Clinical Applications of hCG
The concept of tumor markers has widened in recent years. In the 1950s and 1960s we thought of them primarily as means of detecting and monitoring tumors. In the past decade their potential value at the immunocytochemical level has become more evident, and now the possibilities of in vivo localization with antibodies and of drug targeting have come under serious study. A marker which is ideal for one purpose is not necessarily the best for another; as more trophoblastic products are defined, we may find different markers coming into use for different purposes. The four best known trophoblastic products are human chorionic gonadotropin (hCG), the so-called placenta specific protein (SP1), human placental lactogen (hPL), and placental alkaline phosphatase (PLAP). The first two of these are secreted freely by trophoblast in the earliest stages of pregnancy, whereas the last two reach their peak values late in pregnancy. As serological markers, hCG and SP1 are much the better for trophoblastic tumors. SP1 is a good marker for trophoblastic tumors and only slightly inferior to hCG. For some patients SP1 may indeed be slightly superior (1–3), but in my experience this was not sufficient to merit measuring SP1 in all cases. For the concept of serum tumor markers, hCG remains the best model we have. Many other placental products have been described in recent years, but none have so far been shown to be superior to hCG as a marker for trophoblastic tumors.
KeywordsBrain Metastasis Hydatidiform Mole Trophoblastic Tumor Placental Alkaline Phosphatase Malignant Teratoma
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