Pediatric Cancer

At Loma Linda University Cancer Center, we understand our younger patients have very special needs. That is why we have a dedicated unit in our Children’s Hospital just to care for children with cancer. Patients benefit from our support services that we have specifically designed to help children battling cancer.

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Germ Cell Tumors

What are germ cell tumors?

Germ cell tumors are malignant (cancerous) or nonmalignant (benign, noncancerous) tumors that are comprised mostly of germ cells. Germ cells are the cells that develop in the embryo (fetus, or unborn baby) and become the cells that make up the reproductive system in males and females. These germ cells follow a midline path through the body after development and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells. Most ovarian tumors and testicular tumors are of germ cell origin. The ovaries and testes are called gonads.

Germ cell tumors are rare, accounting for about two to four percent of all cancers in children and adolescents younger than age 20. Germ cells are the cells that develop in an unborn baby and become the cells that make up the reproductive system in males and females.

Tumor sites outside the gonad are called extragonadal sites. The tumors also occur along the midline path and can be found in the head, chest, abdomen, pelvis, and sacrococcygeal (lower back) area.

Germ cell tumors are rare. Germ cell tumors account for about 2 to 4 percent of all cancers in children and adolescents younger than age 20.

Germ cell tumors can spread (metastasize) to other parts of the body. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system. Rarely, germ cell tumors can spread to the bone, bone marrow, and other organs.

What are the symptoms of germ cell tumors?

The following are the most common symptoms of germ cell tumors. However, each child may experience symptoms differently. Symptoms vary depending on the size and location of the tumor and may include:

  • A tumor, swelling, or mass that can be felt or seen
  • Elevated levels of alpha-fetoprotein (AFP)
  • Elevated levels of beta-human chorionic gonadotropin (ß-HCG)
  • Constipation, incontinence, and leg weakness can occur if the tumor is in the sacrum (a segment of the vertebral column that forms the top part of the pelvis) compressing structures
  • Abdominal pain
  • Abnormal shape, or irregularity in, testicular size
  • Shortness of breath or wheezing if tumors in the chest are pressing on the lungs

The symptoms of germ cell tumors may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are germ cell tumors diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for germ cell tumors may include:

  • Biopsy. A sample of tissue is removed from the tumor and examined under a microscope.
  • Complete blood count (CBC). This measures size, number, and maturity of different blood cells in a specific volume of blood.
  • Additional blood tests. These tests may include blood chemistries, evaluation of liver and kidney functions, tumor cell markers, and genetic studies.

Multiple imaging studies, including:

  • Computed tomography (CT) scan. This is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI). This is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body, without the use of X-rays.
  • X-ray. This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Ultrasound (also called sonography). This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

What is the treatment for germ cell tumors?

Specific treatment for germ cell tumors will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include(alone or in combination):

  • Surgery (to remove the tumor and involved organs)
  • Chemotherapy
  • Radiation
  • Bone marrow transplantation
  • Supportive care (for the effects of treatment)
  • Hormonal replacement (if necessary)
  • Antibiotics (to prevent or treat infections)
  • Continuous follow-up care (to determine response to treatment, detect recurrent disease, and manage the late effects of treatment)

Skin Cancer

What is melanoma/skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the U.S. alone, more than 2 million Americans will be diagnosed in 2013 with nonmelanoma skin cancer, and more than 76,000 will be diagnosed with melanoma, according to the American Cancer Society.

Fortunately, skin cancers are rare in children. Limiting exposure to sunlight in children and teens may pay large dividends in preventing skin cancers later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma later in life.

What are the symptoms and signs of skin cancer?

The following are the most common symptoms of melanoma. However, each individual may experience symptoms differently.

Symptoms may include:

  • Change in the size, shape, or color of a mole
  • Oozing or bleeding from a mole
  • A mole that looks different from your other moles or feels itchy, hard, lumpy, swollen, or tender to the touch

Because most malignant melanoma cells still produce melanin, melanoma tumors are often shaded brown or black. Melanoma can also appear on the body as a new mole. Melanoma can spread quickly to other parts of the body through the lymph system, or through the blood. Like most cancers, melanoma is best treated when it is diagnosed early.

The symptoms of melanoma may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How to find melanoma early

It is important to examine your child's skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Larger moles that are present at birth and atypical moles, have a greater chance of becoming malignant. Recognizing changes in your child's moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage.

The warning signs are:

Normal mole / melanoma Sign   Characteristic
Asymmetry   When half of the mole does not match the other half
Border   When the border (edges) of the mole are ragged or irregular
Color   When the color of the mole varies throughout
Diameter   If the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission:
National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may show few or none. New moles, moles that have grown or changed, and moles that are itchy or bleeding should be checked by your child's doctor. Always consult your child's doctor if you have questions about a mole or other skin lesion.

How is skin cancer diagnosed?

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining your children (and yourself) is usually the first step in detecting skin cancer. The following suggested method of examination comes from the AAD:

  • Examine your child's body front and back, then the right and left sides, with arms raised.
  • Look carefully at your child's forearms, the back of his or her upper arms, and the palms of the hands. Check between the fingers and look at the nail beds.
  • Look at backs of his or her legs and feet, spaces between the toes, the toenail beds, and the soles of the feet.
  • Examine the back of his or her neck and scalp.
  • Check his or her back, buttocks, and genital area.
  • Become familiar with your child's skin and the pattern of moles, freckles, and other marks.
  • Be alert to changes in the number, size, shape, and color of pigmented areas.
  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your child's doctor promptly if you notice any changes.