Germ Cell Cancer

Germ cells are the cells in your body that are used in sexual reproduction and live in the gonads (reproductive glands). Males have germ cells called sperm, found in the testes, and females have germ cells called eggs, found in the ovaries. Sometimes, germ cells are created in another part of the body and need to migrate to the gonads.

Like all cells in the body, germ cells can start to grow too fast or stop dying when they are supposed to. If this happens, the cells can grow into a lump called a tumor. If the tumor doesn’t spread to other parts of the body, it is called benign or noncancerous. If the cells in the tumor spread to other nearby parts of the body, the tumor is called malignant or cancerous.

Since most germ cells live in the gonads, they often turn into cancer of those body parts. However, germ cells that end up in other parts of the body can also turn cancerous. As a result, the three main types of germ cell cancer are:

• Testicular cancer
• Ovarian cancer
• Extra-gonadal germ cell tumors

Like other cancers, germ cell cancer begins to grow and then spreads. How much it has grown and spread is called the stage of the cancer. The stages of cancer are:

• Stage 0. This is the earliest stage of cancer where the cells have not grown beyond the germ cells themselves.
• Stage 1. This stage describes growth into the tissue surrounding the germ cells, but has not spread to any lymph [LIMF] nodes or other areas.
• Stage 2. The outermost layers of the tissue surrounding the germ cell are affected by cancer at this stage, but other organs and lymph nodes are not.
• Stage 3. Tumors have penetrated through the layers of the tissue surrounding the germ cell, but have not reached other organs. Some surrounding lymph nodes are usually affected at this stage.
• Stage 4. Tumors have penetrated the tissue of the organ where the germ cell is, and cancerous cells have spread to other organs of the body, with or without affecting lymph nodes. This stage is often referred to as metastasized [muh-TAS-tuh-sahyzd] cancer.

The symptoms of germ cell cancer can be very different for each person. Your child might have different symptoms, more severe symptoms, or no symptoms at all depending on these factors:

• Location. Your child might have symptoms in their testes or ovaries, or other areas including the chest, pelvis, and cranium.
• Spread. If the cancer has metastasized (spread to other parts of the body), your child might have symptoms in more than one place.
• Stage. Early stages of germ cell cancer usually have fewer symptoms.

Symptoms are also different for different types of tumors caused by germ cell cancer. Germ cell cancer might cause any of the following:

Testicular cancer

Symptoms of testicular cancer include:

• A painless lump or swelling in one or both testicles
• A change in how the testicles feel
• A dull ache in the lower abdomen (belly) or groin
• A build-up of fluid in the scrotum, the pouch that holds the testicles
• Pain in the testicle or scrotum

Ovarian cancer

Symptoms of ovarian cancer include:

• A heavy feeling in the pelvis
• Pain in the lower abdomen
• Weight gain or weight loss
• Abnormal periods or no periods
• Unexplained back pain that gets worse

Other germ cell cancers

The symptoms of other germ cell cancers can vary depending on the part of the body the cancerous germ cells are growing in. Your child might have symptoms like:

• A lump in the abdomen (belly) or lower back
• Pain in the abdomen
• Fever
• Constipation

Girls with ovarian or other germ cell cancers might have unusual vaginal bleeding. They might stop having their period or might not get it at a normal age.

You should see a doctor right away if your child shows any of the signs of testicular cancer, ovarian cancer, or another germ cell cancer. If the cancer is detected early, it will be easier to treat and cure.

Many of the symptoms of germ cell cancer can also be caused by other conditions. Some of these can be very serious. A doctor can do exams and tests to rule out other illnesses and diagnose germ cell cancer.

The basic cause of germ cell cancer is damage to the sperm or eggs that causes the cell to grow and reproduce without stopping. This can result in a lump of cells called a tumor. If this tumor starts to spread to other parts of the body, it is called cancer.

Most of the time, doctors aren’t sure what causes the cell damage that leads to germ cell cancer, but they have found some risk factors that can increase your child’s chance of getting ovarian cancer, testicular cancer, and other germ cell cancers. Some of these risk factors include:

• Family history. If your child has close family members who have had this cancer, such as parents, siblings, aunts or uncles, and grandparents, they might be at higher risk.
• Genetic mutations. BRCA1 and BRCA2 are two genes in the body’s DNA that can increase your child’s risk of ovarian and breast cancer if they are mutated.
• Undescended testicle. Boys with an undescended testicle might have a higher chance of developing testicular cancer.
• Genetic syndromes. Some genetic syndromes like Klinefelter, Swyer, and Turner syndromes can increase the risk of germ cell tumors in different parts of the body.

If your child’s doctor thinks your child might have testicular cancer, ovarian cancer, or another germ cell cancer, they will do a physical exam and probably order imaging tests to take pictures of the part of your child’s body that has symptoms. They might also refer you to a pediatric oncologist, a doctor who specializes in diagnosing and treating cancer in children.

Some of the tests your child’s doctor or oncologist might do include:

• X-rays
• Blood chemistry studies
• CT scan
• MRI
• Ultrasound

In addition to imaging tests, your doctor might order a biopsy. In this procedure, the doctor takes a small piece of tissue from the part of your child’s body that might have cancer. This tissue is sent to a lab for testing, which might include cytogenetic analysis (looking at the tissue under a microscope) or immunochemistry (looking for certain chemicals that are signs of cancer).

If your child’s doctor thinks the cancer might have spread to other parts of their body, they might do more tests to look for cancer in nearby areas. These tests can include the imaging tests above as well as:

• Thoracentesis. The doctor removes fluid from the space between the chest and lungs to look for signs of cancer in this part of the body.
• Paracentesis. The doctor removes fluid from the space between the abdomen and your child’s internal organs and studies it for cancer.

If your child is diagnosed with germ cell cancer, their doctor will probably do more tests to find out exactly where the cancer is and what stage it is at. This information will help your doctor decide if your child should have treatment, and what treatment will be best. Common treatments include:

• Surgery.  A surgeon makes a cut in your child’s body which lets them get to the organ or area where the cancer is. The surgeon can then cut the cancer out or burn the cancer tissue so it stops growing.
• Chemotherapy. During chemotherapy, your child is given medicines that target and kill the cancer cells or limit how fast they can grow.
• Radiation therapy. High-energy beams of radiation are pointed at the part of your child’s body with cancer, which can kill the cells or stop them from reproducing.

Sometimes, your child has a very early stage of cancer, or cancer that is hard to treat with chemotherapy or radiation. In these cases, they may choose to watch your child’s cancer for signs that it is growing or changing.

Because doctors aren’t sure what causes germ cell cancer, there are not good ways to prevent it. This is especially true in children, where cancer is rare, harder to predict, and more often the result of congenital disorders that were present from birth or in your child’s genes. If you are planning to have children, genetic counseling might help give you more information about diseases like germ cell cancer that you could pass on to your children.

Germ cell cancer is an abnormal growth of germ cells, the cells in your child’s body that turn into sperm and eggs. This cancer can affect the ovaries, testes, or other parts of the body where germ cells travel and can get stuck.