{"id":2170,"date":"2018-12-12T23:01:04","date_gmt":"2018-12-12T23:01:04","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1418"},"modified":"2026-02-06T19:15:38","modified_gmt":"2026-02-06T19:15:38","slug":"markers-testicular","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/markers-testicular\/","title":{"rendered":"Biochemical Markers in Testicular Cancer"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Patients with testicular cancer most frequently present with\u00a0a painless testicular mass. The initial work-up includes a\u00a0history and physical exam, cross-sectional imaging of the retroperitoneum, chest x-ray, and serum levels of AFP, hCG,\u00a0and LDH.<!--more--><\/p>\r\n<p>Serum levels of AFP, hCG, and LDH should be obtained before orchiectomy and repeated weekly thereafter until marker levels normalize. Postorchiectomy tumor marker levels are used for risk stratification and are incorporated into the American Joint Committee on Cancer TNM Staging System for Testis Cancer. Men with nonseminomatous germ cell tumors (NSGCTs) with persistently elevated hCG or AFP following orchiectomy are presumed to have metastatic disease even without identifiable mass on imaging.<\/p>\r\n<p><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script> <ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-0127150553352455\" data-ad-slot=\"7834404329\"><\/ins> <script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script><\/p>\r\n<p><strong>American Joint Committee on Testis Cancer S Stage parameters<\/strong><\/p>\r\n<table style=\"border-collapse: collapse; width: 100%; height: 120px;\" border=\"1\">\r\n<tbody>\r\n<tr style=\"height: 24px;\">\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">Stage<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">AFP (ug\/I)<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">hCG (IU\/I)<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">LDH<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 24px;\">\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">S0<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">WNL<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">WNL<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">WNL<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 24px;\">\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">S1<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&lt;1000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&lt;5000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&lt;1.5 \u00d7 normal<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 24px;\">\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">S2<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">1000\u201310,000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">5000\u201350,000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">1.5\u201310 \u00d7 normal<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 24px;\">\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">S3<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&gt;10,000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&gt;50,000<\/span><\/td>\r\n<td style=\"width: 25%; text-align: center; height: 24px;\"><span style=\"font-size: 10pt;\">&gt;10 \u00d7 normal<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<!-- \/wp:paragraph -->\r\n<p>&nbsp;<\/p>\r\n<!-- wp:paragraph -->\r\n<p><span style=\"font-size: 10pt;\">Abbreviations: AFP, alpha fetoprotein; hCG, human chorionic gonadotropin; LDH, lactate dehydrogenase; WNL, within normal limits.<\/span><\/p>\r\n<!-- \/wp:paragraph -->\r\n<p>&nbsp;<\/p>\r\n<!-- wp:paragraph -->\r\n<p>The degree of AFP or hCG elevation is directly proportional\u00a0to tumor burden, and higher serum levels of these tumor\u00a0markers have been recognized as poor prognostic indicators.\u00a0Therefore, the degree of marker elevation in patients with\u00a0NSGCTs has been incorporated with staging criteria to\u00a0stratify patients into good, intermediate, and poor risk\u00a0groups according to the International Germ Cell Consensus\u00a0Classification.\u00a0<\/p>\r\n<p><strong>Prognostic-based staging system for metastatic germ cell cancer<\/strong><\/p>\r\n<table style=\"border-collapse: collapse; width: 100%; height: 295px;\" border=\"1\">\r\n<tbody>\r\n<tr style=\"height: 13px;\">\r\n<td style=\"width: 21.8607%; height: 13px;\"><span style=\"font-size: 10pt;\"><strong>Group<\/strong><\/span><\/td>\r\n<td style=\"width: 35.0935%; height: 13px;\"><span style=\"font-size: 10pt;\"><strong>Non-seminoma<\/strong><\/span><\/td>\r\n<td style=\"width: 35.0457%; height: 13px;\"><span style=\"font-size: 10pt;\"><strong>Seminoma<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 83px;\">\r\n<td style=\"width: 21.8607%; height: 128px;\"><span style=\"font-size: 10pt;\">Good-prognosis<\/span><\/td>\r\n<td style=\"width: 35.0935%; height: 128px;\"><span