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Childhood Cancer Types — Parent’s Guide
Ovarian & testicular germ cell tumours in children — explained clearly for parents
Medically reviewed by Dr. C. Raghavendra Reddy, DM (Medical Oncology, Gold Medal) · Last reviewed June 2026
If your child has been told they have a germ cell tumour — whether in the ovary, the testicle, or somewhere else in the body — you deserve a clear, honest explanation before decisions are made. Germ cell tumours are a distinct group of tumours that arise from the cells that normally form eggs or sperm. They behave differently from most other childhood cancers, and many respond very well to treatment. This page explains what these tumours are, what signs to watch for, and how they are diagnosed and treated at a specialist paediatric oncology centre.
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Understanding germ cell tumour treatment
Types of germ cell tumours in children — what every parent should know
Not every germ cell tumour is the same. The tumour’s specific type, where it has arisen, and whether it is benign or malignant all determine how it is treated. Understanding the main types helps parents make sense of what their child’s team is telling them.
Most common — often benign
Mature Teratoma
Mature teratomas are the most frequently encountered germ cell tumours in children. They contain fully developed tissues — typically a mixture of hair, skin, fat, and sometimes teeth or cartilage — because germ cells carry the genetic blueprint to form any type of body tissue. In children, mature teratomas are most often benign: they grow but do not spread to other parts of the body. The most common sites in younger children are the tailbone (sacrococcygeal region) and the ovary. Treatment is surgical removal, and when the tumour is fully removed with clear margins, no further treatment is usually needed. However, long-term follow-up with tumour marker blood tests and imaging is important to confirm that no cancerous elements were missed on pathology.
- Contains mature, differentiated tissue (hair, skin, cartilage)
- Usually benign; surgical removal is the primary treatment
- Most common in the tailbone area in newborns and young children; in the ovary in older girls
Ovarian — girls and young women
Malignant Ovarian Germ Cell Tumour
When a germ cell tumour in the ovary is malignant, it is most commonly a dysgerminoma, a yolk sac tumour (endodermal sinus tumour), or an immature teratoma. Dysgerminomas are the most common malignant ovarian germ cell tumour in adolescent girls and young women; they are notable for being very sensitive to chemotherapy and radiotherapy. Yolk sac tumours produce alpha-fetoprotein (AFP), a tumour marker measurable in the blood, which makes them easier to detect and monitor during treatment. Immature teratomas contain embryonic-type tissue alongside mature elements. All malignant ovarian germ cell tumours are treated with surgery (usually fertility-sparing, preserving the opposite ovary and the uterus) followed by chemotherapy.
- Includes dysgerminoma, yolk sac tumour, immature teratoma
- Many produce alpha-fetoprotein or beta-hCG (measurable tumour markers)
- Fertility-sparing surgery is the standard surgical approach
Testicular — boys and adolescents
Testicular Germ Cell Tumour in Boys
Testicular germ cell tumours in young boys (before puberty) are most often yolk sac tumours or mature teratomas. Yolk sac tumours in young boys tend to behave less aggressively than the equivalent tumour in adult men, and when diagnosed early and confined to the testicle, many can be managed with surgery alone, without chemotherapy. In adolescent boys and young men, the range of testicular germ cell tumour types is broader and includes seminomas and non-seminomatous types (similar to adult presentations). Treatment for malignant testicular tumours involves removal of the affected testicle followed by chemotherapy, with the plan tailored by the tumour’s stage and histology. The remaining testicle is preserved.
- Young boys: predominantly yolk sac tumours and mature teratomas
- Adolescents: broader range, including seminomatous and non-seminomatous types
- Surgery (orchiectomy) followed by chemotherapy for malignant disease
Outside the reproductive organs
Extragonadal Germ Cell Tumour
Some germ cell tumours arise not in the ovary or testicle but in other locations along the midline of the body, where germ cells migrated during fetal development. The most common extragonadal sites in children are the sacrococcygeal region (the tailbone, most often in newborns and young infants), the mediastinum (the chest between the lungs), the retroperitoneum (the back of the abdominal cavity), and, less commonly, the central nervous system. Sacrococcygeal teratomas detected at birth are often benign but require prompt surgical removal because delayed surgery increases the risk that the tumour will become malignant. Extragonadal malignant germ cell tumours at other sites (chest or abdomen) are treated with a combination of chemotherapy and surgery.
- Most common extragonadal site in young children: sacrococcygeal (tailbone)
- Other sites: mediastinum, retroperitoneum, central nervous system
- Treatment tailored by site, size, and whether benign or malignant
Germ cell tumours are one of several childhood cancer types explained at CION. For a broader overview of all childhood cancers, visit the Pediatric Cancer hub. If your child has an abdominal or pelvic lump, you may also find our guide to abdominal lumps and swelling in children useful.
