To help diagnose and monitor gestational trophoblastic disease or germ cell tumors
When your symptoms suggest gestational trophoblastic disease or germ cell tumors; to evaluate the effectiveness of treatment for these conditions; to monitor for recurrence
A blood sample drawn from a vein
Human chorionic gonadotropin (hCG) is a hormone, made up of an alpha and beta subunit, that is produced by the placenta and normally is only measurable during pregnancy. Some abnormal tissues, tumors, and cancers, however, may also produce hCG, making the hCG test useful as a tumor marker. This test measures the amount of intact hCG, and sometimes the beta subunit of hCG, in the blood.
An increased level of hCG is seen with gestational trophoblastic disease and some germ cell tumors (benign and cancerous). If hCG is increased with these conditions, then the hCG test can be used as a diagnostic and monitoring tool.
Gestational trophoblastic disease (GTD) is a group of tumor types that develop in a woman's uterus from the layer of cells surrounding an embryo that creates the placenta during a normal pregnancy (trophoblasts) and produces hCG. GTD usually occurs at the beginning of pregnancy after an egg has been fertilized, but instead of supporting the growth of a fetus, the cells form abnormal tissue masses. In most cases, the tumors are benign, but in a small percentage of people, they are cancerous. According to the American Cancer Society, GTD occurs in about 1 in 1,000 pregnancies. It can also occur after a normal pregnancy or after a miscarriage or abortion. The primary forms of GTD are:
Note: With appropriate treatment, the cure rate for most GTD is very high. For more on this, see the links in the Related Content section below.
Germ cell tumors and cancers occur primarily in the ovaries and testicles but can also rarely develop in other locations such as the chest.
Levels of hCG may also be elevated in other diseases such as liver, breast, lung, skin, and stomach cancers. Increased levels may also be seen in non-cancer conditions such as cirrhosis, duodenal ulcer, and inflammatory bowel disease.
Quantitative human chorionic gonadotropin (hCG) testing, often called beta hCG (βhCG), measures the amount of hCG present in the blood. It may be used to help diagnose gestational trophoblastic disease (GTD) or, with other tests such as AFP and lactate dehydrogenase, to help diagnose germ cell tumors.
Since hCG is not normally present in men or non-pregnant women, it is useful as a tumor marker. If the tumor or cancer is producing hCG, then the hCG test can be used to help detect and monitor tumor activity.
When testing hCG as a tumor marker, unlike detecting pregnancy, it is important to measure the intact (alpha + beta subunits) form of hCG. There may be some benefit to also measuring the beta-subunit of hCG in certain tumors, and different labs will detect intact and βhCG differently. For this reason, it is very important to continue to use the same lab when monitoring GTD or germ cell tumors.
A quantitative hCG test may be ordered when a healthcare practitioner suspects that a person may have gestational trophoblastic disease (GTD) or a germ cell tumor due to the person's clinical presentation, signs and symptoms.
In women, signs and symptoms of GTD may include:
Signs and symptoms of a germ cell tumor in women and men are similar to those of ovarian cancer and testicular cancer, respectively.
If a person is diagnosed with one of these conditions and the hCG is initially elevated, then the test will be ordered at intervals to monitor the effectiveness of treatment and to detect tumor recurrence.
In men and in non-pregnant women, the hCG level is normally undetectable.
When the test is used as a tumor marker, an elevated hCG level may mean that an individual has a germ cell tumor or gestational trophoblastic disease (GTD).
A high level of hCG occurs in both GTD and normal pregnancy. However, hCG rises at a constant and predictable rate, doubling approximately every 36-48 hours in early normal pregnancy. Levels of hCG in GTD show altered rates of production and, paired with imaging such as ultrasound, can identify abnormalities in the pregnancy requiring intervention. Alternatively, the hCG levels may be much higher than expected in normal pregnancy or not show the expected decrease after pregnancy or abortion/miscarriage.
During treatment for GTD or a germ cell tumor, a falling hCG level generally indicates that the condition is responding to treatment (approximately 50% decrease expected every 1.5 days), while persistent or rising levels may indicate that it is not responding to therapy. An increased hCG level after treatment may indicate a recurrence of disease.
False-positive serum hCG results may occur due to the presence of certain drugs such as anticonvulsants, antiparkinsonian agents, hypnotics, and tranquilizers that may interfere with the test. In addition, certain types of antibodies that may be present in some individuals and fragments of the hCG molecule, if present, can also interfere with test results. Generally, if results are questionable, they may be confirmed by testing with a different method.
Rarely, an hCG test may be ordered to help diagnose and monitor tumors and cancers other than GTD or germ cell tumors.
If hCG is elevated in the blood, then it will be elevated in the urine, but the results are not interchangeable. Blood is the preferred sample for tumor testing.
No. Other than to avoid becoming pregnant, GTD is not preventable since GTD is associated with pregnancy. However, since it is rare, most women will never have the condition. Since GTD can be detected soon after conception in most cases and successfully treated, it is rarely considered a significant cause to avoid pregnancy.
Yes, in most cases, although you will be at a higher risk of having GTD again. After treatment for GTD, you will need to wait for a period of time as advised by your healthcare provider before becoming pregnant again.