style=\"font-size: 10pt;\">All of the following criteria:<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Testis\/retroperitoneal primary<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 No non-pulmonary visceral metastases<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 AFP &lt; 1,000 ng\/mL<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 hCG &lt; 5,000 IU\/L (1,000 ng\/mL)<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 LDH &lt; 1.5 x ULN<\/span><\/td>\r\n<td style=\"width: 35.0457%; height: 128px;\"><span style=\"font-size: 10pt;\">All of the following criteria:<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any primary site<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 No non-pulmonary visceral metastases<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Normal AFP<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any hCG<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any LDH<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 83px;\">\r\n<td style=\"width: 21.8607%; height: 10px;\"><span style=\"font-size: 10pt;\">Intermediate prognosis<\/span><\/td>\r\n<td style=\"width: 35.0935%; height: 10px;\"><span style=\"font-size: 10pt;\">All of the following criteria:<br \/>\u2022 Testis\/retroperitoneal primary<br \/>\u2022 No non-pulmonary visceral metastases<br \/>\u2022 AFP 1,000 &#8211; 10,000 ng\/mL or<br \/>\u2022 hCG 5,000 &#8211; 50,000 IU\/L or<br \/>\u2022 LDH 1.5 &#8211; 10 x ULN<\/span><\/td>\r\n<td style=\"width: 35.0457%; height: 10px;\"><span style=\"font-size: 10pt;\">All of the following criteria:<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any primary site<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Non-pulmonary visceral metastases<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Normal AFP<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any hCG<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Any LDH<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 144px;\">\r\n<td style=\"width: 21.8607%; height: 144px;\"><span style=\"font-size: 10pt;\">Poor prognosis<\/span><\/td>\r\n<td style=\"width: 43.0935%; height: 144px;\"><span style=\"font-size: 10pt;\">Any of the following criteria:<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Mediastinal primary<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 Non-pulmonary visceral metastases<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 AFP &gt; 10,000 ng\/mL or<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 hCG &gt; 50,000 IU\/L (10,000 ng\/mL) or<\/span><br \/><span style=\"font-size: 10pt;\">\u2022 LDH &gt; 10 x ULN<\/span><\/td>\r\n<td style=\"width: 35.0457%; height: 144px;\"><span style=\"font-size: 10pt;\">No patients classified as poor prognosis<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script> <ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-0127150553352455\" data-ad-slot=\"7834404329\"><\/ins> <script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script><\/p>\r\n<p><strong>References:<\/strong><\/p>\r\n<ol>\r\n<li>Adra N, Einhorn LH. Testicular cancer update.\u00a0Clin Adv Hematol Oncol. 2017 May;15(5):386-396. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28591093\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Adra N, Einhorn LH. Testicular cancer update.\u00a0\r\nClin Adv Hematol Oncol. 2017 May;15(5):386-396. [Medline] (opens in a new tab)\">[Medline]<\/a><!-- \/wp:paragraph --><\/li>\r\n<li>Milose JC, Filson CP, Weizer AZ, Hafez KS, Montgomery JS. Role of biochemical markers in testicular cancer: diagnosis, staging, and surveillance.\u00a0Open Access J Urol. 2011 Dec 30;4:1-8.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24198649\/\" target=\"_blank\" rel=\"noreferrer noopener\">[Medline]<\/a><\/li>\r\n<li>Egan J, Salari K. Biomarkers in Testicular Cancer: Classic Tumor Markers and Beyond. Urol Clin North Am. 2023 Feb;50(1):133-143. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36424077\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\r\n<\/ol>\r\n<p>&nbsp;<\/p>\r\n<p>Created Dec 11, 2018.<br \/>Up-date Feb 6, 2026.<\/p>\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[272],"tags":[324,327,322,123,326,323,328,325],"class_list":["post-2170","post","type-post","status-publish","format-standard","hentry","category-oncology","tag-biochemical","tag-bioquimicos","tag-cancer","tag-diagnosis","tag-marcadores","tag-markers","tag-seminoma","tag-testicular"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2170","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2170"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2170\/revisions"}],"predecessor-version":[{"id":10642,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2170\/revisions\/10642"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2170"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2170"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}