{"entity":{"id":"germ-cell-tumour-markers","kind":"technology","name":"AFP, hCG and LDH in germ cell tumours (IGCCCG risk groups)","aka":["germ cell tumour markers","IGCCCG classification","alpha-fetoprotein and beta-hCG","testicular cancer blood tests"],"tldr":"In testicular and other germ cell cancers three blood tests, AFP, beta-hCG and LDH, are part of the staging itself: their levels after surgery sort patients into good, intermediate and poor risk groups that fix how many cycles of chemotherapy they get, and their return to normal defines cure.","summary":"What they measure. Non-seminomatous germ cell tumours secrete alpha-fetoprotein from yolk sac elements and beta-human chorionic gonadotropin from trophoblastic elements; pure seminomas never make AFP and only sometimes make hCG. Lactate dehydrogenase reflects tumour bulk. All three are measured at diagnosis, again after orchidectomy (the post-operative values are the ones that count), before each chemotherapy cycle, and at every follow-up visit for years.\n\nWhat changes. The International Germ Cell Cancer Collaborative Group classification of 1997, updated in 2021, combines the post-orchidectomy marker levels with the primary site and the presence of non-lung visceral metastases to define good, intermediate and poor prognosis groups. Good-risk patients receive three cycles of BEP (bleomycin, etoposide, cisplatin) or four of EP; intermediate and poor-risk patients receive four cycles of BEP or VIP, and poor-risk patients are candidates for intensified trials. The rate at which markers fall during the first cycles predicts outcome, and a slow decline has been used to intensify treatment. After treatment, a rising marker is recurrence and is treated without waiting for a scan to show a mass, while a residual mass with normal markers is resected. Persistently raised AFP without visible disease is one of the few situations in oncology where a blood test alone drives chemotherapy.\n\nCaveats. AFP is also raised by liver disease and some hepatocellular cancers, hCG by pregnancy, marijuana use and some pituitary states, and LDH by haemolysis and almost any cell damage, so a value must be interpreted with the clinical picture and repeated on the same assay. The tests cost a few pounds and are available everywhere, which is one reason germ cell tumours are among the most curable cancers even in low-resource settings. The same markers, hCG above all, run the management of gestational trophoblastic disease, where hCG surveillance after a molar pregnancy is the whole basis of early treatment.","status":"standard-of-care","asOf":"2026-09-17","links":[{"label":"Journal of Clinical Oncology 2021: Predicting outcomes in men with metastatic nonseminomatous germ cell tumors, the IGCCCG update consortium","url":"https://doi.org/10.1200/JCO.20.03296"}],"tags":[],"related":[],"cancers":["testicular","non-seminoma","seminoma","extragonadal-germ-cell-tumour","paediatric-germ-cell-tumours","gestational-trophoblastic"],"sections":["diagnostics"],"technologies":["serum-tumour-markers","thyroid-cancer-markers","cea-surveillance-colorectal","ct"],"targets":[],"drugs":["cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":["afp","tumour-marker","tumour-markers"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Serum AFP, beta-hCG and LDH measured before and after orchidectomy and serially during treatment; post-orchidectomy levels enter the IGCCCG risk classification, and normalisation or rise defines remission and relapse.","strengths":["Part of staging and directly sets chemotherapy intensity","Rising markers define relapse without imaging","Cheap and universally available"],"limitations":["Seminoma and some non-seminomas are marker negative","Benign causes of elevation, including liver disease and haemolysis","Assay differences require following one laboratory"]},"route":"/technologies/germ-cell-tumour-markers/","neighbours":{"cancer":[{"id":"extragonadal-germ-cell-tumour","kind":"cancer","name":"Extragonadal germ cell tumour","route":"/cancers/extragonadal-germ-cell-tumour/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"gestational-trophoblastic","kind":"cancer","name":"Gestational trophoblastic neoplasia","route":"/cancers/gestational-trophoblastic/"},{"id":"non-seminoma","kind":"cancer","name":"Non-seminomatous germ cell tumour","route":"/cancers/non-seminoma/"},{"id":"seminoma","kind":"cancer","name":"Seminoma","route":"/cancers/seminoma/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"technology":[{"id":"cea-surveillance-colorectal","kind":"technology","name":"CEA surveillance after colorectal cancer surgery","route":"/technologies/cea-surveillance-colorectal/"},{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"serum-tumour-markers","kind":"technology","name":"Serum tumour markers: proper use and misuse","route":"/technologies/serum-tumour-markers/"},{"id":"thyroid-cancer-markers","kind":"technology","name":"Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up","route":"/technologies/thyroid-cancer-markers/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"term":[{"id":"afp","kind":"term","name":"Alpha-fetoprotein (AFP)","route":"/terms/afp/"},{"id":"tumour-marker","kind":"term","name":"Tumour marker","route":"/terms/tumour-marker/"},{"id":"tumour-markers","kind":"term","name":"Tumour markers (CEA, LDH, chromogranin, thyroglobulin)","route":"/terms/tumour-markers/"}]}}