A 25-year-old man presents with a non-tender left testicular mass. Serum AFP is elevated at 450 ng/mL. Radical orchidectomy pathology confirms non-seminomatous germ cell tumor (NSGCT), stage I. Post-orchidectomy AFP remains elevated at 6 weeks. What does this indicate?
- A Normal — AFP elevation may persist up to 3 months postoperatively
- B AFP is not produced by NSGCT; the elevation is due to hepatic regeneration
- C Elevated AFP confirms benign yolk sac tumor remnant requiring observation only
- D Persistent disease — the AFP elevation indicates residual tumor ✓
Explanation
After orchidectomy for NSGCT, tumor markers (AFP, beta-hCG, LDH) should normalize according to their half-lives: AFP half-life is 5-7 days, beta-hCG half-life is 24-36 hours. AFP elevation persisting at 6 weeks (approximately 6 half-lives) strongly indicates residual disease — either occult nodal metastases or systemic spread — and requires staging CT and assessment for adjuvant treatment (surveillance, retroperitoneal lymph node dissection, or chemotherapy). AFP is produced by yolk sac tumors (endodermal sinus tumors) and embryonal carcinoma; it is not produced by pure seminoma.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.