Early recurrence detection

All patients with germ cell tumours should continue to have serial tumour marker estimation after completion of chemotherapy to detect relapse early. Serial marker estimation is also invaluable as part of the surveillance programme of patients with stage 1 disease

Table 6.1 Assessment of prognosis by marker in germ cell tumours

AFP ng/ml

HCG IU/L

LDH x upper limit normal

Good risk

>1000

and

<500

and

<1.5 x upper limit normal

Intermediate

1000-10 000

or

5000-50 000

or

1.5-10 x upper limit normal

Poor risk

>10 000

or

>50 000

or

>10 x upper limit normal

following orchidectomy. Because tumour markers can double rapidly, it is important that they are measured at least monthly, and more frequently if raised.

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