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Serum tumor markers in testicular germ cell tumors

INTRODUCTION

Testicular cancers germ cell tumors (GCTs) have become one of the most curable solid neoplasms, due to remarkable treatment advances that began in the late 1970s. Prior to that time, testicular cancer accounted for 11 percent of cancer deaths in men between the ages of 25 to 34, and the five-year survival rate was 64 percent [1]. Currently, the five-year survival rate is over 95 percent, largely due to better understanding of the natural history of testicular tumors, improved staging and surgical techniques, the use of effective platinum-based combination chemotherapy, and the availability of highly sensitive serum tumor markers to detect minimal residual disease. (See "Overview of the treatment of testicular germ cell tumors".)

Three serum tumor markers have established roles in the management of men with testicular germ cell tumors:

  • The beta subunit of human chorionic gonadotropin (beta-hCG)
  • Alpha fetoprotein (AFP)
  • Lactate dehydrogenase (LDH)

Serum concentrations of AFP and/or beta-hCG are elevated in 80 to 85 percent of men with nonseminomatous germ cell tumors (NSGCTs). In contrast, serum beta-hCG is elevated in fewer than 25 percent of seminomas, and AFP is not elevated in pure seminomas (table 1).

Although these markers can provide supportive evidence for the initial diagnosis of a testicular cancer and are useful for prognosis and risk stratification, their main utility is for monitoring response to treatment and detecting recurrence. The role of these serum tumor markers in the management of men with testicular germ cell tumors (GCTs) will be reviewed here. The integration of serum tumor markers into the overall follow-up plan for patients who have completed their initial treatment for a germ cell tumor is discussed separately. (See "Posttreatment follow-up for men with testicular germ cell tumors".)

                    

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Literature review current through: Mar 2014. | This topic last updated: Jul 2, 2013.
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References
Top
  1. Einhorn LH. Treatment of testicular cancer: a new and improved model. J Clin Oncol 1990; 8:1777.
  2. Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol 2010; 28:3388.
  3. Hori K, Uematsu K, Yasoshima H, et al. Testicular seminoma with human chorionic gonadotropin production. Pathol Int 1997; 47:592.
  4. Kricka LJ. Human anti-animal antibody interferences in immunological assays. Clin Chem 1999; 45:942.
  5. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/TipsandArticlesonDeviceSafety/ucm109390.htm (Accessed on July 02, 2013).
  6. Garnick MB. Spurious rise in human chorionic gonadotropin induced by marihuana in patients with testicular cancer. N Engl J Med 1980; 303:1177.
  7. Braunstein GD, Thompson R, Gross S, Soares JR. Marijuana use does not spuriously elevate serum human chorionic gonadotropin levels. Urology 1985; 25:605.
  8. Stenman UH, Alfthan H, Hotakainen K. Human chorionic gonadotropin in cancer. Clin Biochem 2004; 37:549.
  9. Oosting SF, de Haas EC, Links TP, et al. Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors. Ann Oncol 2010; 21:104.
  10. Yuasa T, Yoshiki T, Ogawa O, et al. Detection of alpha-fetoprotein mRNA in seminoma. J Androl 1999; 20:336.
  11. Nazeer T, Ro JY, Amato RJ, et al. Histologically pure seminoma with elevated alpha-fetoprotein: a clinicopathologic study of ten cases. Oncol Rep 1998; 5:1425.
  12. Javadpour N. Significance of elevated serum alphafetoprotein (AFP) in seminoma. Cancer 1980; 45:2166.
  13. Mencel PJ, Motzer RJ, Mazumdar M, et al. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol 1994; 12:120.
  14. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997; 15:594.
  15. AJCC Cancer Staging Manual, 5th, Fleming ID, Cooper JS, Henson DE, et al (Eds), Lippincott-Raven, New York 1997.