Some athletes, including professional and international athletes, must submit to tests that detect steroids and other performance-enhancing substances. These athletes are often tested throughout their careers to ensure that no 'doping' occurs. Urine tests can detect about 200 compounds, including steroids and other anabolic substances, erythropoietin, and substances that cause false-negative results (masking agents) to hide illicit substance use. Sports organizations specify which compounds they might be looking for by doing a complete screen.
Some athletes who use steroids take beta-hCG to reverse shrinking of their testicles, which can be a side effect of steroids. Thus, some athletes may be tested for hCG to help identify steroid use. (For more on this, see the article on Drug Abuse Testing.)
Sources Used in Current Review
2018 review performed by Kristin Hauff, PhD, FCACB, Interior Health Laboratories BC.
Sisinni L., Landriscina M. (2015) The Role of Human Chorionic Gonadotropin as Tumor Marker: Biochemical and Clinical Aspects. In: Scatena R. (eds) Advances in Cancer Biomarkers. Advances in Experimental Medicine and Biology, vol 867. Springer, Dordrecht.
Nwabuobi C, et al. (2017) hCG: Biological Functions and Clinical Applications. International Journal of Molecular Science. 18(10) pii: E2037. Available online at https://www.mdpi.com/1422-0067/18/10/2037/htm. Accessed October 2018.
Stenman U., Alfthan H. (2013) Determination of human chorionic gonadotropin. Best Practice & Research Clinical Endocrinology & Metabolism. 27(6); 783-793.
Sokoll L.J., Rai A.J., and Chan D.W. (2012) Tumor Markers. In: Burtis C.A, Ashwood E.R and Burns D.E. (eds) Tietz Textbook of Clinical Chemistry and Molecular Diagnostics 5th edition Elsevier, St. Louis, Missouri.
Braustein GD, Buster JE, Soares JR and Gross SJ (1983). Pregnancy hormone concentrations in marijuana users. Life Science 33(2): 195-9.
Braustein GD, Thompson R, Gross SJ and Soares JR (1983). Marijuana use does not spuriously elevate serum human chorionic gonatotropin levels. Urology 25(6): 605-6.
Montagnana M., et al. (2011) Human chorionic gonadotropin in pregnancy diagnostics. Clinica Chimica Acta 412(17): 1515-1520. Available online at http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-guidelines/gynecology/gestational-trophoblastic-neoplasia#Diagnosis-Gestational-Trophoblastic-Neoplasia. Accessed October 2018.
Sources Used in Previous Reviews
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
(2004). Germ Cell Tumors: Beta-Human Chorionic Gonadotropin. Specialty Laboratories, Use and Interpretation of Laboratory Tests, Books [On-line information]. Available online at http://oncology.specialtylabs.com/books/display.asp?id=544.
American Cancer Society. What is gestational trophoblastic disease? Available online at http://www.cancer.org/Cancer/GestationalTrophoblasticDisease/DetailedGuide/gestational-trophoblastic-disease-what-is-g-t-d. Accessed March 2011.
MedlinePlus Medical Encyclopedia. Gestational Trophoblastic Disease. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007333.htm. Accessed March 2011.
Enrique Hernandez, MD, FACOG, FACS. Gestational Trophoblastic Neoplasia. Available online at http://emedicine.medscape.com/article/279116-overview. Accessed March 2011.
Farinde, A. (Updated 2014 July 2). Human Chorionic Gonadotropin (hCG). Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2089158-overview. Accessed September 2014.
(Revised 2014 March 3). Gestational Trophoblastic Disease. American Cancer Society [On-line information]. Available online at http://www.cancer.org/acs/groups/cid/documents/webcontent/003104-pdf.pdf. Accessed September 2014.
(Revised 2013 October 30). Tumor Markers. American Cancer Society [On-line information]. Available online at http://www.cancer.org/acs/groups/cid/documents/webcontent/003189-pdf.pdf. Accessed September 2014.
(Modified 2014 April 25). General Information About Gestational Trophoblastic Disease. National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/gestationaltrophoblastic/HealthProfessional. Accessed September 2014.
(Modified 2014 July 11). General Information About Testicular Cancer. National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional. Accessed September 2014.
Zhang, Y. (2013 March 13). Tumor Markers: Alpha-fetoprotein (AFP) and human Chorionic Gonadotropin (hCG). Clinical Chemistry Trainee Council Pearls of Laboratory Medicine [On-line information]. Available online through http://www.aacc.org. Accessed September 2014.
Hussain, F. et. al. (Updated 2012 August 1). Gynecologic Tumor Markers Tumor Marker Overview. Medscape Drugs & Diseases http://emedicine.medscape.com/article/269839-overview. Accessed September 2014.
Storck, S. (Updated 2012 November 8). Hydatidiform mole. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000909.htm. Accessed September 2014.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 558-560.
Sturgeon C, et. al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem 2008; 54(12):e11-79. Available online through http://www.aacc.org. Accessed October 2014.
United States Anti-Doping Agency. Effects of Performance Enhancing Drugs. Available online at http://www.usada.org/substances/effects-of-performance-enhancing-drugs/. Accessed October 2014.
Quest Diagnostics. Bet-HCG, serum quant tumor marker. Available online at http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=20862&labCode=QER. Accessed October 2014.
Medscape. Beta human chorionic gonadotropin. Available online at http://emedicine.medscape.com/article/269839-overview#aw2aab6b4. Accessed October 2014.