AFP Tumor Markers

More Sharing ServicesShare on printShare on email

Share on twitterShare on facebook
Share this page:
Was this page helpful?
Also known as: AFP; Total AFP; AFP-L3%
Formal name: Alpha-fetoprotein, Total; Alpha-fetoprotein-L3
Percent
Related tests: CEA; hCG; Tumor Markers; DCP
Were you looking instead for AFP Maternal, ordered during pregnancy?
At a Glance
Test Sample
The Test
Common Questions
Ask Us
Related Pages
The Test
1. How is it used?
2. When is it ordered?
3. What does the test result mean?
4. Is there anything else I should know?
How is it used?
AFP is used as a tumor marker to help detect and diagnose cancers of
the liver, testes, and ovaries. Though the test is often ordered to monitor
people with chronic liver diseases such as cirrhosis, chronic hepatitis
B or hepatitis C because they have an increased lifetime risk of
developing liver cancer, most current guidelines do not recommend this
use. A doctor may order an AFP test, along with imaging studies, to try
to detect liver cancer when it is in its earliest and most treatable stages.
If a person has been diagnosed with hepatocellular carcinoma or
another form of AFP-producing cancer, an AFP test may be ordered
periodically to help monitor the person's response to therapy and to
monitor for cancer recurrence.
An AFP-L3% is sometimes also ordered to compare the amount of the
AFP variant called AFP-L3 to the total amount of AFP. The AFP-L3%
test is not yet widely used in the U.S. but has gained wider acceptance
in other countries such as Japan. The test is used to help evaluate the
risk of developing hepatocellular carcinoma, especially in those with
chronic liver disease, and also to evaluate response of hepatocellular
carcinoma to treatment.
^ Back to top
When is it ordered?
A physician may order an AFP blood test when:
It is suspected that someone has liver cancer or certain cancers of
the testes or ovaries; cancer may be suspected when, for example,
lumps are felt in the abdominal area during a physical exam or when
imaging tests detect possible tumors.
Someone who has been diagnosed with and treated for a cancer of
the liver, testes, or ovaries is being monitored for the effectiveness of
treatment
Someone is being monitored for cancer recurrence
An AFP-L3% is sometimes ordered to help evaluate the risk
of hepatocellular carcinoma when a person has chronic liver disease or
to test the effectiveness of treatment of of hepatocellular carcinoma or
monitor for its recurrence.
^ Back to top
What does the test result mean?

