What is a germ cell cancer?
Germ Cell Cancer is a malignant neoplasm that originates from germ cells. With this, the neoplasm can metastasize and affect other areas of the body. Germ cells are cells that develop in the embryo which later becomes eggs and sperm in the ovaries and testes respectively. Germ cells found outside these reproductive organs can also travel to other areas of the body such as the mediastinum, chest and abdomen but are very rare.
Tumors originating from germ cells can divided into germinomatous and nongerminomatous. It is important to differentiate the two as the latter has a faster rate of growth and it usually detected at an earlier age compared to germinomatous. However, germinomatous have higher survival rates because they respond more to treatment such as radiation and chemotherapy. For tumors originating in the gonads (ovaries and testes), these could lead to ovarian and testicular cancer if malignant. For germ cell tumor growth outside the gonads, they are termed as extracranial or extragonadal and usually begin in the sacrum and coccyx during early childhood. These are also often found in the lower chest for teenagers and young adults.
In women, 30% of ovarian tumors originate from germ cells. Younger women, commonly patients under the age of 21, are more common. 60% of these ovarian tumors are germ cell in origin and a third of it is found to be malignant.
In men, germ cell tumors occur most commonly after puberty and most of them develop to testicular cancer in the long run.
Causes Of Germ Cell Cancer
Like many other types of cancer, there is no known exact cause of germ cell cancer. Some scientists suggest that during embryogenesis, abnormal relocation of germ cells happens while others propose that these germ cells normally relocate to various sites during this time, carrying within them genetic information and functioning at somatic sites.
Further research has revealed that germ cell tumors found outside these reproductive organs and may have been congenital in nature and can exist and not only a result of metastases from the gonads. Sacrococcygeal teratoma is the most common of these and commonly diagnosed during birth and neonatal period. This type of tumor can affect children 4 years and below.
Risk factors such as genetics, family history, infertility and exposure to carcinogenic materials and substances are also being considered.
Symptoms of germ cell cancer can be different for ovarian cancer and testicular cancer, the two most common types of germ cell cancer.
The signs and symptoms of ovarian cancer is important for early detection and prevention of progression of the disease. The patient may manifest the following:
- Gastrointestinal disturbances (including nausea, diarrhea, gas pain, difficulty and/or pain in passing out stool)
- Abdominal pain (one or both the ovaries may be affected by ovarian cancer; thus, the patient may experience pain in the lower abdomen, either on the left or right side and may aggravate when the ovarian tumor grows and exerts pressure on the organs in the abdomen)
- Pain during sexual intercourse and/or urination
- Abdominal swelling and tenderness (develops when the tumor presses unto the abdominal wall and causes build up of fluid in the abdominal cavity)
- Anorexia (also includes loss of appetite as the growth of the tumor presses the stomach and interferes the feeling of hunger)
- Back pain (this is also caused by compression of muscles resulting to a strain)
- Vaginal bleeding (unusual heavy and long irregular bleeding such as those that happen even after menopausal period or when a menstrual period is unexpected)
Manifestations of testicular cancer are the following:
- Painless nodule (the presenting symptom on physical exam)
- Unusually heavy sensation or dullness in lower abdomen
- Digestive disturbances (due to metastasis to the gastrointestinal system includes anorexia, nausea and others)
- Respiratory discomforts (due to metastasis to the respiratory system includes chest pain, shortness of breath, cough and hemoptysis or blood tinged sputum)
- Back pain (indicating spread to retroperitoneal areas)
- Gynecomastia (rare manifestation that results from production of human chorionic gonadotropin secreted systemically and could also result to hyperthyroidism)
- Extragonadal germ cell tumors which are malignant also exhibit the following manifestations:
- Chest pain, Fatigue, Headache, Difficulty in movement
Diagnosis and Treatment
Blood work up and imaging studies contribute to the diagnosis of ovarian cancer. However, excisional biopsy remains the trusted confirmatory test of the disease and its progression in ovarian cancer. Magnetic resonance imaging (MRI), CT scans and ultrasound are usually done but do not usually indicate how extensive the disease has progressed. If the patient is experiencing gastrointestinal disturbances, upper GI series and barium enema are ordered as well.
Surgery remains as the desired mode of treatment for ovarian cancer as this will not only resect the visible tumor, it could also confirm the diagnosis and determine the extent of the disease. Chemotherapy and radiation therapy can be initiated after the initial excision. Other options such as estrogen replacement therapy post surgery is considered as well. Long term monitoring is needed for all those who have undergone such procedures until declared cancer free. Unfortunately, the patients whose ovarian cancer is found to be in their late stages, palliative care remains the only option.
In testicular cancer, complete blood work up is ordered and chemistry profile is checked including, tumor markers (as well as AFP), lactate dehydrogenase (LDH) and human chorionic gonadotropin (hCG). Abnormal increases in LDH, AFP and hCG could be indicative of possible testicular problems. Physical examination and history taking are also very essential.
Like ovarian cancer, surgery is also the preferred approach in treating testicular cancer coupled with either chemotherapy and radiotherapy. Palliative care is also done for those incurable testicular cancers.
Survival Rate & Prognosis
There is a great risk for relapse even after treatment of germ cell cancer. Because of the variety of tumors that could arise from germ cells, prognosis is dependent whether the type of tumor is very sensitive to chemotherapy or radiation after surgery. Men are most likely to survive testicular cancer compared to women with ovarian cancer although choriocarcinoma of the testicles in men remain as the type of germ cell cancer with poorest prognosis.
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