Germ Cell Tumors

Mediastinal and Retroperitoneal Tumors

Most mediastinal germ cell tumors (central chest cavity) develop in young men 20 to 30 years old. Many of those tumors are malignant (cancerous). Symptoms may include coughing, chest pain, breathing problems, and fever. Retroperitoneal (originating behind the abdominal cavity) tumors are thought to occur as a result of germ cells left in the abdomen during migration of the testes to the scrotum during embryonic development. Other tumors occur as a result of spread from a testicular germ cell cancer.

Diagnosis

Physicians use the following techniques to diagnose germ cell tumors that occur in the mediastinum and retroperitoneum:

• Chest X-rays generate two-dimensional views of the chest to help physicians locate abnormalities.
• Computed tomography (CT) scans generate two-dimensional images of the chest that may reveal whether cancer has invaded other tissues or organs. New technology available at Mayo Clinic enables three-dimensional reconstruction of the CT images.
• Magnetic resonance imaging (MRI) technology uses magnetic fields and radio waves to create two- and three-dimensional views used to identify small abnormalities in the soft tissue of the chest.
• Biopsies involve taking tissue from the tumor. To get the sample, physicians sometimes perform a fine-needle aspiration, in which they insert a needle into the tumor to remove cells for examination in a laboratory.

Treatment

Physicians at Mayo Clinic usually treat germ cell tumors with chemotherapy followed by surgery to remove remaining tumor tissue. The form of treatment depends on the type of germ cell tumor found.

Chemotherapy

The chemotherapy regimens used to treat germ cell cancers use a number of drugs, which are given intravenously (through the vein). Advances in chemotherapy over the past 30 years have resulted in a marked improvement in outlook for patients with germ cell tumors. Prognosis is related to the volume (bulk) of disease and the elevation of tumor markers in the blood. Medical oncologists, who specialize in treating cancer with medication, prescribe the chemotherapy.

Surgery

After chemotherapy, residual germ cell cancer masses may remain in the body. In most cases, removing the residual masses is important because they may contain living cancer cells; or they may be composed of benign non-germ cell tissue (mature teratoma) that could grow over time. It is also possible that the residual masses may be composed of only necrotic (dead) cancer cells. Only examination of the tissue by a pathologist can determine the type of cells in any residual mass. Mature teratoma may be genetically unstable tissue that may degenerate to malignant tissue. The residual masses may also contain immature teratoma, malignant non-germ cell tissue that can only be cured by surgical removal. Surgery to remove these residual masses is difficult and complex, requiring a surgical team experienced in operating on these difficult problems. Surgeons at Mayo Clinic have special expertise in removing residual germ cell masses. The surgical approach differs for each patient and is based on the tumor's exact location.

Radiation therapy

Germ cell tumors in the mediastinum that are classified as seminomas may be treated with radiation. Seminomas involving lymph nodes in the retroperitoneum may also be treated with radiation. This form of treatment may also be considered for patients whose germ cell tumors have spread to the brain or other parts of the body. Radiation therapy involves the use of high-energy X-rays to kill cancer cells. Radiation oncologists at Mayo Clinic tailor each treatment to protect nearby normal tissue. Patients have access to the most advanced systems of treatment planning and delivery.