Increased AFP levels may indicate the
presence of cancer, most commonly liver cancer, cancer of the ovary,
or germ cell tumor of the testes. However, not every liver, ovarian, or
testicular cancer will produce significant quantities of AFP. Elevated
levels may sometimes be seen with other cancers such as
stomach, colon, lung, breast, and lymphoma, although it is rarely
ordered to evaluate these conditions. Other diseases such
as cirrhosis and hepatitis can also cause increased levels.
When AFP is used as a monitoring tool, decreasing levels indicate a
response to treatment. If concentrations after cancer treatment do not
significantly decrease, usually to normal or near normal levels, then
some of the tumor tissue may still be present. If concentrations begin to
increase, then it is likely that the cancer is recurring. However, since
AFP can be increased in hepatitis or cirrhosis, AFP levels can
sometimes be misleading. If AFP levels are not elevated prior to
treatment, then the test will not generally be useful to monitor the
effectiveness of treatment or to monitor for recurrence.
When the AFP concentrations of people with chronic liver disease go
from moderately elevated to greatly elevated, their risk of developing
liver cancer increases. When total AFP and AFP-L3% are significantly
elevated, then the affected person has an increased risk of having or
developing hepatocellular carcinoma in the next year or two. However,
both AFP and AFP-L3% concentrations can be elevated, and fluctuate,
in people with chronic hepatitis and cirrhosis. In these cases, a sharp
increase in AFP is more important than the actual numerical value of the
test result.
^ Back to top
Is there anything else I should know?
Not every person with increased AFP and AFP-L3% test results has
cancer or will develop liver cancer. The AFP and AFP-L3% tests are not
diagnostic; they are indicators. They must be used in conjunction with
information from a history and physical examination as well as imaging
studies to look for the development of tumors. Although these tests can
provide useful information, they are not as specific or sensitive as
doctors would wish. AFP can temporarily increase whenever the liver is
injured and regenerating, and moderate elevations can be seen with a
variety of conditions. Because of this, AFP testing can give some false
positives. In addition, not every cancer will produce AFP, so a person
could still have cancer even when the AFP is normal. For these reasons,
the AFP test should not be used to screen the general population for
cancer.
AFP is not only a tumor marker. Because AFP is produced by the fetus,
levels are normally higher in pregnant women and in their newborns. For
more information on AFP testing during pregnancy, see Triple or Quad
Screen.
Alpha-Fetoprotein Tumor Marker
(Blood)
Does this test have other names?
AFP
What is this test?
This is a blood test to look for alpha-fetoprotein (AFP) in your blood.
AFP is normally made by a fetus's liver and yolk sac. It's the main
protein during the first three months of development. AFP greatly
decreases by age 1 and should only be found in adults in very low
levels.
AFP is one of several tumor markers. Tumor markers are molecules in
the blood that are higher when a person has certain cancers. AFP is
found mainly in liver cancer and nonseminomatous germ cell tumors,
which are rare. These are found in the pineal gland in the brain.
Some people with cirrhosis or chronic active hepatitis also have higher
blood levels of AFP.
Why do I need this test?
You may have this test if your health care provider suspects you have
liver cancer, testicular cancer, or cancers of the brain, mediastinum, or
blood.
This test is also used to watch cancer treatment or see if cancer has
come back after treatment.
What other tests might I have along with this
test?
If your doctor suspects you have liver cancer, you may also have:
Liver function tests, or LFTs. These tests look at the part of your liver
that is not affected by cancer to see how well your liver is working. The
tests look for levels of certain substances in your blood, such as bilirubin,
albumin, ALP, AST, ALT, and GGT.
Blood clotting tests. Your liver makes proteins that help your blood
clot. You may have blood tests, such as prothrombin time, or PT, to find
out how well your liver makes these proteins and to look at your risk of
bleeding.
Blood urea nitrogen, or BUN, and creatinine level tests. These show
how well your kidneys are working.
Complete blood count, or CBC. This test measures your red blood
cells, white blood cells, and platelets, which help blood to clot. It also
shows how well your bone marrow is working. Your marrow is where
new blood cells are made.
Electrolytes and blood chemistry tests. You may have your blood
calcium and cholesterol levels checked because these can rise when
you have liver cancer.
Viral hepatitis tests. Hepatitis B and C are linked to liver cancer, so you
may have tests for viral hepatitis.
You may also have tests for other tumor markers in your blood,
including:
Human chorionic gonadotropin, or hCG
Lactate dehydrogenase, or LDH
Your doctor also is likely to order imaging tests such as ultrasound, CT
scan, and MRI to check for different cancers.
What do my test results mean?
Many things may affect your lab test results. These include the method
each lab uses to do the test. Even if your test results are different from
the normal value, you may not have a problem. To learn what the results
mean for you, talk with your health care provider.
AFP is measured in nanograms per milliliter (ng/mL). An AFP level of
less than 10 ng/mL is normal for adults. An extremely high level of AFP
in your blood greater than 500 ng/mL could be a sign of liver tumors.
High levels of AFP may mean other cancers, including Hodgkin disease,
lymphoma, and renal cell carcinoma (kidney cancer).
Not all people with these cancers will have an elevated AFP. And
elevated AFP levels also could be a sign of cirrhosis or chronic acute
hepatitis.
How is this test done?
The test requires a blood sample, which is drawn through a needle from
a vein in your arm.
Does this test pose any risks?
Taking a blood sample with a needle carries risks that include bleeding,
infection, bruising, or feeling dizzy. When the needle pricks your arm,
you may feel a slight stinging sensation or pain. Afterward, the site may
be slightly sore.
What might affect my test results?
If you are pregnant, your serum AFP level may be higher than normal. If
you have hepatitis or cirrhosis, your AFP level may also be elevated.
If you had cancer and the treatment worked, your AFP levels should be
normal.
How do I get ready for this test?
You don't need to prepare for this test.



