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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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My Child Has:
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Germ Cell Tumors - Brain
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A germ cell tumor arises from primitive developing cells that form in the embryo and may otherwise become the reproductive system. Most germ cell tumors occur outside the brain, in the chest or abdomen. In the brain, germ cell tumors are most commonly found in the pineal and suprasellar regions.
Germ cell tumors account for approximately 2 percent of all pediatric brain tumors. Around half of these tumors occur in young people between 10 and 20 years old.
[See germ cell tumors as part of the general solid tumors section of this site for more information on germ cell tumors located in parts of the body other than the brain.]
As you read further below, you will find general information about germ cell tumors. If you would like to view summary information about brain tumors first, see the overview on brain tumors.
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Symptoms vary depending on size and location of tumor. A tumor can block the normal flow of CSF, causing increased pressure on the brain (hydrocephalus) and enlargement of the skull and a variety of symptoms. Common symptoms may include:
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- headaches ( especially upon awakening)
- nausea and vomiting (especially upon awakening)
- lethargy and irritability
- problems feeding or walking
- enlarged head size or fontanels (the soft "spot" that occurs before the bones in the head become solid) in infants
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For germ cell tumors found in other areas of the brain, common symptoms may include:
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- visual loss
- hormone abnormalities
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The symptoms of a brain tumor may resemble other conditions or medical problems - ranging from the simple to the serious. Always consult your child's physician for diagnosis and treatment.
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Germ cell tumors are a widely varied group of tumors. They range from very low grade or benign to highly malignant or aggressively growing cancers. Most are germinomas, others are known as teratomas (ranging from the mature to immature and even malignant), and finally the so-called mixed non-germinomas, a group that contain frankly cancerous malignant types (embryonal carcinoma, choriocarcinoma, endodermal sinus [yolk sac] tumors). The prognosis and treatment of each of these depends on their location, size, and other characteristics.
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Diagnostic procedures for germ cell tumors, like other brain tumors, are necessary to determine the exact type of tumor and whether the tumor has spread. These may include:
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- physical exam - your child's physicians can test neurologic function including: reflexes, muscle strength, eye and mouth movement, coordination, and alertness.
- scans - magnetic resonance imaging (MRI) scans are obtained using computerized, large magnetic fields to produce detailed images of organs and structures within the body. This will provide information on the location, size and characteristics of the tumor. The magnetic fields are not harmful and are safer than even routine x-rays. Computerized tomography (CT) or CAT scans using x-rays are also occasionally used.
- biopsy - a tissue sample from the tumor taken during surgery to remove part or all of the tumor. The sample will provide definitive information about the type of tumor.
- lumbar puncture (spinal tap) - to remove a small sample of cerebrospinal fluid (CSF), a special needle is placed into the lower back, into the spinal canal, the area around the spinal cord. CSF is the fluid that bathes the brain and spinal cord. The sample is sent for testing to determine if any tumor cells have started to spread. In children, this procedure is safely performed under sedation, and is less difficult and less painful than placing an intravenous (IV) catheter.
- markers - certain germ cell tumors release substances into the blood and CSF that can be measured (e.g. alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (B-HCG)). These tumor markers can be repeatedly tested to follow the response of a tumor to treatment.
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Specific treatments to cure intracranial germ cell tumors will be determined by your child's physician based on:
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- type, location, and size of the tumor
- extent of the disease
- your child's age, overall health, and medical history
- how your child's doctors expects the disease to progress
- your child's tolerance for specific medications, procedures, or therapies
- your preference and judgement
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Treatment may include (alone or in combination):
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- surgery - usually the first step and mainstay in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while preserving neurological function. Tumor specimens are examined by neuropathologists to determine the exact diagnosis. Attempts to completely remove the tumor through surgery can often cause major neurologic problems. Surgery is usually limited to well encapsulated teratomas, a particular tumor that includes all three cellular layers of germ cells, or in the case of blocked CSF flow.
Complete resection or surgical removal of the entire tumor is ideal when this is feasible. However, tumor location and other characteristics may limit removal to a partial or sub-total resection. A biopsy is the surgical removal of a sample of the tumor for diagnostic purposes. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal.
- ventriculo-peritoneal shunt (VP shunt) - when tumor causes blockage of CSF flow leading to symptoms, special tubing can be surgically implanted in the ventricles to drain excess CSF to the abdomen. This bypasses the tumor blockage and relieves symptoms of hydrocephalus.
- radiation therapy - precisely targeted and dosed radiation is used to kill cancer cells left behind after surgery. This therapy is important to control the local growth of tumor. Tumors that are not likely to spread receive radiation only to the tumor and the area surrounding it. If, based on the type of tumor and its cellular-level make-up, it seems the tumor is more likely to spread beyond the original tumor location, radiation to other parts of the brain and spinal cord may be recommended. If the tumor has spread, radiation to the whole brain and spinal cord are important to treat certain germ cell tumors.
- chemotherapy - a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Chemotherapy before surgery may help shrink the tumor, making it possible to remove.
Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat. While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
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- as a pill to swallow
- as an injection into the muscle or fat tissue
- intravenously (directly to the bloodstream; also called IV)
- intrathecally - chemotherapy given directly into the spinal column with a needle
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- follow-up care - to manage disease complications, to screen for early recurrence of tumor and to manage late effects of treatment, regular visits with physical exams, laboratory testing, and scans are routine follow-up. In addition to neurosurgeons, radiation oncologists, pediatric oncologists and neurologists, the endocrinologists, neuro-psychologists, alternative/complementary therapy specialists, school liaison and psychosocial personnel continue to serve as members of the neuro-oncology team.
- rehabilitation- Speech, physical, and occupational therapists are also part of the neuro-oncology team, and may be involved during and after treatments.
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Outcomes vary widely, depending on the precise type of tumor. Mature teratomas are curable with complete resection alone, while immature teratomas usually require additional therapy. In general, germinomas are cured in greater than 85 percent of cases with combined treatment. Other germ cell tumors, the mixed and malignant types, are more difficult to treat.
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Children's Hospital and Dana-Farber Cancer Institute are conducting numerous research studies that will help clinicians better understand and treat germ cell tumors. For more information on current research, see the Brain Tumor Program.
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The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
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Copyright © Children's Hospital Boston. All rights reserved. |
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