Children's Germ Cell Tumors

Germ cells, the cells from which life grows or germinates, are cells in a fetus which become sperm in a boy’s testicles or eggs in a girl’s ovaries. Usually these tumors start in a boy’s testicles or a girl’s ovaries.

Sometimes as a fetus develops, these germ cells stray into other parts of a child’s body and form benign or malignant tumors. You may hear doctors call these tumors “extragonadal germ cell tumors.” Usually if the tumor is outside the gonads (testes or ovaries), it forms in the abdomen, chest, lower part of the spinal column or brain. These cells rarely lodge in a child’s brain.

Doctors see some germ cell tumors in infants, but they peak at puberty, generally in teen-agers aged 15-19. Germ cell tumors account for fewer than 4 percent of cancers in those 20 and younger. Germ cell tumors are rare with about 900 cases diagnosed annually in the United States, and need the care of doctors who have experience in treating them.

What are germ cell tumors?

These tumors can be benign or malignant. You’ll hear the term “teratoma” which is a tumor that contains different kinds of tissue such as hair, bone and muscle. Doctors place them into three groups:

• Mature teratomas: These tumors are benign and unlikely to become malignant. The cells look much like normal cells. These tumors can become large but do not grow into nearby organs.
• Immature teratomas: These tumors may contain many types of tissue such as hair, bone and muscle. The cells look different from normal cells, but they are not malignant. They can become malignant.
• Malignant germ cell tumors: These include three subtypes: yolk sac tumors, which produce the AFP (alpha-fetoprotein) marker; germinomas, which make the bhCG (beta-human chorionic gonadotropin) marker; and choriocarcinomas, which make the bhCG marker.

Biopsy and pathology

A biopsy is the way doctors remove some tissue or fluid from your child’s body so it can be examined under a microscope. For suspected germ cell tumors, doctors try to remove the entire tumor keeping the tumor capsule (its external boundary with normal tissue) intact. The tumor usually must be removed whether benign or malignant. Once doctors have removed it, they send it to a pathologist to be evaluated.

While only a pathologist can say for sure if cancer is present, the imaging tests and results of the tests for blood tumor markers provide strong indicators of whether the mass is benign or malignant.

Pathology

Experienced, board-certified pathologists diagnose children’s cancers. They look at tissue samples under a microscope to see if cancer cells are present. A biopsy and examining tissue under a microscope are the only ways to accurately identify cancer. Today, pathologists have more tools than ever to pinpoint the specific type of cancer your child has, to indicate how far it has spread and to identify the features that help doctors determine the best treatment for your child. Some cancers may appear similar to others.

Markers, molecules in cancer cells that doctors can see under a microscope, help your child’s pathologist distinguish between the cancer subtypes and help them identify the kind of tumor your child has. This is crucial so your child’s doctors can determine the best treatment for your child. Your child’s doctors will explain these reports and what they mean.

Your child’s pathologist will look for:

• How tumor cells look under a microscope. If they look a lot like normal cells, this could indicate a slow-growing cancer. If they have little resemblance to normal cells, this could indicate an aggressive cancer.
• How the cells are clustered or the pattern of the cells. Malignant cells that are not attached to one another may indicate one cancer type. Tumor cells that cluster together in small groups could indicate another cancer type.
• How the cells absorb or do not absorb various stains. Some cancers have particular proteins. Certain antibodies will attach to those proteins. So your pathologist uses different antibodies labeled with special stains, to see if specific proteins are present. If the protein is present, the antibody will attach to it and show up as a different color when viewed under a microscope. Then your pathologist knows the malignant cell belongs to a particular cell family. This helps your child’s pathologist identify the type of malignant tumor your child has and helps them eliminate some tumors from consideration.

Pathologists will search for particular tumor markers, proteins called alpha-fetoprotein (AFP) and beta human chorionic gonadotropin (bhCG), produced by germ cell tumors. The rate at which these markers fall during and after treatment also can help doctors measure the effectiveness of treatment.

Can my child survive a germ cell tumor?

The short answer is “yes.” The numbers are on their side. If these cancers are found before they spread, more than 90 percent of patients survive. Families should know that statistics will not drive the outcome for your child. Each person is different, so statistics cannot determine an individual’s outcome. Your doctors will discuss your child’s cancer with you as well as other health conditions that may affect their outcome. At Children’s Cancer Center, where research already has led to longer survival, doctors are searching for more and more ways for your child to defeat cancer.

Your child's care team

When a malignant germ cell tumor strikes your child, you need a team of doctors, nurses and other specialists with training in treating these cancers.

Children's Cancer Center has pediatric oncologists, pediatric surgeons, and specialists in pathology, radiology and radiation oncology. Other team members include nurse practitioners, nurses, palliative care specialists, child life specialists, psychologists and even families who have traveled this road.

Most of these team members meet every week to discuss your child’s case, their progress and any new treatments or techniques that may help them. All are focused on helping your child and your family succeed against cancer. You will meet many members of your child’s team, but may never see others.

What we do

Your child's care team works with you and your family throughout your child’s treatment. Children's Cancer Center is part of Children's of Mississippi and the UMMC Cancer Center and Research Institute. Team members listen to you, talk to you and then talk to each other in an effort to provide the best and most seamless care possible. Our doctors, nurses and other specialists are involved every day in treating patients, teaching the next generation of caregivers and doing research on how to better cure the very cancer your child may be battling. That means they stay up to date on the latest treatments and research available.

This team also knows that battling any disease is emotionally, physically and financially draining, so they do all they can to help. For example, they will try to arrange all your child’s appointments for the same day, and various specialists will visit your child in one room so you don’t have to roam across the hospital’s large campus. Treatment caters to your child with toys, movies and other distractions to help ease the boredom and fear that can accompany medical visits.

This team knows its first priority is curing your child’s cancer, but team members never forget they’re dealing with children. Needles will be a part of this healing process, but your child will get more hugs than shots from this team. If you choose, a family that has been in your situation will contact you to offer social support and the wisdom of their experience.

Children’s Cancer Center offers many support services for patients and their families. Services include counselors, dentists, teachers and many others who work with your family during this critical time.