Liver function tests
From Wikipedia, the free encyclopedia
"LFTs" redirects here. For other uses, see LFT.
Liver function tests
Intervention
ICD-10-PCS K-70 to K-77
ICD-9-CM 570573
MeSH D008111
MedlinePlus 003436
Liver function tests (LFTs or LFs) are groups of clinical
biochemistrylaboratory blood assays designed to give
information about the state of a patient's liver.
[1]
The
parameters measured include prothrombin time (PT/INR),
aPTT, albumin, bilirubin (direct and indirect), and others. Liver
transaminases (AST or SGOT and ALT or SGPT) are useful
biomarkers of liver injury in a patient with some degree of
intact liver function.
[2][3][4]
Most liver diseasescause only mild
symptoms initially, but these diseases must be detected early.
Hepatic (liver) involvement in some diseases can be of crucial
importance. This testing is performed by a medical
technologist on a patient's serum or plasma sample obtained
by phlebotomy. Some tests are associated with functionality
(e.g., albumin), some with cellular integrity
(e.g., transaminase), and some with conditions linked to the
biliary tract (gamma-glutamyl transferase and alkaline
phosphatase). Several biochemical tests are useful in the
evaluation and management of patients with hepatic
dysfunction. These tests can be used to detect the presence
of liver disease, distinguish among different types of liver
disorders, gauge the extent of known liver damage, and follow
the response to treatment. Some or all of these
measurements are also carried out (usually about twice a
year for routine cases) on those individuals taking certain
medications anticonvulsants are a notable example to
ensure the medications are not damaging the person's liver.
Contents
[hide]
1 Standard liver panel
o 1.1 Albumin
o 1.2 Aspartate transaminase
o 1.3 Transaminases
o 1.4 Alkaline phosphatase
o 1.5 Total bilirubin
o 1.6 Direct bilirubin
o 1.7 Congenital bilirubin disorders
o 1.8 High bilirubin in neonates
o 1.9 Gamma glutamyl transpeptidase
o 1.10 INR
2 Other tests commonly requested alongside LFTs
o 2.1 5' Nucleotidase
o 2.2 Coagulation test
o 2.3 Serum glucose
o 2.4 Lactate dehydrogenase
3 See also
4 References
5 External links
Standard liver panel[edit]

This section needs additional citations
for verification. Please help improve this
article by adding citations to reliable
sources. Unsourced material may be
challenged and removed. (November 2008)
Although example reference ranges are given, these will vary
depending on age, gender, ethnicity, method of analysis, and
units of measurement. Individual results should always be
interpreted using the reference range provided by the
laboratory that performed the test.
Albumin[edit]
Albumin is a protein made specifically by the
liver, and can be measured cheaply and
easily. It is the main constituent of total
protein (the remaining from globulins). Albumin levels are
Reference range
3.5 to 5.3 g/dL
decreased in chronic liver disease, such as cirrhosis. It is also
decreased in nephrotic syndrome, where it is lost through the
urine. The consequence of low albumin can be edema since
the intravascular oncotic pressure becomes lower than the
extravascular space. An alternative to albumin measurement
is prealbumin, which is better at detecting acute changes
(half-life of albumin and prealbumin is about 2 weeks and
about 2 days, respectively).
Aspartate transaminase[edit]
AST, also called serum glutamic oxaloacetic
transaminase or aspartate
aminotransferase, is similar to ALT in that it
is another enzyme associated with liver parenchymal cells. It
is raised in acute liver damage, but is also present in red
blood cells, and cardiac and skeletal muscle, so is not specific
to the liver. Theratio of AST to ALT is sometimes useful in
differentiating between causes of liver damage.
[6][7]
Elevated
AST levels are not specific for liver damage, and AST has
also been used as a cardiac marker.
Transaminases[edit]
Main article: Elevated transaminases
AST/ALT elevations instead of ALP elevations favor liver cell
necrosis as a mechanism over cholestasis. When AST and
ALT are both over 1000 IU/L, the differential can include
Reference range
6-40 IU/L
[5]

