The term germ cell tumor covers a variety of different tumors that arise from the germ cells. The characteristics of these tumors are highly dependent on gender.
What is a germ cell tumor?
A germ cell tumor has its starting point in the germ cells of the organism. There are very different forms of this disease. The dignity (valence or dangerousness of the course) of the tumors depends on gender. In men, in addition to a few benign neoplasms, malignant space-occupying tumors occur very frequently, while in women the tumor is usually benign. The germ cell tumors of men are divided into seminomas (originating from the semen) and non-seminomas. Seminomas are malignant testicular tumors that often occur between the ages of 30 and 40. Seminomas represent the majority of germ cell tumors in men. Non-seminomas of the male include yolk sac tumor, chorionic carcinoma, embryonal carcinoma, and teratoma. There are also malignant forms among non-seminomas. In women, teratomas, yolk sac tumors, dysgerminomas, and chorionic carcinomas are distinguished. Each of these different forms of germ cell tumors represent specific diseases with different prognoses for cure.
Causes
The causes of germ cell tumors are varied and depend on which form it is. Male seminomas result from degeneration of spermatogonia. Spermatogonia are the stem cells in the germinal epithelium of the testis. The degeneration of these cells occurs in different steps. First, the DNA increases in the gametes present as spermatogonia, resulting in a tetraploid nucleus. In the further course, the amount of DNA decreases more and more, whereby the seminoma cells become aneuploid. That is, the chromosome number in the cell becomes completely irregular. As a result, aggressive cell growth takes place. Another germ cell tumor of the male is embryonal carcinoma. Here, scattered embryonic stem cells degenerate. This type of cancer often occurs between the ages of 20 and 30. The germ cell tumors occurring in women are mostly benign teratomas of the ovaries in 95 percent of cases. Teratomas involve the growth of stem cells. Depending on how differentiated the stem cells already are, the tumor may contain tissue from various organs, such as fatty tissue, muscle, hair, teeth, and bone, cartilage, mucous membrane, or nerve tissue. Men can also get teratomas. Specific to women is dysgerminoma of the ovary, which can be compared to seminoma in men. It arises from undifferentiated germ cells. Germ cell tumors affecting both sexes are yolk sac tumor arising from undifferentiated cells of early embryogenesis and choriocarcinoma arising from placental cells.
Symptoms, signs, and complaints
The symptoms of each germ cell tumor vary. Teratomas are benign tumors of the ovaries or malignant tumors of the testes that arise from differently differentiated stem cells and thus may take on characteristics of certain types of tissue. Seminoma, on the other hand, is noticeable in men between the ages of 30 and 40 as a painless swelling of the testicle. The success of treatment depends on the stage of the disease. Male embryonal carcinoma of the testis presents with necrosis, bleeding and cysts. Female dysgerminoma corresponds to male seminoma and appears as a solid tumor on the genitals of girls, pubescents or pregnant women. Chorionic carcinoma of the male is a special case. Because the initial cells of this germ cell tumor are embryonic placental cells, gynecomastia (breast development) may occur.
Diagnosis and disease progression
The diagnosis of a germ cell tumor depends on what the disease is. Often, tentative diagnoses can already be made based on symptoms, but these still need to be confirmed by laboratory tests. For example, in male chorionic carcinoma, high concentrations of the pregnancy hormone hCG are found in the blood because this carcinoma develops from scattered placental cells.
Complications
A germ cell tumor represents a very severe health limitation for the patient. If treatment is not received, the germ cell tumor can also lead to the death of the patient. It is not uncommon for the germ cell tumor to cause severe swelling in the testicles. This swelling is usually not associated with pain.It is not uncommon for patients to suffer from bleeding or cysts as well. As with other cancers, this tumor can spread to other regions, leading to severe limitations and complications. The patient’s life expectancy is usually greatly reduced by this tumor. The patient continues to suffer from fatigue and exhaustion. It is not uncommon for cancer patients to also suffer from psychological discomfort or depression. The treatment of the germ cell tumor depends on the position of the tumor. In most cases, however, it can be removed surgically, and chemotherapy is also necessary. Psychological complaints can also be treated by a psychologist. This does not lead to further complications. The further course of the disease depends on the extent of the tumor.
When should one go to the doctor?
Changes in the genital organs should be examined by a doctor in both men and women. If there is swelling of the testicles or the female sex area, a formation of cysts or other growths, a doctor is needed. If there are irregularities in the female menstrual cycle, shortened or prolonged menstrual periods, or a failure to menstruate, a doctor’s visit is needed. A general feeling of illness, a feeling of tightness in the abdomen, inner restlessness or malaise are warning signs of the organism that should be clarified by a doctor. Changes in sexual drive, listlessness, a diffuse sensation of pain, and other complaints during the sexual act must be examined more closely by a physician. Since the germ cell tumor can take a fatal course without timely medical care, a visit to the doctor is advisable at an early stage with the onset of the first abnormalities. If death of tissue layers is noticed or unexplained bleeding occurs, a doctor should be consulted. Tiredness, reduced performance and fatigue are signs of an existing disease. If the symptoms persist over a longer period of time, increase in intensity or spread, a doctor should be consulted as soon as possible. If psychological problems, behavioral abnormalities or a depressed mood occur, consultation with a physician is recommended to clarify the cause.
