eMedicine Specialties > Oncology > Carcinomas of the Central and Peripheral Nervous System

Germinoma, Central Nervous System: Follow-up

Author: Amani AlKofide, MBBS, Assistant Professor, Alfaisal University College of Medicine; Consultant, Department of Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Further Inpatient Care

  • A repeat MRI of the brain should be performed within the first 48 hrs of surgery to assess for residual disease.
  • During hospitalization, daily weights and intake/output should be measured.
  • Care must be taken not to overcorrect fluid and sodium levels; repletion should be guided by fluid balance and electrolyte levels.

Further Outpatient Care

Neuropsychological assessment should  be provided — especially for adolescents, to ensure proper schooling and adjustment. 
 

Complications

  • Patients may have persistent neurological deficits, even after tumor control.
  • Endocrine abnormalities usually persist and require lifetime hormonal replacement 
  • Chemotherapy related - see Medication, above
  • Surgical

Pineal region tumors have a surgical morbidity of 2-5%, including transient movement abnormalities of eyes, ataxia, and cognitive dysfunction.

  • Radiation Therapy
    • The deleterious effects of brain radiation therapy on intelligence have been well documented, particularly in children. In older patients, studies have shown a decline in neurocognitive function and performance IQs19 .
    • Brain injury including atrophy, multifocal encephalomalacia, focal necrosis, and cerebrovascular occlusion have been reported after radiation therapy.20 .
  • Secondary Neoplasms

Radiation therapy and chemotherapy may promote the development of secondary cancers, including acute myeloid leukemia and radiation-induced brain neoplasms.
 

Prognosis

  • Germinomas are generally associated with an excellent prognosis. Even in those with syncytiotrophoblasts that secrete β -hCG, 5-year survival is 70-90% and 10-year survival is 70%.3,1
  • With mixed germ cell tumors, 5-year survival is 60-80%.
  • With NGGCTs, 5-year survival is 30-50%.

Patient Education

Patients and their caregivers should receive education with regard to disease, treatment options, prognosis, and expected and anticipated complications.

Miscellaneous

Medicolegal Pitfalls

Patients can present with symptoms such as enuresis or psychiatric disturbances that may lead to delay in diagnosis.7,23 This delay may have clinical consequences—continued tumor growth, and perhaps metastasis, and thus poorer outcome — with subsequent legal implications.

Special Concerns

  • Fertility – Although no hard data are available in patients with CNS GCTs, fertility could be impaired via several mechanisms. The endocrine dysfunction from the tumor itself may cause infertility.47,19 Chemotherapy, such as with ifosphamide and cyclophosphamide, may lead to infertility. Radiation therapy to the hypothalamic, pituitary and spinal areas may all lead to infertility.
  • Pregnancy – As with cancer in general, the risk of treatment during pregnancy resulting in fetal death or malformations depends on the chemotherapeutic agents administered. The risk is greatest during the first trimester. Pregnant women who require radiation therapy for CNS GCTs may benefit from proper abdominal protection.
  • Anesthesia – Proper monitoring of fluid balance and sodium levels is essential, particularly in patients with diabetes insipidus.
 
Acknowledgments

Hindi N Al-Hindi, MD, FCAP
Consultant Anatomic Pathologist and Neuropathologist
Coordinator, Anatomic Pathology Residency Training Program
Director of Electron Microscopy Services
Department of Pathology and Laboratory Medicine
King Faisal Specialist Hospital & Research Center
P O Box 3354
Riyadh 11211
Kingdom of Saudi Arabia

Tel  966 1 442 4207
Fax 966 1 442 4280

email: hal-hindi@kfshrc.edu.sa



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References
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Further Reading

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Keywords

Intracranial germ cell tumors, germinoma, nongerminomatous germ cell tumor, germ cell tumor, teratoma, pineal lesions, suprasellar lesions, gonadotrophines, tumor markers, alpha-fetoprotein (AFP),  beta-human chorionic gonadotrophins (β-hCG) , primordial germ cells, Klinefelter syndrome, syncytiotrophoblasts
 
 

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Contributor Information and Disclosures

Author

Amani AlKofide, MBBS, Assistant Professor, Alfaisal University College of Medicine; Consultant, Department of Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh
Amani AlKofide, MBBS is a member of the following medical societies: American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Medical Editor

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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