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In recent years, numerous serum and cell/tissue-based markers have been described for colorectal cancer (CRC). The aim of this article was to provide guidelines for the routine clinical use of some of these markers. Lack of sensitivity and specificity preclude the use of any available serum markers such as carcinoembryonic antigen (CEA), CA 19-9, CA 242, CA 72-4, tissue polypeptide antigen (TPA) or tissue polypeptide-specific antigen (TPS) for the early detection of CRC. However, preoperative measurement of CEA is desirable as this may give independent prognostic information, help with surgical management and provide a baseline level for subsequent determinations. For patients with stage 2 (Dukes' B) and 3 (Dukes' C) disease who may be candidates for liver resection, CEA levels should be measured every 2-3 months for at least 3 years after diagnosis. For monitoring treatment of advanced disease, CEA should also be tested every 2-3 months. Insufficient evidence is presently available to recommend the routine use of other serum markers for monitoring purposes. Similarly, the new cell and tissue-based markers (e.g, ras, P53) cannot yet be recommended for routine clinical use.

Long-term outcome of salvage treatment was reviewed in 67 unselected patients relapsing during or after their primary cisplatin-based chemotherapy for metastatic testicular cancer. Salvage treatment predominantly consisted of cisplatin-ifosfamide-based chemotherapy ± surgery. With a median follow-up of 90 months 20 patients (30%) are alive with no evidence of disease. Prognostic factor analysis included year of diagnosis, age, primary site (testicular versus extragonadal), initial tumour burden, relative dose intensity of cisplatin, response to primary therapy, relapse-free interval, and tumour burden and marker status at relapse. Univariate analysis identified age ≤35 years, testicular origin, low tumour burden at diagnosis and at relapse, complete response (CR) to primary therapy and a relapse-free interval >3 months as predictors of favourable outcome. Multivariate analysis confirmed age ≤35, CR to primary therapy, and a relapse-free interval >3 months. Patients with these good-risk features had a 5-year survival of 72%. Prognosis for the remaining patients is poor with only 11% 5-year survival emphasising the need for innovative and more aggressive approaches.