All patients suspected of having a germ cell tumour should have a baseline tumour marker estimation before excision of the primary tumour. Patients whose clinical status could be compromised by biopsy should be considered for an NSGCT if disease distribution is compatible with such a tumour and there is gross elevation of either HCG or AFP. An elevated HCG can be found in patients with pure semino-ma but a patient with an elevated AFP should never be considered to have a pure seminoma, regardless of histological findings.

Failure of tumour marker levels to fall to normal post-operatively indicates the presence of occult metastatic disease.

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