Germ cell tumors account for a relatively small number of childhood brain and central nervous system tumors in the United States. Depending on the type of tumor, its location and other factors, a majority of germ cell tumors can be successfully treated with a combination of surgery, radiation and chemotherapy.
What Are Germ Cell Tumors?
Germ cell tumors, or GCTs, arise from germ cells, immature reproductive cells that form in a developing embryo and eventually become eggs in females and sperm in males. Most germ cell tumors do develop in the reproductive system, though they can spread to other locations in the body.
In some cases, these specialized cells also appear in the brain, where they can develop into tumors that contain the same characteristics as the original embryonic cells. These intracranial germ cell tumors typically occur in regions of the brain near the pituitary gland or the pineal gland.
Germ cell tumors are divided into several subtypes, depending on the kind of cells in the tumor, its behavior and location. Because these tumor types can have very different characteristics, treatment depends on a clear diagnosis.
Germinoma
Germinomas are considered “pure” germ cell tumors. When they occur In the brain and spinal cord, these tumors are typically treated with a combination of surgery, radiation and chemotherapy. Germinomas respond well to treatment, with around a 90 percent five-year cure rate.
Nongerminomatous Tumor
Several other subtypes of germ cell tumors can contain a mixture of different germ cell types, and some can produce hormones on their own. Nongerminomatous tumors typically grow faster than germinomas and can be malignant.
Embryonal Carcinoma
Embryonal carcinomas are malignant and fast-growing tumors that typically occur in the testes but can also occur in the brain. Embryonal carcinomas of the reproductive system can also spread, or metastasize, to other parts of the body, including the brain.
Yolk Sac Tumor
Yolk sac tumors, also called endodermal sinus tumors, arise from germ cells that usually appear in the ovaries. Fast growing and usually malignant, these tumors produce a hormone called alpha-fetoprotein, which can help to distinguish a yolk sac tumor from other types of germ cell tumors.
Choriocarcinoma
A choriocarcinoma is a rare type of germ cell tumor that arises from the chorion cell layer in the placenta during pregnancy. Typically malignant, choriocarcinomas grow very fast and produce the hormone beta-human chorionic gonadotropin, or hCG.
Teratoma
Teratomas contain a mixed group of germ cells that can develop into hair, bone and other kinds of tissue. These types of tumors are usually benign, although some can be malignant. Some teratomas produce hCG, but because not all of them do, this is not a reliable way to diagnose a teratoma.
Symptoms of Germ Cell Tumors
Symptoms of germ cell tumors can vary widely, depending on their type and location. When germ cell tumors occur in the reproductive system and other areas outside the brain, symptoms can include a lump or solid mass, abnormal hair growth and early puberty.
In the brain, symptoms depend on whether the tumor is located near the pituitary gland or the pineal gland. Tumors near the pituitary gland produce symptoms related to hormone production, such as hair growth, puberty-related symptoms and diabetes.
Pineal tumors produce symptoms such as headaches, nausea and Parinaud’s syndrome — a cluster of vision-related symptoms that include double vision, difficulty looking up and nystagmus (a jerky movement of the eye).
Treatments for Germ Cell Tumors
Depending on a child’s age and health, the location of the tumor, and the kind of tumor, treatment for germ cell tumors of all kinds may include surgery, radiation and chemotherapy, often in combination.
Surgery may be performed to biopsy a tumor for better diagnosis, to remove it either partially or completely, or to perform an endoscopic procedure (i.e. With a camera) to biopsy the tumor or help prevent the buildup of cerebrospinal fluid from a blockage in the brain. During surgery, the brain tumor surgeon may perform a craniotomy to remove a piece of skull and access the brain. Without complications, patients generally recover in the hospital for less than a weekand return to normal activity within four to six weeks.
In some cases, chemotherapy is used before surgery to shrink a tumor’s size or after surgery to destroy remaining tumor cells. Delivered orally or intravenously, chemotherapy can also be used alone or with radiation to treat tumors in inaccessible locations. Chemotherapy typically takes place in several cycles over a period of weeks.
Radiation therapy can also be used after surgery, either with chemotherapy or alone to treat germ cell tumors in the brain. For localized tumors and those with low risk of malignancy, radiation is directed to the tumor site. For aggressive and malignant tumors, radiation treatment may include the whole fluid pathways in the brain and spine area. Painless and noninvasive, radiation therapy is done in multiple treatments on an outpatient basis.
Success rates for treating germ cell tumors of the brain and central nervous system are very high — up to 90 percent for those with germinomas and as much as 85 percent for those with nongerminomatous tumors at various stages of development.
Why Choose Neurosurgeons of New Jersey?
Neurosurgeons of New Jersey combines decades of experience and research on brain tumors with patient-centered care and cutting-edge technology. The center’s specialists in pediatric neurosurgery provide state of the art treatment options tailored to the unique needs and circumstances of each patient. At Neurosurgeons of New Jersey, your brain cancer surgeon and health care team work with you to create the treatment plan that’s right for your child.