The epidemiology of malignant germ cell tumors: The EUROCARE study

Abstract

This chapter is based on results of germ cell tumors from the EUROCARE (European Cancer Registry-based study on survival and care of cancer patients). Most germ cell tumors (GCTs) arise in the gonads, mainly in the testis. The incidence of testicular GCT is high in Western industrialised countries (Europe, North America, Australia) but low in Asia and Africa, while the incidence of ovarian malignant GCT remains low in all continents. In males, non-seminomas are more common than seminomas until the age of 30 years. In females, non-seminomas are more common than seminomas in almost every age group. In males, non-seminomas are mainly represented by mixed germ cell tumours, embryonal carcinoma and teratomas, while in females, non-seminomatous tumours are represented by teratomas and yolk sac tumors. Gonadal GCTs are typical tumours of adolescents and young adults. Extragonadal GCTs (EGGCTs) are mainly non-seminomas and arise in the central nervous system (CNS), mediastinum, thorax, abdomen and pelvis, with differences between males and females. GCTs of the CNS are typical of children and adolescents (0-19 years), while other EGGCTs occur mainly in young adults (25-39 years of age). An increasing incidence of testicular cancer has been reported over the last 20 years, which contrasts with a stable incidence for both ovarian GCT and EGGCT. The 5-year relative survival for GCT is very good (93 %), with seminomas having better survival than non-seminomas. Gonadal GCTs have a better survival than extragonadal ones, and, among these, the brain and retroperitoneum locations report the highest survival. Survival decreases with increasing age with the worst survival data observed in patients older than 40 years, especially females.