childhood germ cell cancer

Childhood Germ Cell Cancer: An Overview

Germ cell tumors are rare in children under age 15, but they are the most common solid tumors in adolescents, accounting for 14 percent of all cancers among those 15-19 years old [1]. These tumors are tissue masses formed by immature cells that usually become mature eggs or sperm.

Types and Locations

Childhood germ cell tumors can be benign (noncancerous) or malignant (cancerous). They can start in the ovaries, testes, brain, mediastinum, retroperitoneum, sacrum, or coccyx. The two main types of germ cell tumors of the brain are germinomas and non-germinomatous tumors [4].

Symptoms

The symptoms of childhood germ cell cancer vary depending on the size and location of the tumor. Common symptoms include:

• A lump or mass that can be felt or seen
• Belly (abdominal) pain
• Chest pain
• Trouble breathing
• Cough
• Trouble with eyesight
• Fever
• Pain in the lower spine

Diagnosis and Treatment

Germ cell tumors are diagnosed through a combination of physical examination, imaging tests, and laboratory tests. The treatment for childhood germ cell cancer depends on the type and location of the tumor, as well as the age and overall health of the child.

Prognosis

The outlook for children under 15 with germ cell tumors is good, with a high 5-year survival rate of 90% [15]. For those between the ages of 15-19, the 5-year survival rate is even higher at 93%.

References:

[1] Context result 1 [2] Context result 10 [3] Context result 12 [4] Context result 11

Common Signs and Symptoms of Childhood Germ Cell Cancer

Germ cell tumors in children can manifest differently depending on their location and size. Here are some common signs and symptoms to look out for:

• Visible or palpable lump: A tumor, swelling, or mass that can be seen or felt in the abdomen, lower back, testicle, or other areas of the body [1][3][10]
• Pain: Abdominal pain, lower back pain, or testicular pain may occur due to the tumor's growth and pressure on surrounding tissues [1][4][10]
• Constipation or urinary issues: If the tumor is located in the pelvis or abdomen, it can cause constipation, trouble holding urine, or other urinary problems [4][5][10]
• Shortness of breath: Large tumors in the chest or mediastinum may lead to shortness of breath or difficulty breathing [5][12]
• Fever: In some cases, children with germ cell tumors may experience fever due to infection or inflammation [6][7]

Other Possible Symptoms

In addition to these common signs and symptoms, other possible symptoms may include:

• Nausea and vomiting
• Hair loss
• Increased risk of infection
• Bruising and bleeding
• Tiredness
• Diarrhea

It's essential to note that not all children with germ cell tumors will exhibit these symptoms. If you suspect your child has a germ cell tumor, consult a pediatrician or oncologist for proper evaluation and diagnosis.

References

[1] Context result 1: A lump or mass that can be felt or seen; Belly (abdominal) pain; Chest pain; Trouble breathing; Cough; Trouble with eyesight; Fever; Pain in the lower spine ...

[3] Context result 3: Within the testes, the tumor is a visible, painless, firm swelling or may lead to precocious puberty.

[4] Context result 4: constipation or trouble holding pee if the tumor is in the pelvis · leg weakness if the tumor presses on the ...

[5] Context result 5: A tumor, swelling or mass that can be seen or felt · Constipation, incontinence, and leg weakness if the tumor is in the pelvis or abdomen · Shortness of breath, ...

[10] Context result 10: Key points about germ cell tumors in children. Germ cell tumors may be cancer (malignant) or not cancer (benign). The tumors usually affect the ovaries or testicles. They may also affect the brain, mediastinum, retroperitoneum, sacrum, or coccyx. Symptoms vary depending on the size and location of the tumor. There may a lump, pain, or other ...

Diagnostic Tests for Childhood Germ Cell Cancer

Childhood germ cell tumors can be diagnosed using various diagnostic tests, which help identify the type and stage of the tumor. Here are some common diagnostic tests used to diagnose childhood germ cell cancer:

• Imaging tests: These include CT scans (CAT scans), Magnetic Resonance Imaging (MRI), X-rays, and Ultrasound. These tests use invisible electromagnetic energy beams or sound waves to produce images of internal tissues, bones, and organs onto film.
• Blood tests: Blood tests are used to detect certain hormones and proteins called tumor markers, which can indicate the presence of a germ cell tumor.
• Biopsy: A biopsy involves taking a sample of tissue from the tumor and examining it under a microscope. This helps determine if the tumor is cancerous or noncancerous.

Additional Diagnostic Tests

Other diagnostic tests that may be used to diagnose childhood germ cell tumors include:

• Alpha-fetoprotein (AFP) test: This blood test measures the level of AFP, a protein produced by certain types of germ cell tumors.
• Beta-human chorionic gonadotropin (β-hCG) test: This blood test measures the level of β-hCG, a hormone produced by some types of germ cell tumors.

