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Germinoma

  • Overview

    At Dana-Farber/Children’s Hospital Cancer Center, we have already helped many infants, children and adolescents who have been diagnosed with a germinoma: a specific type of germ cell tumor that is usually malignant (cancerous). These tumors, which originate from sex cells, become “trapped” in the brain during utero instead of migrating down toward the testes or ovaries.

    Here is some basic information about germinomas:

    • Germinomas are sensitive to chemotherapy and radiation therapy and both can be used to help achieve an excellent cure rate. 
    • The prognosis and treatment of each of these depends on their location, size, and other characteristics.
    • Most germ cell tumors are found in the ovaries or testes. When found in the brain, they’re known as “intracranial germ cell tumors.”

    Learn more detailed information about germ cell tumors of the brain and germ cell tumors of the ovaries.

    How Dana-Farber/Children’s Hospital Cancer Center approaches germ cell tumors of the brain

    At the Dana-Farber/Children’s Hospital Cancer Center, we hold a weekly brain tumor clinic for newly diagnosed children currently receiving treatment. At each appointment, you meet with specialists on your child’s team, from our pediatric neuro-oncologist, neurologist and neurosurgeon, to our pediatric endocrinologist, psycho-oncologist and School liaison.

    Dana-Farber/Children’s Hospital Cancer Center’s Pediatric Brain Tumor Program offers the following services:

    • Access to high-tech resources, like the intra-operative MRI, which allows our pediatric neurosurgeons to visualize the tumor as they operate with MRI scans. This means they can remove as much of the tumor as possible, and sometimes eliminate additional surgeries.
    • Expert neuropathological review, using advanced molecular diagnostic testing, to identify your child’s exact type of tumor. This information helps predict which treatments are more likely to work.
    • Access to unique Phase I clinical trials, from our own investigators, the Children’s Oncology Group and the Pediatric Oncology Experimental Therapeutics Investigators Consortium. Studies offer treatment options beyond standard therapy.
    • Ongoing care from pediatric neurologists familiar with the early symptoms and side effects of brain tumors and their treatments.
    • Access to one of the nation’s few dedicated pediatric brain tumor survivorship programs. This weekly clinic offers ongoing care to manage late effects caused by your child’s tumor or the treatment they received.

    Germinoma: Reviewed by Peter E. Manley, MD
    © Children’s Hospital Boston; posted in 2012

     
  • In-Depth

    At Dana-Farber/Children’s Hospital Cancer Center, we understand that a diagnosis of a brain tumor such as a germinoma comes with many questions and concerns for parents and families.  We’ve provided straightforward information about germinoma here, and when you meet with the team of doctors at Dana-Farber/Children’s Hospital Cancer Center, they’ll be able to explain your child’s condition and options fully.

    What are the different types of germinomas?

    There are two main types of germinomas: pure germ cell tumors and mixed germ cell tumors.

    Pure germ cell tumors

    • Pure germ cell tumors are undifferentiated tumors.
    • Although these tumors can be aggressive, they typically respond well to chemotherapy and radiation.
    • Pure germ cell tumors have a 90 percent cure rate.

    Mixed cell tumors

    • Mixed germ cell tumors (also known as nongerminomatous germ cell tumors) are more difficult to treat than pure germ cell tumors and require more aggressive therapy.
    • Mixed non-germinomas contain cancerous, or malignant, forms of these tumors, including:
      • embryonal carcinoma
      • choriocarcinoma
      • endodermal sinus [yolk sac] tumors
    • In mixed germ cell tumors, there can be a teratoma component and a malignant component.
    • Benign teratomas can grow aggressively, although they do not spread.
    • In Malignant teratomas (such as one with an embryonal carcinoma), the malignant component can grow aggressively and spread to other parts of the body.
    • In malignant teratomas chemotherapy and radiation treat the malignant component, but the teratoma component sometimes does not respond well to chemotherapy and additional surgery is sometimes necessary to remove the remaining tumor. 
    • Mixed germ cell tumors have a 70 – 75 percent cure rate

    Causes

    What causes germinomas? 

    Typically, germ cells migrate down towards the testes or ovaries during fetal development. Germinomas, however, are thought to occur when these germ cells don’t move to the right area and instead become “trapped” in the brain. This is why germinomas originate from sex cells, despite being located in the brain.

    Symptoms

    What are the symptoms of germinomas?

    If your child has a germinoma, his symptoms will depend on where it’s located within his brain and the rate at which the tumor is growing.

    One of the most common issues that occur when it comes to this type of tumor is hydrocephalus, or the blockage that occurs when spinal fluid builds up in and around the brain. This blockage creates pressure in the head. In turn, a child with hydrocephalus may experience:

    • headache
    • blurred or doubled vision
    • vomiting
    • chronic fatigue
  • Tests

    At Dana-Farber/Children’s Hospital Cancer Center, we know that an early and accurate diagnosis of your child’s germinoma is the first step to efficient and effective treatment.

