Outlook for different groups of germ cell tumours

On this page there is information about

• What germ cell tumours are
• What prognosis means
• Outlook for germ cell tumours
• Points to remember about prognosis
• More information about germ cell tumours

Germ cells are the reproductive cells within our bodies. These are the cells that are used to make sperm in men and eggs in women. Germ cell tumours develop from these cells.

Germ cell tumours develop most commonly in men’s testicles (testicular cancers). But germ cells can be left behind in other parts of the body when a baby is developing in the womb. So, rarely, you can get germ cell tumours elsewhere in the body, for example in the chest, abdomen or brain. The medical name for germ cell tumours that develop outside of the ovaries or testicles is extragonadal germ cell tumour (EGGCT).

There are several different types of germ cell cancers. Doctors sort these into two main groups, based on the type of cell in which the cancer originally developed

• Seminomas
• Non seminoma germ cell tumours

The non seminoma group includes a mixture of the following different types of tumours

• Teratoma
• Choriocarcinoma
• Embryonal tumour
• Yolk sac tumour

Prognosis is the likely outcome of your disease and treatment. In other words, how likely you are to get better and how long you are likely to live. Generally, the outlook for germ cell tumours is good.

If your germ cell cancer has spread from where it started, doctors look at various factors to work out how easy or difficult it is likely to be to cure. They decide whether your cancer is in the ‘good’, ‘intermediate’ or ‘poor’ outlook (prognosis) group. This matters because it helps the specialist to decide on your treatment. Your doctors will want to give you enough treatment to make sure you have the best possible chance of cure. But they don’t want to give you more treatment than you need.

When working out which treatment is best for men with germ cell tumours that have spread, doctors look at non seminoma and seminoma germ cell tumours individually. The links below will take you to the right section for you

• Outlook for non seminoma germ cell tumours
• Outlook for seminomas

Outlook for non seminoma germ cell tumours

Doctors divide non seminoma germ cell tumours into 3 groups

• Good
• Intermediate
• Poor

To group these cancers they look at

• Where the germ cell tumour started - tumours that developed in the testicle or at the back of the abdomen (retroperitoneal area) have a better outlook than germ cell tumours that developed in the chest (mediastinum).
• Cancer spread - if your tumour has spread to your liver or brain, the outlook is poorer
• Levels of certain hormones made by the cancer cells (doctors call these markers - the higher the marker level, the poorer the outlook

There are 3 markers for non seminoma tumours. These are measured in simple blood tests. They are called alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactate dehydrogenase (LDH).

Good prognosis non seminoma germ cell tumours

This is when the germ cell tumour started in the testicle or back of the abdomen, there is no secondary cancer apart from in the lungs or lymph nodes, and you have marker levels of

• AFP less than 1,000 ng/ml (nanograms per millilitre)
• HCG less than 5,000 mIU/ml (milli International Units per millilitre)
• LDH less than 1.5 times the upper limit of normal

Intermediate prognosis non seminoma germ cell tumours

As for good prognosis, this is when your cancer started in the testicle, or back of the abdomen, and has spread nowhere but the lungs or lymph nodes. But the marker levels are higher, with levels of

• AFP between 1,000 to 10,000 ng/ml
• HCG between 5,000 to 50,000 mIU/ml
• LDH between 1.5 and 10 times the normal level

Poor prognosis non seminoma germ cell tumours

If you are in the poor prognosis group, it means one of three things

• Your germ cell tumour started in the chest (mediastinal primary tumour), or
• The cancer has spread somewhere other than your lungs or lymph nodes - the liver, brain or bones for example, or
• You have very high marker levels

For this group, high marker levels mean

• AFP over 10,000 ng/ml
• HCG over 50,000 mIU/ml
• LDH more than 10 times the normal

Outlook for seminomas

There is no poor prognosis group for seminomas. Doctors divide pure seminoma germ cell tumours into 2 groups 

• Good prognosis seminoma which is when it has not spread to anywhere except the lungs or lymph nodes
• Intermediate prognosis seminoma means that the cancer has spread to other body organs apart from the lungs and lymph nodes, such as the liver, brain or bones

These groupings are a general guide to help your doctors decide which treatment will suit you best. Generally, this means that someone with a poorer outlook may need more treatment than someone with a good outlook. But everyone is different and can respond differently to treatment. So no groupings or statistics can tell you for certain how well the treatment will work.

There is information about clinical trials on our clinical trials database, and you can find detailed information about germ cell tumours, including their prognosis, in our testicular cancer section.