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From first suspicion to treatment completion
How a germ cell tumour is diagnosed and treated — step by step
The path from a first concern — a swelling, an abdominal mass, a raised tumour marker — to a completed treatment plan follows a sequence that is logical once you understand it. Each step builds on the last. Here is what that journey typically looks like at a specialist paediatric oncology centre.
Initial examination and ultrasound — confirming there is a mass
When a doctor finds or suspects an abdominal or pelvic mass, or a lump in the testicle, the first investigation is nearly always an ultrasound scan. Ultrasound is quick, painless, uses no radiation, and gives immediate information about the size, location, and nature of the mass — whether it is solid, fluid-filled, or a mixture. For an ovarian mass, ultrasound can assess whether the opposite ovary appears normal. For a testicular lump, it can distinguish between a mass within the testicle and swelling of the surrounding structures. A solid mass in these locations, particularly in a child, requires prompt further investigation to determine whether it is benign or malignant.
Tumour marker blood tests — a critical diagnostic clue
Blood tests for alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) are among the most important investigations in diagnosing and managing germ cell tumours. Many germ cell tumour subtypes produce these proteins, and a significantly raised AFP or beta-hCG in a child with a pelvic or gonadal mass is a strong indicator of a malignant germ cell tumour. These markers also act as a monitoring tool throughout treatment: levels should fall as treatment eliminates tumour cells. The oncology team will explain what your child’s specific marker levels mean, bearing in mind that AFP is naturally elevated in infants under 12 months and must be interpreted with age-specific reference values.
CT scan or MRI — staging and surgical planning
An CT scan or MRI of the abdomen, pelvis, and chest gives a full picture of the tumour’s extent: how large it is, whether it has grown into surrounding structures, whether the lymph nodes in the retroperitoneum (the back of the abdominal cavity) are enlarged, and whether there is any spread to the lungs or liver. This information is essential for staging the disease. The stage — from localised disease confined to the organ of origin, through to distant spread — directly determines how much chemotherapy is needed and whether any radiation therapy is required. Accurate staging requires high-quality imaging reviewed by an experienced paediatric radiologist.
Multidisciplinary team review — a plan made together
Before any treatment begins, the imaging, tumour marker levels, and clinical findings are reviewed by a multidisciplinary team (MDT) comprising a paediatric oncologist, a gynaecological or paediatric surgeon, a radiologist, and a pathologist. At CION, every child’s case is presented at a tumor board meeting before any protocol is finalised. This step is not a formality — it is where decisions are made about whether to proceed directly to surgery, whether to biopsy first, and whether chemotherapy should be given before or after surgery. The team will explain the reasoning behind the recommended plan and answer your questions before anything proceeds.
Surgery — fertility-sparing where possible
Surgery is a central part of treatment for most germ cell tumours. For ovarian germ cell tumours, the standard surgical approach aims to remove the tumour while leaving the opposite, healthy ovary and the uterus intact. This fertility-sparing approach is possible in the large majority of girls even with malignant disease, because most ovarian germ cell tumours are on one side. For testicular tumours, the affected testicle is removed (orchidectomy via an inguinal incision — the standard surgical approach to avoid tumour spillage), while the opposite testicle is left in place. For extragonadal germ cell tumours (such as sacrococcygeal teratomas), complete surgical removal with clear margins is the aim, and the extent of the operation depends on the tumour’s size and local involvement.
Chemotherapy — for malignant tumours that have spread or are high risk
Malignant germ cell tumours are notably sensitive to chemotherapy. Children with malignant ovarian or testicular germ cell tumours that are confined to the organ at diagnosis and have been completely removed may be observed closely after surgery rather than receiving immediate chemotherapy, with chemotherapy reserved in case the disease returns. For disease that has spread beyond the organ, or where the surgical removal was incomplete, chemotherapy is given after surgery. For some very large tumours, chemotherapy may be given before surgery to shrink the mass and make it safer and easier to remove. Germ cell tumours’ sensitivity to chemotherapy means that even children with more advanced disease at diagnosis often respond well to treatment.
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Common questions
Your questions about germ cell tumours in children — answered
What is a germ cell tumour in a child and where do they develop?
Germ cell tumours arise from primordial germ cells — the specialised cells that normally develop into eggs in the ovaries or sperm in the testes. During early fetal development, these cells travel from the yolk sac to the reproductive organs. Occasionally, some cells stray along this migration path and settle in places such as the lower abdomen, the pelvis, the tailbone (sacrum), the chest, the brain, or the reproductive organs themselves. When these misplaced cells or cells within the ovaries or testes undergo abnormal growth, they can form a germ cell tumour. In children, germ cell tumours can be benign (mature teratomas are the most common example), or malignant (cancerous). They are distinct from most other childhood cancers in their biology and their response to treatment, and both ovarian germ cell tumours and testicular tumours in children carry different implications than their adult counterparts.
