β-hCG (human chorionic gonadotropin): Its level is very low in normal adult males. Syncytiotrophpblastic tissues in some germ cell tumors produce this substance. Therefore, it can be detected in all choriocarcinomas, 40-60% in embryonal cell carcinomas and 7% in pure seminomas. They rarely exceed 2 times the normal in seminomas.
AFP (alpha fetoprotein): It is an oncofetal protein and is detected in testicular and liver tumors. Its half-life is 5-7 days. It is elevated in embryonal carcinoma, teratoma, teratocarcinoma, yolk sac tumors. They are not elevated in pure seminomas and choriocarcinomas.
LDH (Lactate dehydrogenase): LDH is a cellular enzyme that normally has 5 isoenzymes. It is found in muscle tissue, liver, kidney and brain. It is not specific for testicular tumor, but it can give an idea about the size of the tumor. It is thought that it may have a role in the follow-up of advanced seminomas and persistent nonseminomas whose tumor markers do not increase.
In conclusion, considering all stages, one or both tumor markers are elevated in 90% of nonseminomatous tumors. AFP is elevated in 50-70% of patients, and ß-hCG is elevated in 40-60% of patients. One or two of these are elevated in two-thirds of patients in stage 1. After treatment, the level of tumor markers decreases according to their half-lives. A high level or slow fall should suggest residual disease. A decrease in the level to normal does not mean that a cure has been achieved in the treatment of the disease.
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