Treatment and therapy
Different germ cell tumors respond to different treatments and also have different prognoses. Female teratomas, for example, usually have a good prognosis. Malignant teratomas occur only in girls and young women, but they also respond poorly to radiation or chemotherapy. In males, the course is usually benign in childhood, while metastases may develop in adults. Male seminoma is a malignant tumor of the testis. Its treatment depends on the stage of the disease. Orchiectomy (removal of the affected testicle) often has to be performed. After that, close monitoring is performed. If the disease recurs, chemotherapy is given. Since radiation can also have harmful side effects, it is used only at a later stage of the disease. With treatment in early stages of the disease, the risk of recurrence is 20 percent if therapy is not continued. The use of drugs also depends on the stage of the disease. In the treatment of non-seminomas, orchiectomy is also performed. Their further treatment also depends on the stage or type of the disease. In benign progressions, no further therapy is required. In case of recurrences, chemotherapies are used. Preventively, the lymph nodes in the posterior abdomen can be removed. In nonseminoma patients, immediate treatment of the germ cell tumor with chemotherapy is necessary for lymph node metastases and for metastases to other organs.
Outlook and prognosis
The prognosis for germ cell tumor depends on the nature of the tumor as well as the stage of diagnosis. If the tumor is benign, the prognosis is much better than if it is malignant. In addition, the patient’s general state of health is decisive for the further course of the disease. If the immune system is weakened, the treatment options and their success are limited. If the diagnosis is made early and treatment is started quickly, recovery can be documented in the further course of the disease in a large number of patients.Without medical care, the affected person risks the spread of cancer cells and premature death. The same applies to an advanced stage of the disease as well as to a malignant germ cell tumor. Cancer therapy is associated with numerous side effects and risks. It can lead to secondary diseases. In addition, it is a long-term therapy in which the patient’s quality of life is limited. If surgery is performed, further complications may occur. Nevertheless, the prospect of a favorable prognosis has improved considerably in recent years. Due to various therapeutic approaches and treatment options, the survival rate of patients has increased significantly. In the course of life, despite recovery, tumor recurrence can occur at any time. The prognosis is unchanged if another germ cell tumor develops.
Prevention
General prevention of germ cell tumors is not possible. Their causes often lie in a dysregulation of hormonal processes. However, undescended testis is considered a major risk for testicular cancer. In this case, the testicle remains in the groin area or migrates back there. Other risk factors for germ cell tumors may well be genetic predisposition.
Follow-up
After any tumor disease, follow-up care is inevitable. This is to determine whether the tumor is forming again. Doctors hope that diagnosis at an early stage will provide better treatment options. It also allows life-threatening metastases and thus the spread of the disease to be ruled out. The situation is no different with germ cell tumors. The scheduled follow-up examinations are arranged individually. They usually take place in the clinic where the initial intervention was performed. The rhythm is determined, among other things, by the progress of the disease at the start of therapy. In principle, patients have to expect more frequent follow-up examinations during the first year. The interval from appointment to appointment decreases in the following years. After the fifth year of freedom from symptoms, annual follow-up is sufficient. The risk of recurrence of the disease is low. The same procedures are used to detect a germ cell tumor as for the initial diagnosis. Blood tests and radiological procedures, along with a detailed interview, are important components of follow-up care. Doctors also provide information about contact and counseling centers. If necessary, professional reintegration is discussed. If complaints remain after the initial treatment, an accompanying pain therapy is indicated. A fundamental change in lifestyle habits can possibly be taught in rehabilitation under expert guidance.
What you can do yourself
With an existing germ cell tumor, there are limited options or measures that can help affected individuals improve. It is important to diagnose early and quickly so that appropriate therapy can be initiated. Only if the visit to the doctor is immediate and prompt, the chances of a full recovery are good. Home remedies or freely available prescriptions will have no effect on an existing germ cell tumor. If a malignant tumor is present, chemotherapy may even be necessary to achieve a complete recovery. Even after therapy, regular visits to the doctor are recommended and indispensable. This can prevent the tumor from returning and complications from arising. For this reason, the following applies: One’s own measures for improvement can only be undertaken to a limited extent in the case of a germ cell tumor. In order for the human body to recover quickly from the therapy, a healthy and balanced diet is also very important. This strengthens the immune system so that rapid regeneration can be initiated. Otherwise, there are no effective measures that can bring about an improvement.
