AFP (Alpha-Fetoprotein)

**What is the significance of the test results?**

Elevated AFP levels can serve as an indication of the presence of certain cancers, with liver cancer, ovarian cancer, and germ cell tumors of the testicles being the most common suspects. Nevertheless, it's important to note that not all instances of liver, ovarian, or testicular cancer will necessarily result in notably increased AFP levels.

Occasionally, heightened AFP levels can also be associated with other types of cancer, such as stomach, colon, lung, breast, and lymphoma. However, it's infrequently ordered for the evaluation of these conditions. Furthermore, diseases like cirrhosis and hepatitis have the potential to cause AFP levels to rise.

When AFP is employed as a monitoring tool, a decrease in levels typically signifies a positive response to treatment. Failure to achieve a significant reduction in AFP levels after cancer treatment, typically to within the normal range, may suggest the persistence of some tumor tissue.

If your AFP levels begin to rise, it may be an indication of cancer recurrence. However, it's important to be aware that since AFP levels can also increase in the presence of hepatitis or cirrhosis, they can sometimes be misleading. In cases where AFP levels were not elevated prior to treatment, the test is generally not useful for monitoring treatment effectiveness or recurrence.

In individuals with chronic liver disease, if AFP levels transition from normal or moderately elevated to a significant elevation, the risk of developing liver cancer escalates. When both total AFP and AFP-L3% levels are substantially elevated, there is an increased risk of developing or already having hepatocellular carcinoma within the next year or two. However, it's worth noting that both AFP and AFP-L3% concentrations can fluctuate and become elevated in cases of chronic hepatitis and cirrhosis. In such situations, a sharp increase in AFP is more significant than the specific numerical value of the test result.

**Is there any additional information I should be aware of?**

It's important to understand that not everyone who receives elevated AFP and AFP-L3% test results has cancer or will necessarily develop liver cancer. These tests serve as indicators rather than standalone diagnostic tools. To assess their significance, they should be considered in conjunction with your medical history, physical examination, histopathological analysis, and imaging studies aimed at detecting tumor development.

While these tests offer valuable insights, they may not possess the level of specificity and sensitivity desired by healthcare professionals. AFP levels can temporarily rise when the liver is undergoing repair and regeneration, and mild elevations can be associated with various medical conditions. Therefore, relying solely on AFP testing for cancer diagnosis is not advisable. Furthermore, not all types of cancer produce AFP, meaning cancer could still be present even when AFP levels appear normal. Due to these limitations, AFP testing is not employed as a general cancer screening tool for the entire population.

It's worth noting that AFP isn't exclusively a tumor marker. Since it's produced by fetuses, it's naturally higher in pregnant women and their newborns.

**What factors elevate the risk of developing liver cancer?**

Liver cancer risk is predominantly associated with the presence of chronic liver scarring, known as cirrhosis. The primary culprits behind cirrhosis are often chronic infections from either hepatitis B or hepatitis C viruses. Additionally, the excessive consumption of alcohol is a significant contributing factor to cirrhosis. Inherited conditions, particularly hemochromatosis, characterized by excessive iron absorption leading to its deposition in the liver and other organs, can also lead to cirrhosis and eventually hepatocellular carcinoma. Non-alcoholic steatohepatitis (NASH), which entails the accumulation of fat in the liver, accompanied by inflammation and damage, is another condition that can contribute to this heightened risk.

**Should an abnormal AFP result be detected, will additional tests be necessary?**

In cases where there is an abrupt increase in AFP levels or a significantly elevated AFP in individuals with chronic liver infection or damage, healthcare providers typically recommend further investigations to assess the liver's condition. These additional tests may include an ultrasound examination, a CT scan, an MRI scan, or a biopsy for the histopathological assessment of tumor tissues, with the aim of identifying any potential liver cancers. Additionally, a blood test for des-gamma carboxy prothrombin (DCP), also known as prothrombin induced by vitamin K absence-II (PIVKA-II), may be ordered by the healthcare provider to aid in the detection and ongoing monitoring of liver cancer.

**Is it feasible to have an AFP test done in the convenience of your own home or at a healthcare provider's clinic?**

Home-based AFP testing is not an option, and it's not commonly carried out in a healthcare practitioner's office. Instead, this type of testing is usually performed at either a hospital laboratory or a reference laboratory.