Tumor markers are biologic attributes of malignant cells, that help to distinguish those malignant cells from normal cells. These can be divided into three categories: (1) protein markers, (2) chromosomal markers, and (3) other molecular markers, including abnormal expression of oncogenes and tumor suppressor genes. Markers may be uniquely identified with certain neoplasms, or they may be normal constituents that, in the face of a tumor, are expressed in abnormal locations and/or quantities or display abnormal functions. They may be located intracellularly, on the cell surface, or they may be excreted, at times being detectable in bodily fluids such as urine or serum. In germ cell tumors (GCTs), serum protein markers such as a-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) dominate and will therefore be the focus of this chapter.
GCTs were among the first tumors for which serum markers were applied. The first step was taken in 1930, when hCG was detected in the urine of men with choriocarcinoma.1 Since that time, they have acquired increasing importance in the management of GCTs. In fact, today it is impossible to discuss almost any aspect of GCTs without a thorough understanding of the role of these serum markers. They provide critical information for diagnosis, prognosis, staging, monitoring response to therapy, and diagnosing recurrence; each of these functions will be addressed in this chapter.
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