From the Guidelines
Germ Cell Tumors (GCTs) Diagnosis and Treatment Germ cell tumors are typically diagnosed at an early stage, with 60%–70% of patients having stage I disease, and have an excellent prognosis with long-term disease-free status of about 90% 1.
Diagnosis
The diagnosis of GCTs involves a combination of physical examination, imaging studies, and tumor marker testing, including AFP and hCG levels 2.
Treatment
The treatment of GCTs depends on the type, stage, and location of the tumor.
- Surgery: Fertility-sparing surgery is recommended for patients with stage I GCTs who desire to preserve fertility, with excellent survival outcomes 1.
- Chemotherapy: The chemotherapy regimen often includes BEP (Bleomycin, Etoposide, and Cisplatin), given for 3-4 cycles, which is the most commonly used combination 1, 2, 3.
- Surveillance: Patients with stage I dysgerminoma or stage I, grade 1 immature teratoma can be managed with close surveillance after fertility-sparing surgery, reserving chemotherapy for those who experience recurrence 1.
Follow-up
Follow-up visits for GCT patients must include history, physical and pelvic examinations, and exploration of tumor markers every 3 months for the first 2 years, every 6 months during the third year, and then yearly until progression 4.
Important Considerations
- Fertility preservation: Fertility-sparing surgery should be considered for patients who desire to preserve fertility, regardless of stage 2.
- Chemotherapy side effects: The most frequent side effects of BEP include pulmonary toxicity, decreased diffusing capacity of the lungs for carbon monoxide (DLCO), acute myeloblastic leukemia (AML), neuropathy, Raynaud’s disease, tinnitus, high tone hearing loss, gonadal dysfunction, cardiovascular disease/hypertension, and nephrotoxicity 4.
- Secondary malignancies: There is a risk of secondary malignancies, particularly for young survivors, which should be monitored during follow-up 4.
From the Research
Diagnosis of Germ Cell Tumors (GCTs)
- GCTs can be diagnosed through various methods, including radiologic findings and pathologic subtypes 5
- Seminomas appear as uniformly solid, lobulated masses with fibrovascular septa that enhance intensely, while nonseminomatous GCTs appear as heterogeneous masses with areas of necrosis, hemorrhage, or cystic degeneration 5
- Fat and calcifications are hallmarks of teratomas, most of which are benign 5
Treatment of Germ Cell Tumors (GCTs)
- GCTs are some of the most curable cancers in adults, but some patients exhibit resistance to standard treatments 6
- Treatment modalities include chemotherapy, radiation, and surgery, and ongoing preclinical and epidemiological studies highlight the complexities underlying germ cell tumor pathogenesis 7
- Expression profiling, both at the gene and protein levels, is beginning to identify, at the molecular level, some of the factors associated not only with germ cell pluripotency but also with the different histologic subtypes of germ cell tumors 7
- Positron emission tomography can be used to evaluate residual lesions in seminoma 7
Molecular Characteristics and Age-Related Features
- GCTs have different molecular characteristics, biology, and requirements for curative treatments based on primary site and/or age at presentation 6
- Age-related biological features of GCTs show marked molecular biological differences within identical histological subtypes between pediatric and adult populations 8
- Clinical management of GCTs should consider specific molecular biological factors in addition to clinical parameters in the context of patient-specific age group rather than medical specialty 8