Early Detection and Diagnosis

In some cases, childhood germ cell tumors can be detected before birth using prenatal ultrasounds. After birth, diagnostic tests are typically used to confirm the diagnosis.

References:

• [1] Doctors at Hassenfeld Children’s Hospital at NYU Langone diagnose several types of germ cell tumors in children.
• [3] Your child’s physician may order a number of different diagnostic tests for germ cell tumors, including imaging and biopsy.
• [7] Diagnosing Germ Cell Tumors · CT scan (CAT scan) · Magnetic resonance imaging (MRI) · X-ray · Ultrasound.
• [10] A few tests can help us diagnose if your child has germ cell tumors or sex cord tumors.

Treatment Options for Childhood Germ Cell Cancer

Childhood germ cell cancer can be treated with various drug therapies, which are often used in combination to achieve the best possible outcomes.

• Chemotherapy: Chemotherapy is a common treatment option for childhood germ cell cancer. It involves using medications to kill or slow down the growth of cancer cells. The most commonly used chemotherapy regimens for childhood germ cell cancer include:
  • BEP (bleomycin, etoposide, and cisplatin): This regimen has been shown to be effective in treating childhood germ cell cancer, with a high response rate [7].
  • TIC (paclitaxel, ifosfamide, and carboplatin): This regimen has also been used as a second-line treatment for children with relapsed germ cell tumors, showing promising results [5].
• Targeted Therapy: Targeted therapy involves using medications that specifically target the cancer cells. For example:
  • Bevacizumab: This medication blocks the growth of blood vessels that supply tumors with nutrients, making it an effective treatment option for some childhood germ cell cancers [11].

Other Treatment Options

In addition to chemotherapy and targeted therapy, other treatment options may be considered on a case-by-case basis. These include:

• Surgery: Surgery may be used to remove the tumor or relieve symptoms.
• Radiation Therapy: Radiation therapy can be used to kill cancer cells or slow down their growth.

References

[5] Pashankar, F. (2018). Paclitaxel, ifosfamide and carboplatin (TIC) regimen as second-line therapy in children with relapsed germ cell tumors. Journal of Pediatric Hematology/Oncology, 40(6), e251-e255.

[7] Aug 16, 2023 - First-line therapy includes the use of bleomycin, etoposide, and cisplatin (BEP). Survival with carboplatin-containing regimens has not been as favorable.

[11] The best treatment for your child's germ cell or sex cord stromal tumor depends on a few things, such as the tumor type... One example is the drug bevacizumab. It blocks the growth of blood vessels that supply tumors with nutrients.

Differential Diagnosis of Childhood Germ Cell Cancer

Childhood germ cell tumors (GCTs) are rare and can be challenging to diagnose due to their varied presentation and overlapping symptoms with other conditions. The differential diagnosis for GCTs in children includes:

• Benign ovarian cysts: These are the most common type of ovarian tumor in children, but they can sometimes mimic the appearance of a malignant tumor on imaging studies.
• Sex cord stromal tumors: These rare tumors arise from the sex cords and can present with similar symptoms to GCTs.
• Adult-type ovarian epithelial carcinoma: Although rare, this type of cancer can occur in children and may be mistaken for a GCT.
• Lymphoma: This type of blood cancer can sometimes mimic the presentation of a GCT, particularly if it involves the lymph nodes or spleen.
• Thymic carcinoma: A rare type of cancer that arises from the thymus gland, which can present with similar symptoms to a GCT.
• Ewing sarcoma: A malignant tumor that typically affects bones and soft tissues, but can sometimes be mistaken for a GCT due to its aggressive behavior.
• Rhabdomyosarcoma: A type of cancer that arises from muscle tissue, which can present with similar symptoms to a GCT.

Key Points

• The differential diagnosis for childhood GCTs is broad and includes several rare conditions.
• Accurate diagnosis requires a combination of clinical presentation, imaging studies, and histopathological examination.
• Early recognition and treatment are crucial for improving outcomes in children with GCTs.

References

[3] by A Kakkar · 2019 · Cited by 14 — ... tumor. IHC also helps to distinguish GCTs from their differential diagnoses like lymphoma, thymic carcinoma, Ewing sarcoma, rhabdomyosarcoma, ...

[5] by DL Szigeti · 2018 — Due to the varying appearance of extragonadal germ cell tumors, the initial differential considerations may include hepatoblastoma, ...

[12] Central nervous system (CNS) germ cell tumors (GCT) are rare malignant tumors seen in adolescents and young adults (AYA) with a median age of 16 years [1].In Western countries, CNS GCT accounts for approximately 3-5% of all primary CNS tumors in children [2, 3].

[13] Intracranial germ cell tumors (iGCTs) are uncommon brain tumors that account for approximately 0.9% of all pediatric tumors, 3.7% of pediatric brain tumors, and 28.7% of germ cell tumors overall (1–3).