Fast Five Quiz: Testicular Cancer

Elwyn C. Cabebe, MD

Disclosures

June 15, 2021

Blood should be obtained for a chemistry profile that includes LDH; complete blood cell count; and serum tumor markers, including AFP and beta-hCG.

Serum levels of AFP and/or beta-hCG are elevated in most patients with nonseminomatous germ cell tumors, even when nonmetastatic. Patients with pure seminoma may have elevated levels of beta-hCG but do not have elevated AFP levels. If AFP is elevated in patients with pure seminoma, then the presence of nonseminomatous germ cell tumors should be considered.

Elevation of serum beta-hCG and AFP levels, alone or in combination, is not sufficiently sensitive or specific to establish the diagnosis of testicular cancer in the absence of histologic confirmation, although markedly elevated levels are rarely found in normal individuals. However, AFP, beta-hCG, and LDH levels are vital in the evaluation and management of patients with testicular cancers. They are used for determining diagnosis, staging, and prognosis and for following response to therapy. Measurement of AFP, beta-HCG, and LDH in patients in whom testicular cancer are suspected is mandatory before treatment, as is monitoring of these levels during and after treatment.

Serum AFP features are as follows:

  • Secretion is restricted to nonseminoma.

  • Reference adult concentration is < 10 ng/mL.

  • Serum half-life is 4-5 days.

  • Concentrations > 10,000 ng/mL are seen exclusively in germ cell tumor and hepatocellular carcinoma.

  • Levels may be elevated in patients with hepatic dysfunction, hepatitis, cirrhosis, and drug or alcohol abuse.

Beta-hCG features are as follows:

  • Increased levels of beta-hCG can be found in either seminoma or nonseminoma.

  • Serum half-life is 18-36 hours.

  • Patients with high levels of beta-hCG may experience nipple tenderness or gynecomastia.

  • Serum beta-hCG concentrations above 10,000 mIU/mL are seen exclusively in germ cell tumors.

  • Elevated levels may also be seen in patients with trophoblastic differentiation of a lung or gastric primary cancer or with hypogonadism.

  • False-positive elevations may result from marijuana use.

LDH features are as follows:

  • LDH has independent prognostic significance; increased levels reflect tumor burden, growth rate, and cellular proliferation.

  • LDH is not a sensitive or specific indicator of disease recurrence and therefore is not a useful serum marker for posttreatment surveillance.

Read more about the workup of testicular cancer.

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