Do you have a strange lump on your body? Could it be a germ cell tumor? Let's talk!

Have you ever heard of 'Germ Cell Tumor'? Maybe the name sounds a little scary, but don't worry. Today we'll talk about it in a simple way that you can understand. Because it's very important to be aware of these things, especially since they can sometimes develop in young children and young adults.

What are these germ cell tumors?

Simply put, a germ cell tumor is a tumor that develops from our reproductive cells, called 'germ cells'. The word "germ" means "to germinate" or "to mature." Now, in a girl, these germ cells will later become the `eggs'. In a boy, these will become the `sperm'. So, these germ cell tumors are most likely to develop in the areas where eggs are produced, namely the `ovaries', and where sperm are produced, namely the `testicles'.

However, sometimes these tumors can develop in other parts of the body besides the ovaries and testicles. For example, they can develop in places like the abdomen, chest, lower back, tailbone, and brain. Tumors that develop in other places like this are called extragonadal tumors . That is, tumors that develop outside the reproductive glands.

Most importantly, these germ cell tumors are most commonly seen in young children, teenagers, and young adults .

Are there any types of germ cell tumors?

Yes, there are two types of germ cell tumors. Some can be malignant , meaning they are cancerous. The other type is benign . Both types of tumors can grow large. However, only cancerous germ cell tumors can spread to other parts of the body. When they spread (metastasized), they can damage our internal organs and are a little more difficult to treat.

Let's now see what the main types of germ cell tumors are:

Teratoma

These are a very special type of fruit. These fruits can contain tissues like teeth, hair, muscle, and bone. Think of it like a fruit made up of all sorts of different things. These can be 'mature' or 'immature'.

• Mature teratomas , sometimes called dermoid cysts , are the most common type of germ cell tumor that develops in the ovaries. Most of the time, they are not cancerous.
• Immature teratomas are usually cancerous, and they grow very quickly.

Yolk Sac Tumors or Endodermal Sinus Tumors

These tumors contain cells that are similar to those found in a developing embryo. They are malignant and spread very quickly to the lymph nodes and other organs. These are the most common type of cancerous germ cell tumors that develop in young children.

Germinoma

This is also a type of cancerous tumor. It can develop in either the ovaries or the testicles. However, it is most commonly found in the brain and spinal cord (central nervous system). When it develops in the ovaries, it is called a dysgerminoma , and when it develops in the testicles, it is called a seminoma .

Embryonal Cell Carcinoma

This is a rare, cancerous germ cell tumor. Sometimes it can occur alone, but more often it is seen in combination with other types of tumors, forming a mixed germ cell tumor .

Polyembryoma

These tumors contain parts that resemble embryos. This is also a very rare, fast-growing type of cancerous tumor. Most often, these tumors form in combination with other germ cell tumors.

Choriocarcinoma

These tumors are formed from cells that form the placenta during pregnancy. As you may know, the placenta is the organ that helps the mother and baby exchange nutrients. Choriocarcinoma is also a rare, cancerous germ cell tumor. Although it can develop in the ovaries or testicles, it most often develops in the uterus. What is special about it is that it can spread to both the fetus and the mother.

Mixed Germ Cell Tumors

These are tumors that form when two or more types of cancerous germ cell tumors come together. In fact, many germ cell tumors are mixed together like this.

What is the difference between seminoma and non-seminoma tumors?

Germ cell tumors in men, especially testicular cancer, are divided into two types: seminomas and non-seminomas . Both are cancerous tumors.

• Seminomas: These usually grow and spread more slowly than non-seminomas.
• Non-seminomas: These grow and spread more quickly than seminomas. Yolk sac tumors, embryonal cell carcinomas, choriocarcinomas, and teratomas belong to this category of non-seminomas.

How common are these germ cell tumors?

Germ cell tumors are actually rare in young children. They account for about 3.5% of all cancers in children. However, they are seen more frequently in teenagers and young adults. They account for about 13.9% of all cancers in people between the ages of 15 and 19.

Who is most affected by this situation?