What are the warning signs of an ovarian germ cell tumour in a girl?
Ovarian germ cell tumours in girls and young women often grow to a considerable size before causing obvious symptoms — the ovaries sit deep in the pelvis, and the abdomen can accommodate a surprisingly large mass. The most common signs include: a noticeable swelling or fullness of the lower abdomen; abdominal pain or a dull, persistent ache that does not resolve; a feeling of pressure or fullness in the lower tummy; nausea or vomiting if the mass is large; and, less commonly, symptoms relating to hormonal activity (some germ cell tumours produce hormones that can cause unexpected puberty-related changes in younger girls, or irregular periods in older girls). In rare cases, an ovarian tumour can twist on itself — called ovarian torsion — causing sudden, severe abdominal pain that requires immediate medical attention. Any unexplained lower abdominal swelling or persistent pain in a girl should be assessed by a doctor.
What are the warning signs of a testicular germ cell tumour in a boy?
Testicular germ cell tumours in boys are most commonly noticed as a painless lump or swelling in one testicle. Unlike many causes of testicular swelling that are painful (such as infection or torsion), a tumour within the testicle is often not painful in the early stages, which can lead to it being overlooked or dismissed. Other signs that can accompany a testicular tumour include: a feeling of heaviness or fullness in the scrotum; a dull ache in the lower abdomen, groin, or lower back; or a sense that one testicle feels firmer or larger than the other. In young boys before puberty, testicular germ cell tumours are usually benign (mature teratomas or yolk sac tumours), but they still require proper surgical evaluation because it is not possible to distinguish a benign from a malignant mass by feel alone. Any painless testicular lump in a boy of any age should be assessed by a doctor without delay.
How is a germ cell tumour diagnosed in a child?
When a germ cell tumour is suspected, the doctor will first take a careful history and perform a physical examination. The key investigations are: Ultrasound — usually the first imaging test, which can confirm a solid mass in the ovary or testicle and assess its size and internal features. Blood tumour markers — many germ cell tumours release measurable proteins (alpha-fetoprotein and beta-hCG are the most important) that appear in the bloodstream; elevated levels can strongly suggest a germ cell tumour and help track response to treatment. CT scan or MRI — to assess the extent of the disease, whether the lymph nodes are involved, and whether the tumour has spread to the lungs, liver, or other sites. These investigations together give the oncology team the information they need to plan treatment. Definitive confirmation requires examination of tumour tissue — usually through surgery or biopsy.
What does treatment for a malignant germ cell tumour in a child involve?
Treatment for malignant germ cell tumours in children combines surgery and chemotherapy. Surgery aims to remove the primary tumour and, where possible, to preserve as much of the affected organ as possible — this is especially important for girls with ovarian tumours, where the goal is to preserve the opposite, healthy ovary and the uterus so that future fertility is not affected. For testicular tumours in young boys, the surgical approach involves removal of the affected testicle (orchiectomy); the opposite testicle is left intact. After surgery, chemotherapy is given to eliminate any cancer cells that may remain. Germ cell tumours are particularly sensitive to chemotherapy, and children with malignant germ cell tumours often respond very well to treatment. The number of treatment cycles and whether any further imaging or monitoring is needed after treatment depends on the stage and histological type of the tumour. At CION, every child’s plan is reviewed by a multidisciplinary tumor board before any treatment begins.
Can a girl still have children after treatment for an ovarian germ cell tumour?
Fertility preservation is a central priority in treating ovarian germ cell tumours in girls and young women. In the large majority of cases — even when one ovary must be removed — the opposite ovary is preserved, as is the uterus. A girl who retains one healthy ovary and an intact uterus can still conceive naturally in adulthood. The surgical approach is specifically designed to be fertility-sparing wherever the tumour’s stage and extent allow this safely. Chemotherapy after surgery may temporarily affect ovarian function and periods, but for most girls treated for germ cell tumours at this age, normal reproductive function resumes once treatment ends. Before any surgery, the oncology team will discuss the specific approach for your child and the expected impact on fertility. Long-term follow-up, including gynaecological review as the child grows into adulthood, is part of the care plan.
Medical disclaimer: This page is for general information only. It does not replace a consultation with a qualified medical professional. If you are worried about symptoms in your child, please see a doctor promptly. CION Cancer Clinics does not diagnose conditions through this website.
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