tumor markers and seminoma

Originally posted by huckchef

I think this question has been asked before but I didn't want to dive into depths of searching...sorry!
Why in seminoma cases are tumor markers checked during surveillance if they normally don't present with increased numbers to begin with? If I go and have chest x-ray and tumor markers every 4 months now what good are tumor markers in presenting a relapse? Unless the relapse would return as a non-seminoma!
Thanks,
Brian

As my Uro told me: There is no oncologist in the world that would approve a surveillance protocol without tumor markers. This is because of a number of reasons, number 1: It is possible that you will not have markers at initial presentation but will develop them later due to "tumor burden". This is true for LDH, especially. Your primary might have been small, and may have been expressing low levels of LDH, but the spread can be extensive, making LDH register as high later on. Of course this is rare. Number 2: Remember, only part of your tumor is actually examined by the pathologist. This is generally adequate, but there is always the possibility that nonseminomatous elements were missed. Perhaps they were small, located in another part of the mass, and very few cells to register any blood markers. Number 3: There is always the possibility of a gonadal or extragonadal second tumor, and the incidence of these tumors is much higher (about 12-fold, but I don't need to tell you that) in people who have had TC than in those who haven't. Although it's rare, there have been cases where the second tumor has been nonseminomatous (it's rare because these tumors usually present before seminomas, so that in a person that has been diagnosed with different tumor types metachronously, the seminoma is usually the second tumor). Number 4: Measuring tumor markers is cheap and non-invasive, and the benefit for finding elevated markers early outweighs any costs and risks by a very wide margin.

Hope this helps,

djm

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