Although anyone can develop germ cell tumors, they are most common in infants, toddlers, teenagers, and young adults . The incidence of these tumors varies with age. For example, they are relatively common from infancy to about 4 years of age, then decrease slightly, and then increase again during puberty.

• Ovarian germ cell tumors: These are most common in girls between the ages of 10 and 14. However, they can also develop in people in their 20s and 30s. Mature teratoma (usually noncancerous) is the most commonly diagnosed type of germ cell tumor.
• Testicular germ cell tumors: This type accounts for 75% of testicular cancers in children, and 90% of all testicular cancers. They are most common in children under 4 years of age and in men between 15 and 35 years of age.
• Extragonadal germ cell tumors: These tumors account for 40% to 50% of all germ cell tumors diagnosed in children under 4 years of age. However, they can also occur in children and adolescents. In infants and young children, they are most commonly found in the sacrum or coccyx. In adolescents and young adults, they are most commonly found in the mediastinum.
• Brain germ cell tumors: Although these are rare, they are most commonly diagnosed in people between the ages of 11 and 30.

What are the symptoms of a germ cell tumor?

The symptoms of this tumor vary depending on the size of the tumor and its location on the body.

Symptoms of ovarian cysts

Germ cell tumors that develop in the ovaries do not always cause symptoms. For example, a mature teratoma may not cause any symptoms until it is large enough to cause abdominal pain. They are often discovered during an ultrasound scan to look for the cause of lower abdominal pain.

Symptoms may be like this:

• Discomfort or pain in the lower abdomen.
• Feeling a painful lump in the ovary.
• Bloating, swelling.
• Abdominal pain (like appendicitis ).
• Irregular vaginal bleeding.
• Nausea.

Symptoms of testicular cysts

The symptoms of germ cell tumors that develop in the testicles are similar to those of testicular cancer.

The characteristics are as follows:

• A hard, solid lump in a testicle that gradually enlarges (may or may not be painful).
• Feeling of pain or heaviness in the scrotum.
• Stomach pain or groin pain.
• Abnormal shape of the testicle.
• Back pain.

Symptoms of tumors occurring in other locations (extragonadal)

If your child has a lump in the buttock or in the middle of the chest , it could be a teratoma. Other symptoms will vary depending on where the tumor is located.

• Difficulty breathing (if lung-related).
• Weakness in the legs (if in the lower back).
• Difficulty urinating and defecating (if the problem is related to the pelvis).
• The child has swelling and severe or dull pain in the abdomen.

Some germ cell tumors secrete reproductive hormones. This can cause children to show signs of puberty early or have abnormal sexual development. Girls may develop breasts, pubic hair, and early menstruation. Boys may develop breasts (gynecomastia).

What causes these germ cell tumors?

Normally, these germ cells are formed as a human embryo develops. These cells then migrate to the embryo's ovaries or testicles, where they become either egg cells or sperm cells.

But, in germ cell tumors, these cells don't fully develop into eggs or sperm. Instead, these germ cells divide abnormally and form tumors in either the ovaries or testicles. In the 'extragonadal tumors' that we talked about earlier, these germ cells go to strange places in the body - places like the chest, brain, abdomen, lower back, buttocks - and form tumors there.

In fact, researchers still haven't figured out exactly why these germ cells behave this way.

What are the risk factors?

You may be more likely to develop a germ cell tumor if someone in your family has had one before, or if you have certain medical conditions.

These are situations like this:

• Having untreated, undescended testicles ( cryptorchidism ).
• A condition called Turner syndrome .
• A condition called Klinefelter syndrome .

These are genetic or developmental conditions that doctors identify.

