Germ Cell Tumour Symptoms In Young Adults

Introduction 

In the realm of health concerns, young adults may not consider cancer as a potential risk until they get older. However, germ cell tumours commonly occur in young adults.¹

Germ cells are a variety of stem cells that can develop into sperm or egg cells. Germ cell tumours originate from germ cells and often occur in the testes and ovaries; however, they can materialize anywhere in the body. They can occur at any age, however, germ cells make up 13.9% of cancers diagnosed between the ages of 15 and 19.² Germ cell tumours may be benign or cancerous, but early identification of tumours and their treatment is crucial for successful recovery and earlier detection is positively associated with better prognosis. 

Types of germ cell tumours

There are several types of germ cell tumours, these may be specific to reproductive organs but can afflict anyone who possesses the specific germ cells that are affected. Typical germ cell tumours will develop in the gonads, with there being several classes that include testicular, ovarian, and extragonadal. 

Testicular tumours occur in the testicles, with 95% of testicular cancer initiatives from germ cells. They can be categorized into two subtypes: seminomas and non-seminomatous. Seminomas have a slow progression and are highly treatable. Non-seminomatous germ cell tumours are more aggressive and their occurrence has been linked to be more common in those in their late teens into their early thirties.³ 

Ovarian tumours are known to be highly curable or benign, they develop in the ovaries. There are several subtypes associated with ovarian tumours in young adults. One of these subtypes is teratomas, with mature teratomas being benign they usually affect women who are of reproductive age.⁴

Extragonadal germ cell tumours form in parts of the body other than the gonads; this is when primary tumours undergo metastasis, which is where secondary tumours develop in other areas of the body. The most common type of extragonadal tumour is a mediastinal non-seminomatous germ cell tumour; this is where a tumour has developed in the mediastinum, which is located between the lungs. These types of tumours are commonly found in young adults aged 15 to 35 and have a higher incidence rate in males.⁵

Common symptoms of germ cell tumours

There are several physical symptoms associated with germ cell tumours; this is typically located in the abdomen, pelvis, or scrotum. Tumour growth may be felt beneath the skin, so it is important to perform regular at-home physical examinations. The swelling caused by tumour growth may cause discomfort and swelling of lymph nodes. Chest pain or coughing can be a sign of tumours forming in the mediastinum. Those with tumours experience fatigue or weakness, unexplained weight loss, and ever or night sweats. 

Due to the primary location of tumours formatting being major endocrine organs, there can be several serious effects caused by the disruption of their hormonal balance.

Germ cell tumours, especially those that occur in the gonads (testes or ovaries), can affect the production and regulation of gonadotropins. Gonadotropins are hormones produced by the pituitary gland that are responsible for the function of the testes and ovaries. Tumours in these organs may disrupt the normal feedback loop between the pituitary gland and the gonads, leading to altered levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Consequently, these tumours can cause fertility problems and sex drive changes as well as hormone-related issues. In those with ovaries, tumours may lead to menstrual abnormalities such as irregular menstrual periods. In those with testicular tumours, the hormonal disruptions can cause gynecomastia in males, where their breasts enlarge.⁶

Diagnostic procedures

Several different diagnostic tests can be performed to identify germ cell tumours. The medical history of a patient suspected of having a germ cell tumour would be assessed, identifying risk factors in their family history and determining when their symptoms originated. 

The presence of tumours can be identified through non-invasive imaging such as ultrasounds, CT scans, and MRIs.These are common and relatively easy to perform, providing valuable insight into the size and progression of the tumour. Blood tests may be used to detect tumour biomarkers, enzymes, and hormones present in the bloodstream. Increased levels of biomarkers in blood tests can help identify tumours and their location. Biopsies of tumours may also be performed to understand the nature of the tumour.

Treatment options

There are several treatments for germ tumours, and for some patients, using a combination would be the recommended procedure. Removal of the tumours may be performed depending on how accessible its location is. If detected early enough, before the tumour has metastasis (spread), tumours can be treated with surgery alone. The goal of the surgery is to remove the whole tumour, if this is not possible further treatment may be required. Chemotherapy is often used on cancers that have metastasized, where there is a possibility of new tumours developing after the primary tumour was removed. Combination therapy is where chemotherapy is also used to treat the tumour before or after surgical treatment. Neoradurant chemotherapy is used before surgery to shrink the tumour to make it more likely for a successful surgical intervention. Adjuvant chemotherapy is used after surgical treatment to prevent any tumour cells left in the body from developing into new tumours. 

Radiation therapy may be used when chemotherapy is ineffective against the tumours. It involved the use of radiation to target tumour cells to shrink the tumours. Two types of radiation therapy may be used to treat germ cell tumours. External beam radiation is often used as adjuvant therapy to prevent cell division, prevent the tumour from growing, and kill off the remaining cancerous cells.

The negative effects of these harsh treatments can be reduced by using stem cell transplantation. Stem cell transplantation may be used to restore bone marrow or blood cell production, which would be severely reduced by chemotherapy. Autogeneic transplantation is when the patient's stem cells are used, and allogeneic stem cell transplantation is when a donor is used. These cells are collected before chemotherapy and then stored for later use.

These harsh treatments may also cause issues with fertility. However, there are several ways in which this can be preserved. Sperm banking is a way for which males can freeze sperm before treatment and then utilize this in vitro fertilization; for those who produce eggs, viable eggs or fertilized embryos can be preserved through cryopreservation. 

Prognosis and follow-up care

Ovarian germ cell tumours have high survival rates, with localized tumours having a survival rate of 98% and those that have metastasized to distant regions of the body having a survival rate of 73%. This demonstrates the importance of early diagnosis, with earlier detection of germ cell tumours before they have metastasized to distant locations having a higher survival rate.⁷

The 5-year relative survival rate for those diagnosed or germ cell tumours and aged between 15 and 19 is 94%.⁸ After diagnosis, the prognosis for individual germ cell tumours may vary depending on several factors. These factors include tumour type, the stage of the tumour, and the response to the treatment used.

Following diagnosis and treatment, follow-up care consisting of regular checkups would be required to check for metastasis recurrence. Regular physical exams, ultrasounds, and blood tests would reassure those recovering from cancer. The frequency of these visits would depend on the tumour state and individual risk factors. Through these appointments, they can monitor for side effects resulting from treatment and can allow for the early detection of recurrence and metastasis; this would then allow for further treatment. 

Psychological support and counselling would be supplied to support those who underwent treatment. Support groups provide connections between those experiencing similar experiences where they can address emotional concerns and coping strategies. 

Summary

In summary, germ cell tumours are caused by mutations in germ cells, which lead to tumour formation. These tumours can be benign or malignant and can affect people of any age, but are especially common in young adults. Identification of these tumours can be done in several ways, with early detection associated with high survival rates and positive outcomes. Treatment would include surgery, chemotherapy, or radiation, with there being several strategies to preserve the patient's fertility. Regular checkups and support groups are available to those undergoing treatment and to those who have finished. The most crucial step is diagnosis, with the best prognosis linked to early identification. If you experience symptoms that suggest this diagnosis, contact your local GP. If left undiagnosed, these tumours can spread and lead to more health effects and defects.