Germ Cell Tumours

The symptoms depend on where the germ cell tumour develops, but usually a lump appears that can either be felt or leads to other problems such as chest or abdominal pain. The tumour may press on adjacent structures, such as the bladder causing excessive urination.

What would you expect to happen first, when you see your GP?

A variety of tests and investigations may be needed to diagnose a germ cell tumour.

A biopsy is likely to be taken; this will help to determine the precise type of tumour and whether it is malignant or benign. A CT or MRI scan will enable doctors to determine the exact position of the tumour. Chest x-rays may be taken to check whether the cancer has spread to the lungs.

Germ cell tumours often produce proteins that can be measured in the blood. These proteins are alpha fetoprotein (AFP) and human chorionic gonadotrophin (HCG) and are known as tumour markers. The levels of these proteins will be checked when the tumour is diagnosed and will be monitored during and after treatment. Sometimes the presence of these markers is enough to diagnose a GCT and a biopsy is not needed.

Staging

The ‘stage’ of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps doctors to decide on the most appropriate treatment. Generally, cancer is divided into four stages:

• Stage 1: the cancer is small and has not spread and has been completely removed.
• Stages 2 and 3: the cancer is larger and may not have been completely removed or may have spread to nearby organs.
• Stage 4: the cancer has spread to other parts of the body. Cancer that has spread to distant parts of the body and formed new tumours is known as secondary or metastatic cancer

Treatment for germ cell cancer often causes side effects and these will be discussed before treatment starts.

The possible side effects of chemotherapy depend upon the drugs used but may include 

• nausea and vomiting, 
• hair loss, 
• reduced resistance to infection, 
• bruising and 
• bleeding, 
• tiredness and 
• diarrhoea.

These problems are all temporary and can be minimised with good supportive care.

A number of children may develop persistent side effects as a result of treatment, sometimes many years later, these are known as late effects. These can include 

• a reduction in normal bone growth 
• reduced fertility 
• a change in heart function 
• a small increase in the risk of developing a second cancer later in life

Follow-up

The outlook for children with germ cell tumours is good.

Children will have regular follow-ups to check for any recurrence of the cancer and for any problems which may arise as a result of the treatment they were given.

A small number of children may develop long-term problems because of their germ cell cancer treatment.

Surgery and radiotherapy may both cause functional or cosmetic problems depending on the area of the body in which the tumour occurred. Removal of a single ovary or testis should not affect a child’s future ability to have children.

Chemotherapy may cause problems with heart and kidney function, fertility problems and a small increase in risk of developing another cancer.

Occasionally, the cancer can recur. This is called a relapse. Relapse occurs most likely as a result of a few of the original cancer cells surviving the treatment. Sometimes, this is because cancer cells spread to other parts of the body and were too small to be detected during the follow-up immediately after treatment.

The treatment and prognosis for relapsed disease will depend on a number of factors including the site of relapse.

Long-term and late effects of treatment

Tattianah was diagnosed with an immature teratoma, a type of germ cell tumour, in 2019, when she was just three months old.