How are germ cell tumors diagnosed? (Diagnosis)

Your doctor will first do a physical exam and ask about your symptoms. Then, they may do one or more of the following tests to determine if you have a germ cell tumor:

• CT scan: This involves taking many X-ray pictures of the inside of your body and using a computer to create a three-dimensional (`3D`) image of the bones and soft tissues. A CT scan of the chest, abdomen, or pelvis can help locate the tumor.
• MRI: This uses a magnet and radio waves to create a computer image of the bones and soft tissues of the body. Like a CT scan, an MRI can show the location of the tumor.
• Ultrasound: This uses sound waves to create pictures of the inside of the body. Ultrasound can show how much of a tumor is solid and how much is fluid (`cystic`). This information can help determine whether a tumor is a germ cell tumor or just a fluid (`cyst`).
• PET scan: This uses a special chemical (a `tracer`) to find areas of cancer cells in the body. A PET scan can also see if the cancer has spread.
• Bone scans: This involves injecting a special dye into the body, allowing it to be absorbed into the bones, and then taking X-ray pictures. This dye helps to highlight abnormalities and can help determine if a tumor has spread to the bones.
• Blood tests: Your doctor may take a blood sample to check the levels of certain enzymes, proteins, or hormones in your blood. High levels of things like human chorionic gonadotropin (hCG) , alpha-fetoprotein (AFP) , and lactate dehydrogenase can be a sign of certain types of germ cell tumors.
• Biopsy: This involves taking a small piece of tissue from the tumor and sending it to a lab for testing. A pathologist , a doctor who specializes in tissue analysis, will examine the sample under a microscope to determine if it is a germ cell tumor.

Important: If your lump is likely to be cancerous, your doctor may decide to remove the entire organ. For example, the standard procedure for diagnosing testicular cancer is to remove the entire testicle ( radical inguinal orchiectomy ). Removing the testicle allows your doctor to analyze the tissue and perform surgery as a treatment.

How are germ cell tumors treated?

There are several treatment options. Your doctor will determine the best treatment based on the type, size, location of the tumor, and your overall health.

• Surgery: Surgery is the main treatment for germ cell tumors. In the case of ovarian tumors, only the tumor may be removed ( ovarian cystectomy ), or the entire ovary and fallopian tube may be removed ( salpingo-oophorectomy ). In the case of testicular cancer, the testicle containing the tumor is removed.
• Chemotherapy: This involves giving you drugs to kill cancer cells or stop them from dividing. If your doctor can’t safely remove the tumor, or if it has spread to other parts of your body, you may be given chemotherapy. After surgery, chemotherapy is also given to kill any remaining cancer cells that may not be seen on scans. Chemotherapy is a very effective treatment for many types of germ cell tumors.
• Radiation therapy: This involves using high-energy X-rays to destroy cancer cells. Some types of germ cell tumors respond well to radiation therapy.

Can a germ cell tumor be completely cured?

The prognosis, or hope of cure, for most germ cell tumors is very good. The disease is often cured if the tumor is completely removed. For example, testicular cancer has a 95% survival rate after treatment. Ovarian germ cell tumors have a 93% survival rate. Germ cell tumors in children have a cure rate of between 82% and 90%.

However, these results depend on several factors that are specific to you. These include:

• your age.
• Type of germ cell tumor.
• The location and size of the tumor.
• The distance the cancer has spread.
• The tumor's response to treatment.

Therefore, it is very important to talk to your doctor about how your diagnosis will affect your results.

Important questions to ask your doctor

You can ask these questions to better understand your diagnosis:

• Is my tumor cancerous (malignant)?
• How fast-growing (aggressive) is my tumor?
• Has the cancer spread?
• What treatments do you recommend?
• What are the possible side effects of treatment?
• What are the possible outcomes associated with each treatment option?
• What tests do I need to do to monitor the effectiveness of the treatment?
• How often will I need to come for follow-up appointments to monitor my tumor/response to treatment?

Finally, things to remember (Take-Home Message)

A germ cell tumor is a tumor that develops from the reproductive cells. Your doctor can explain to you how this diagnosis will affect you or your child. Germ cell tumors are a bit complicated. Your symptoms and your prognosis depend on many factors, all of which your doctor will discuss with you.

The good news is that most germ cell tumors respond well to treatment. As with any tumor (especially cancerous tumors), the sooner you diagnose and start treatment, the better your outcome will be. Therefore, if you have an unusual lump, swelling, or pain, it is wise to seek medical advice rather than ignoring it.

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