    How is a germinoma diagnosed?

    In addition to a medical history and physical examination, a doctor may use the following diagnostic tests, including:

    • Magnetic resonance imaging (MRI) scan. An MRI is an imaging procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.  They do not use any x-rays or radiation
    • Computerized tomography scan (also called a CT or CAT scan) These scans are common procedures used to diagnose germinomas. CT scans use a combination of x-rays and computer technology to produce images of the brain and the body’s internal organs. CT scans are more detailed than general x-rays.

    After your child’s doctors suspect a tumor, they’ll begin the process of figuring out what kind of tumor it is. These may include:

    • Biopsy, the surgical removal of a sample of the tumor for diagnostic purposes. In order to determine the best treatment for your child, the doctors may need more information about the tumor. In this case, a biopsy may be done to get a tiny sample of tumor tissue to study under the microscope.
    • A lumbar puncture (spinal tap) to obtain a small amount of your child’s cerebral spinal fluid, for examination under a microscope. This can help the doctors identify abnormal or cancerous cells in the spinal fluid and determine if the tumor has spread.  Spinal fluid can also be tested for tumor markers to help determine the type of germ cell tumor. 
    • Blood tests to check for “tumor markers”. Certain germ cell tumors release measurable substances into the blood such as alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (B-HCG). These tumor markers can be repeatedly tested in order to track the how well the tumor is responding to treatment.

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. We will then meet with you and your family to discuss the results and outline the best treatment options.

  • At Dana-Farber/Children's Hospital Cancer Center, we understand that a diagnosis of germinoma can cause concern for your child's future growth and development. You are probably wondering where to go from here and how to make sure your child receives the best possible care.

    All of the members the Pediatric Brain Tumor Program at Dana-Farber/Children's Hospital Cancer Center are here to help. Our specialists are dedicated to anticipating any complications that your child may experience and developing the best therapeutic plans to manage them.

    How are germinomas treated?

    Initial treatment for germinomas depends on what is found in the actual tissue from the biopsy. Doctors first need to determine whether the tumor is a pure germinoma or a mixed germinoma. Based on that information, the therapy will differ.

    A pure germ cell tumor will not need a resection (surgical removal) because it will respond well to radiation and chemotherapy.  A mixed germ cell tumor may be resected completely initially but if this is too difficult, a biopsy may be performed for diagnosis, followed by chemotherapy to shrink the tumor before a resection is done to remove it.

    What treatment options are available?

    There are different treatment measures that may be used to treat children with germinoma tumor, including:

    • Surgery: While biopsies can be done to diagnose germinomas, resection (surgical removal) is also used to take out all or parts of the tumor.
    • Radiation therapy: Precisely targeted radiation can kill cancer cells that were left behind after surgery. This treatment is important in controlling the local growth of the tumor and preventing the spread of the tumor. Radiation to the whole brain and spinal cord are used to treat certain germ cell tumors that have spread throughout the brain or spine.  Local tumors do not require whole brain or spinal radiation.
    • Chemotherapy: a drug that interferes with the cancer cell's ability to grow or reproduce. Different of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors. In patients with germinomas, chemotherapy has been recently added to the treatment regimen in order to permit the use of a lower radiation dose.

    Chemotherapy can be given:

    • intravenously (IV), as direct injection into the bloodstream. IV is the most common form of chemotherapy used to treat germ cell tumors.
    • orally, as a pill to swallow
    • Intramuscularly, as an injection into the muscle or fat tissue
    • intrathecally, as a direct injection into the spinal column through a lumbar puncture

    What is the long-term outlook for my child?

    Germinomas carry a relatively excellent prognosis and management has therefore focused on reducing morbidity. It's very unlikely that the tumor will spread outside the central nervous system. In general, germinomas are cured in greater than 85 percent of cases with combined treated.

    However, many children will face physical, psychological, social and intellectual challenges related to their treatment, which requires ongoing assessment and specialized care.

    Coping and support

    Children treated for a germinoma should consider visiting a survivorship clinic every year. The Dana-Farber/Children's Hospital Cancer Care established the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic,  a multi-disciplinary program designed to address long-term health and social issues for families and survivors of childhood brain tumors.

    In this program, children can learn: 

    • to manage disease complications
    • to be screened for early recurrence of tumor
    • to manage late effects of treatment

    The School Liaison and Back to School Programs are two services that address intellectual and motor function by providing individualized services to ease children's return to school and maximize their ability to learn.

    To learn more about our services or to schedule an appointment, please click here

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