Germ Cell Tumors

Introduction

Germ cell tumors start in the reproductive cells (eggs or sperm). They develop when cells that are meant to form sperm in the testicles or eggs in the ovaries travel to other parts of the body. Germ cell tumors are more common among children and young adults. They often are found in the ovaries, testes, or brain.

Ovarian germ cell tumors arise from the germ cells of the ovary. They can be benign (not cancer) or malignant (cancer). They are more common among girls and women ages 10 to 30 years old. Germ cell tumors make up about 20 to 25 percent of all abnormal tissue masses in the ovaries. Only five percent of ovarian cancers are germ cell tumors. The most common benign forms are benign teratomas or dermoids. Cancerous forms include dysgerminomas, yolk sac tumors, mixed germ cell tumors, and non-gestational choriocarcinomas.

Most testicular cancers begin in the germ cells. Learn more about testicular cancer.

Diagnosis

The following tests and scans are used to diagnose germ cell tumors.

  • Physical Exam - A complete exam to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. In men, the testicles may be checked for lumps, swelling, or pain. You may be asked about pains, appetite, and energy level.
  • Chest X-Ray - An x-ray of the organs and bones inside the chest.
  • Serum Tumor Marker Test - A procedure in which a sample of blood is tested to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells. Substances linked to germ cell tumors include:
    • Alpha-fetoprotein (AFP)
    • Beta-human chorionic gonadotropin (β-hCG)
    • Lactate dehydrogenase (LDH)
  • CT Scan (CAT scan) - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be given in a vein or orally to help the organs or tissues show up more clearly.
  • Ultrasound Exam - A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs. This forms a picture of body tissues called a sonogram.
  • Biopsy - The removal of cells or tissues to look for signs of cancer. This is done in a lab. The type used depends on where the germ cell tumor is found.
    • Excisional Biopsy: The removal of an entire lump of tissue.
    • Incisional Biopsy: The removal of part of a lump or sample of tissue.
    • Core Biopsy: The removal of tissue using a wide needle.
    • Fine-Needle Aspiration (FNA) Biopsy: The removal of tissue or fluid using a thin needle.

Staging

In all cases, treatment should be individualized for you. Although germ cell tumors are categorized into different prognoses, each person is unique.

The Following Prognostic Groups Are Used For Germ Cell Tumors:

Good Prognosis
  • Nonseminoma Germ Cell Tumor is in the Good Prognosis group if the tumor is in the back of the abdomen and the tumor has not spread to organs other than the lungs and the levels of tumor markers AFP and β-hCG are normal and LDH is slightly above normal. 
  • Seminoma Germ Cell Tumor is in the Good Prognosis Group if the tumor has not spread to organs other than the lungs and the level of AFP is normal; β-hCG and LDH may be at any level.
Intermediate Prognosis
  • Nonseminoma Germ Cell Tumor is in the Intermediate Prognosis Group if the tumor is in the back of the abdomen and the tumor has not spread to organs other than the lungs and the level of any one of the tumor markers (AFP, β-hCG, or LDH) is more than slightly above normal. 
  • Seminoma Extragonadal Germ Cell Tumor is in the Intermediate Prognosis Group if the tumor has spread to organs other than the lungs and the level of AFP is normal; β-hCG and LDH may be at any level.
Poor Prognosis

Nonseminoma Extragonadal Germ Cell Tumor is in the Poor Prognosis Group if:

  • The tumor is in the chest or the tumor has spread to organs other than the lungs;
  • OR the level of any one of the tumor markers (AFP, β-hCG, or LDH) is high.

Treatments & Side Effects

Most cancerous germ cell tumors are treated with surgery and/or chemotherapy. Different types of treatment are available for patients with a germ cell tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. (A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.)

Your treatment options depend on the type of tumor, the stage of the cancer (whether or not it has spread to other areas outside the site of origin), your overall health, and your preferences about treatment. In all cases, treatment should be individualized for you. Learn more about treatment for ovarian cancer. Although cancers are classified into particular stages, each person is unique.

A treatment plan is a way to deal with both the short and long term goals of managing your cancer. There are several treatment options for germ cell tumors. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.

It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment. There are effective and readily available medications to address traditional side effects from cancer treatment such as:

Surgery

Surgery is used to diagnose and/or treat cancer. It is the most common form of cancer treatment. It may be used alone or with other treatments. Risks of surgery are specific to the type of surgery done. They may include pain, fatigue, the risk of infection at the surgical site, scarring, and numbness. The pain and numbness are often temporary.

Chemotherapy

Chemotherapy involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment. 

Learn about chemotherapy

Radiation Therapy

Radiation therapy is the use of high-energy rays to kill or damage cancer cells.

Learn about radiation therapy

Clinical Trials

Be sure to ask about clinical trials. These are research studies to test new treatments or learn how to use current treatments better. In some cases, the treatments with the best chance of success may be available only through clinical trials. Trials are offered for many cancers, at many different stages. Everyone is not eligible for every trial. If you have cancer that has come back or spread, it is especially important to ask about clinical trials.

Learn about clinical trials