Tumour markers should be taken before orchidectomy – may help with diagnosis, may be indicative of histology, provide a baseline level to assess treatment and assist with staging
50 % will have elevation of one marker, over 90 % in stage 2 disease.
In general, tumour markers are used:
- Pre orchidectomy
- After orchidectomy
- Monitoring chemo response
- After completion of treatment to monitor for relapse
Alpha feto protein (AFP)
- Half-life 5 – 7 days
- Seminomas (and choriocarcinomas) do not produce AFP; so, AFP is diagnostic of NSGCT
- False positives:
- Liver disease
- Infants < 1 year old
- Stomach, pancreas, biliary and lung cancers
beta Human Chorionic Gonadotrophin (bHCG)
- Half-life 1 – 3 days
- Produced by syncitiotrophoblasts
- High levels in choriocarcinoma. 15 % of seminomas will raise bHCG.
- False positives:
- Marijuana use
- Other malignancies
- Other cancers – lung, breast, kidney, bladder
- False positives in hypergonadotropic hypogonadism
Lactate dehydrogenase (LDH)
- Half life ? 24 hours (Campbell’s) or 4 days (Weider’s)
- Marker of tumour volume and disease burden
- Relatively nonspecific and can be raised with liver disease etc.