Germ cell tumors can occur in the:

• Ovary or testicle (gonadal germ cell tumor)
• Neck
• Chest area between the lungs (mediastinal)
• Back part of the abdomen (retroperitoneal)
• Lower part of the spine or tailbone (sacrum, coccyx)
• Brain 

Germ cell tumors can develop at any age. In pediatric patients, they occur most often in young children and in teens. They account for about 3% of childhood cancers.

Surgery is the main treatment for germ cell tumor. In some cases, germ cell tumor can be treated with surgery alone. Chemotherapy may be used with surgery. If surgery can completely remove the tumor, children have an excellent chance of cure.

Symptoms of germ cell tumor

Signs and symptoms of a germ cell tumor depend on the tumor size and location.

Symptoms may include:

• Abdominal pain
• Lump or swelling in the abdomen, lower back, or testicle
• Constipation
• Cough or trouble breathing
• Early onset of puberty

Risk factors of germ cell tumor

Germ cell tumors are most common in young children and in teens. An increase in germ cell tumors is seen in adolescents between 15–20 years old.

The cause of germ cell tumors is largely unknown. Certain inherited syndromes can increase the risk of germ cell tumor. These include Klinefelter syndrome, Swyer syndrome, and Turner syndrome.
In boys, having an undescended testicle can increase risk for gonadal germ cell tumor in that testicle.

Germ cell tumors in infants and young children

Germ cell tumors in young children are usually benign. Malignant tumors are less common in younger children.

Extragonadal tumors in young children most often occur in the lower spine or tailbone. In some cases, part of the tumor may be seen outside the body. If a germ cell tumor develops before birth, there is a risk for preterm delivery. It can also cause problems during birth including tumor rupture and bleeding. Some tumors may be found on routine ultrasound imaging during pregnancy.

Germ cell tumors in teens and young adults

Germ cell tumors in teens and young adults are usually gonadal. These occur within the testes or ovary. They may be benign or malignant. Extragonadal tumors in older children and adolescents often occur in the mediastinum (chest).

Diagnosis of germ cell tumor

Doctors use several types of tests to diagnose germ cell tumor. Tests may include:

• Physical exam and health history
• Blood tests to check blood counts, liver and kidney function, and hormones
• Tests for tumor markers including alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-HCG)
• Tests of fluid in the abdomen or chest to look for cancer cells
• Imaging tests to learn about the size and location of the tumor

• Ultrasound 
• Computed tomography (CT or CAT) scan
• Magnetic resonance imaging (MRI)
• Bone scan
• Positron emission tomography (PET) scan

• Biopsy to identify the specific type of germ cell tumor

Types of germ cell tumor

Germ cell tumors are classified by how the cells look under a microscope.

Types of germ cell tumors include:

1. Mature teratomas (noncancerous)

1. Immature teratomas (cancerous)

1. Malignant germ cell tumors (cancerous)

Stages of germ cell tumor

Staging of germ cell tumor is based on:

• Type of tumor
• Tumor location
• Spread of disease
• Outcome of surgery

In general, there are 4 stages of germ cell tumor.

Treatment of germ cell tumor

Treatment for germ cell tumor depends on several factors including:

• Your child’s age
• Type of tumor
• Location of the tumor
• Stage of disease

The main treatments for germ cell tumors are surgery and chemotherapy.

Radiation therapy is not usually used because surgery and chemotherapy are most effective. However, germ cell tumors can be treated with radiation, especially if the tumor has come back or is harder to treat.

Surgery

Surgery to remove the tumor is a main treatment for germ cell tumors. When possible, the goal is complete removal of the tumor. In some cases, if the tumor can be fully removed, your child may not need other treatment. 

Germ cell tumor often needs special care during surgery. Germ cell tumors can grow near vital organs. They can also break apart easily. If parts of the tumor break off (tumor spill), then the cancer is a higher stage. 

Chemotherapy

Chemotherapy may be used alone or with surgery to treat germ cell tumors. The type of chemotherapy depends on several factors including:

• Your child’s age
• Type of tumor
• Location of the tumor
• Response to therapy  

Chemotherapy for pediatric germ cell tumor usually includes bleomycin, etoposide, and cisplatin.

Chemotherapy before surgery may be used to shrink the tumor. That can make it is easier to remove. Chemotherapy also may be used after surgery to kill any remaining cancer cells. 

High-dose chemotherapy with stem cell transplant may be a treatment option for disease that comes back.  

Prognosis for germ cell tumor

The prognosis for germ cell tumor is quite good when the cancer can be fully removed by surgery. With proper treatment, children with stage 1 or 2 disease have a cure rate of more than 90%. For more advanced disease (stages 3 or 4), survival rates are about 80–85%. But many factors influence the chance of cure.

Factors that influence outlook for germ cell tumor include:

• Type of germ cell tumor
• Location and size of the tumor
• Age of the child
• How the tumor responds to treatment
• If surgery can completely remove the tumor
• If there is spread of disease
• If the tumor is new or has come back

About 1 in 5 patients have spread of disease (metastasis) at diagnosis. The most common places for germ cell tumor to spread are the lung, liver, and lymph nodes. Less often, germ cell tumor may spread to the brain or bone.

Support for patients with germ cell tumor

For most children with germ cell tumor, the chance of cure is good. After treatment, imaging tests and monitoring of tumor markers are used to watch for return of the germ cell tumor.

Late effects of therapy

Childhood cancer survivors treated with chemotherapy or radiation should be monitored at least once a year for long-term side effects or late effects of therapy. It is important to have regular physical checkups and screenings by a primary physician familiar with late effects and survivorship issues.  

Adopting healthy habits such as eating a balanced diet and being active can help survivors protect their health.  

Your care team may prepare a survivorship care plan. This plan is a complete record of treatment, medical concerns, and suggested screenings and health care

Diagnostics of Germ Cell tumors

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • biochemical analysis of blood
  • inflammation markers (CRP, ESR)
  • indicators of blood coagulation
  • tumor markers
• CT/MRI local
• high-resolution computed tomography (HR-CT) of chest
• Pulmonary function tests
• Renal scan
• Bone Scan
• Audiometry
• biopsy with histological and immunohistochemical study according to type of cancer
• nursing services
• consultation of related specialists
• treatment by chief physician and all leading experts
• explanation of individual treatment plan (the cost of medicines is not included)

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Outpatient

Expected duration of the program: 7 days

Chemotherapy of Germ Cell Tumors

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • TSH-basal, fT3, fT4
  • tumor markers
  • inflammation indicators
  • indicators of blood coagulation
• courses of chemotherapy
• nursing services
• consultations of related specialists
• treatment by head doctor and leading experts
• explanation of individual treatment plan

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the inpatient procedure, with mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Inpatient

Duration: 7days

Surgical intervention

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• review of medical records
• laboratory tests:
  • complete blood count
  • general urine analysis
  • biochemical analysis of blood
  • tumor markers
  • indicators of inflammation
  • indicators blood coagulation
• CT/MRI scan of the local tumor
• CT Chest with contrast
• preoperative care
• tumor resection
• histologically and immunohistochemically examination
  of the remote tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Type of program : Inpatient

Expected duration of the program: 10 days