Pediatric Oncology and Cancer Care

Germ Cell Tumor Disease

Germ cell tumor disease in children represents a rare but diverse group of cancers arising from primordial germ cells, which are the precursors of sperm and egg cells. These tumors can occur in both gonadal sites, such as the ovaries and testes, and extragonadal sites including the sacrococcygeal region, mediastinum, retroperitoneum, and brain. Germ cell tumors are classified into benign and malignant types, with malignant forms including yolk sac tumors, embryonal carcinomas, choriocarcinomas, and mixed germ cell tumors. In pediatric patients, yolk sac tumors are the most common malignant subtype and often present with nonspecific symptoms depending on the tumor location, such as an abdominal or pelvic mass, pain, constipation, or urinary difficulties. Testicular tumors may present as painless swelling or firmness in the scrotum, while intracranial germ cell tumors may cause headaches, visual disturbances, or hormonal imbalances. Diagnostic evaluation includes physical examination, imaging studies such as ultrasound, magnetic resonance imaging, or computed tomography, and measurement of tumor markers in the blood, including alpha-fetoprotein and beta-human chorionic gonadotropin, which help in diagnosis, monitoring treatment response, and detecting relapse. Biopsy or surgical resection provides definitive histological confirmation. The mainstay of treatment involves surgical excision of the tumor followed by chemotherapy, especially for malignant and metastatic forms. The chemotherapeutic agents most commonly used are bleomycin, etoposide, and cisplatin, which have proven highly effective in curing many cases. Radiation therapy is rarely used in pediatric germ cell tumors due to their general chemosensitivity. Prognosis is generally favorable, especially in localized disease, with survival rates exceeding 90 percent in many cases, although outcomes vary based on tumor type, location, stage, and patient age. Long-term follow-up is essential for early detection of relapse and monitoring for late effects such as hearing loss, infertility, renal impairment, and psychosocial challenges. Advances in molecular biology are providing new insights into tumor pathogenesis and potential targets for therapy. Challenges remain in the diagnosis and management of germ cell tumors in resource-limited settings due to lack of awareness, delayed presentation, and limited access to diagnostic and treatment services. A multidisciplinary approach involving pediatric oncologists, surgeons, radiologists, endocrinologists, and psychologists is critical to ensure comprehensive care. Family education, emotional support, and transition programs for adolescents moving to adult care are important aspects of survivorship. Germ cell tumor disease in children, while rare, exemplifies the progress possible in pediatric oncology through early diagnosis, effective treatment, and collaborative care.