Many factors go into a doctor’s decision about how to best treat germ cell tumors.  Many factors also affect the outlook for a good outcome.

• Location: The likelihood of a cure can vary with the location of the tumor.  Germ cell tumors of the gonads have a better prognosis than germ cell tumors outside the gonads (extragonadal).  Mediastinal germ cell tumors are usually silent when small and therefore more difficult to treat.
• The cell characteristics: Benign teratomas have an excellent prognosis with surgery.  Malignant tumors include immature teratomas and other germ cell tumors containing malignant cells.  It is usually necessary to use surgery and chemotherapy to treat malignant tumors.  These malignant types include:
• Endodermal sinus tumors (yolk sac tumor)
• Embryonal carcinoma
• Dysgerminoma
• Seminoma
• Choriocarcinoma
• Tumor cell markers: Many tumors produce proteins that can be measured in the blood over time to show the rate of tumor growth and the success of treatment.  Two proteins that can be used as markers are:
• Alpha-fetoprotein (AFP)
• Beta human chorionic gonadotropin (bhCG)

The rate at which these markers fall after surgery or chemotherapy, even if they are high at the outset, is becoming recognized as a prognostic factor.

• Stage: Patients whose tumor has spread from its point of origin to other parts of the body require more therapy and are at risk for poorer outcomes.
• Age of diagnosis: Patients older than 15 (or in general those diagnosed after puberty) are at risk for poorer outcomes than younger patients.

Treating Germ Cell Tumors

There are two primary ways to treat germ cell tumors:

• Surgery to remove the tumor tissue
• Chemotherapy to attack the remaining tumor cells

Surgery

The location of the tumor may influence the need or possibility for surgery.  When possible, the first choice is to try and remove the entire tumor.  Complete surgical removal can be enough to cure most teratomas and immature teratomas.

Surgery alone can also cure some testicular and ovarian malignant germ cell tumors.  For testicular germ cell tumors, successful surgery may make chemotherapy unnecessary.  If the disease has not spread to the lymph nodes, and if the levels of tumor marker proteins decrease to normal after surgery, there may be no need for chemotherapy.

In older boys, a biopsy of lymph nodes in the abdomen may be needed to determine whether the disease has spread.

Chemotherapy

The use of chemotherapy medications has been successful in curing some germ cell tumors.  Standard chemotherapy includes four rounds of treatment known as PEB that includes:

• Cisplatin (P)
• Etoposide (E)
• Bleomycin (B)

The drugs carboplatin and ifosafamide are sometimes also used.

Boys who have had testicular tumors removed completely by surgery may be monitored without chemotherapy.  If tumor marker levels fail to return to normal or rise after surgery during the follow-up period, chemotherapy is then used with good results.  This is sometimes called "salvage chemotherapy" because it can get rid of tumor cells that were not completely removed by surgery.

Patients with other malignant germ cell tumors may also receive four cycles of PEB.  As treatment proceeds, tumor marker levels are monitored.  The purpose is to shrink the tumor as much as possible, after which surgeons will try to remove any tumor tissue that remains.

Research Studies

The majority of children with cancer participate in research studies.  This high rate of participation has been essential to improving the cure rates for children’s cancer.

Researchers design various studies to improve treatment and advance the understanding of cancer and its causes.  Clinical trials are carefully reviewed and must be approved through a formal scientific process before anyone can be enrolled.  If there is a research study “open” that your child is “eligible for,” you may be asked to allow your child to participate.  It is also possible that your child will be asked to participate in more than one study.

Whether an individual is eligible for a particular study may depend on age, location of the cancer, the extent of the disease and other information.  Researchers usually must limit their study to some of these characteristics to have a scientifically valid study.  Further, researchers must follow exactly the same restrictions throughout the study.

If your child is eligible to participate in one or more study, your doctor will discuss these with you during an initial treatment conference (also called informed consent conference).  The doctor will describe the study, potential risks of participation, and other information you need to decide whether or not you would like your child to participate in the study.  You always have the choice to participate or not in research studies.

If you do choose to have your child participate in a study, you doctor will explain what type of information you will receive about the results of the study.  The overall results of the research study will be published to inform the public and other researchers.  No study will publish any information that identifies an individual.

Visit the Clinical Trials section of this website to learn more about the various kinds of research studies.

Last updated September, 2011

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