Serum tumor markers are very useful in the diagnosis and management of germ cell tumors. They have been used in predicting response and determining the presence of residual disease or progressive tumor. a-Fetoprotein (AFP) and beta-human chorionic gonadotropin (P-hCG) are the most valuable tumor markers. Different types of germ cell tumors secrete these markers: yolk sac tumors produce AFP, choriocarcinoma produces P-hCG, embryonal carcinomas can elaborate small amounts of AFP and/or P-hCG, and germinomas can have detectable levels of p-hCG. The serum half-life of AFP is 5 to 7 days in children older than 1 year; that of P-hCG is 24 to 36 hours.10 AFP levels are normally high at birth and slowly decline to adult levels by 8 months of age. Because the half-life of AFP has a wide variability at different ages during the first year of life, the decay of serum AFP levels with therapy in infants less than 1 year of age is difficult to interpret. Normal ranges have been established to address this problem.11
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