changes, headaches or vomiting. Because many conditions might have some of the same symptoms, it is important for a child with complaints like these to see a doctor to find out the cause.

Once a mass is suspected, a thorough physical exam, blood tests and additional imaging tests may be needed. Some germ cell tumors secrete tumor marks that can be measured in blood tests, including AFP, beta-HCG and CEA. For intracranial tumors, lumbar puncture may be performed to look for these tumor markers within the spinal fluid.

Additional imaging is often needed and may include ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scans. Often a biopsy is needed to confirm the diagnosis and plan therapy.

If an ovarian or testicular mass is seen, blood tests to measure inhibin A and B may be done to assess for the presence of sex cord stromal tumor.

How are germ cell tumors treated?
Treatment of germ cell tumors depends on the location of the tumor. Surgery, chemotherapy and radiation therapy may be used alone or in some combination to treat the tumor.

  • Tumors in the chest, ovary or testis are often treated with surgery to obtain a biopsy and remove all or most of the tumor.
  • Surgery alone can cure some testicular and ovarian malignant germ cell tumors; however, others will require chemotherapy following surgery.
  • Intracranial germ cell tumors are sometimes managed with chemotherapy alone, without the need for surgery.
  • Germ cell tumors are also sensitive to radiation therapy, which is used occasionally for these tumors.
  • Stem cell transplant is also an option for some patients with recurrent disease.

About treatment for ovarian tumors at Children’s Minnesota

Our cancer and blood disorders program consistently achieves excellent results ranking it in the top 10 programs in the United States. Children’s Minnesota treats the majority of children with cancer and blood disorders in Minnesota and provides patients access to a variety of clinical trials using ground-breaking new treatments. Through our renowned program, patients experience unparalleled family support, a nationally recognized pain management team, and compassionate, coordinated care.

At Children’s Hospitals of Minnesota, children and young adults with germ cell tumors receive care from a comprehensive team of pediatric experts including oncologists, oncology nurses, gynecology, surgery, child life and others. In the case of ovarian tumors, a pediatric gynecologist may also be involved. Children’s has the only pediatric gynecologist in Minnesota.

Interventions such as physical therapy and hearing screening may help minimize the impact of any side effects associated with treatment for children at risk.

Children’s also houses the International Ovarian and Testicular Stromal Tumor Registry that collects information about these rare tumors from all over the world. The registry collects clinical and biologic information to lead to improved treatment and screening for children with these rare tumors. If you or your child has been diagnosed with a germ cell tumor, contact your physician or the registry for more information regarding enrollment.

Contact us

If you are a family member looking for a Children’s oncologist, please call our clinic at 612-813-5940.

If you are a health professional looking for consultation or referral information, please call Children’s Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.