acetaminophen toxicity, shock, or fulminant liver failure. When
AST and ALT are greater than three times normal but not
greater than 1000 IU/L, the differential can include alcohol
toxicity, viral hepatitis, drug-induced level, liver cancer, sepsis,
Wilson's disease, post-transplant rejection of liver,
autoimmune hepatitis, and steatohepatitis (nonalcoholic).
AST/ALT levels elevated minorly may be due to
rhabdomyolysis, among many possibilities.
Alkaline phosphatase[edit]
Main article: Elevated alkaline phosphatase
Alkaline phosphatase (ALP) is an enzyme in
the cells lining the biliary ducts of the liver.
ALP levels in plasma rise with large bile duct obstruction,
intrahepatic cholestasis, or infiltrative diseases of the liver.
ALP is also present in bone and placental tissue, so it is
higher in growing children (as their bones are being
remodelled) and elderly patients with Paget's disease. In the
third trimester of pregnancy, ALP is about two to three times
higher.
Total bilirubin[edit]
Measurement of total bilirubin includes both
unconjugated and conjugated bilirubin.
Unconjugated bilirubin is a breakdown
product of heme (a part of hemoglobin in red blood cells). It is
Reference range
30 to 120 IU/L
[8]

Reference range
0.11.0 mg/dL
very hydrophobic and is mainly transported bound to albumin
circulating in the blood. Addition of high-concentration
hydrophobic drugs (certain antibiotics, diuretics) and high free
fatty acids can cause elevated unconjugated bilirubin. Heme
can also come from myoglobin, found mostly in muscle,
cytochromes, found mostly in mitochondria, catalase,
peroxidase, and nitric oxide synthase. The liver is responsible
for clearing the blood of unconjugated bilirubin, and about
30% of it is taken up by a normal liver on each pass of the
blood through the liver by the following mechanism: bilirubin is
taken up into hepatocytes, 'conjugated' (modified to make it
water-soluble) by UDP-glucuronyl-transferase, and secreted
into the bile by CMOAT (MRP2), which is excreted into the
intestine. In the intestine, conjugated bilirubin may be
metabolized by colonic bacteria, eliminated, or reabsorbed.
Metabolism of bilirubin intourobilinogen followed by
reabsorption of urobilinogen accounts for the yellow color of
urine, as urine contains a downstream product of
urobilinogen. Further metabolism of urobilinogen into
stercobilin while in the bowels accounts for the brown color of
stool. Thus, having white or clay-colored stool is an indicator
for a blockage in bilirubin processing and thus potential liver
dysfunction or cholestasis.
Increased total bilirubin (TBIL) causes jaundice, and can
indicate a number of problems:
1. Prehepatic: Increased bilirubin production can be due to
a number of causes, including hemolytic anemias and
internal hemorrhage.
2. Hepatic: Problems with the liver are reflected as
deficiencies in bilirubin metabolism (e.g., reduced
hepatocyte uptake, impaired conjugation of bilirubin, and
reduced hepatocyte secretion of bilirubin). Some examples
would be cirrhosis and viral hepatitis.
3. Posthepatic: Obstruction of the bile ducts is reflected as
deficiencies in bilirubin excretion. (Obstruction can be
located either within the liver or in the bile duct).
Direct bilirubin[edit]
The diagnosis is narrowed down further by
evaluating the levels of direct bilirubin.
If direct (conjugated) bilirubin is normal,
then the problem is an excess of unconjugated bilirubin
(indirect bilirubin), and the location of the problem is
upstream of bilirubin conjugation in the liver. Hemolysis, or
internal hemorrhage can be suspected.
If direct bilirubin is elevated, then the liver is conjugating
bilirubin normally, but is not able to excrete it. Bile
Reference range
0.10.4 mg/dL
ductobstruction by gallstones, hepatitis, cirrhosis or cancer
should be suspected.
Congenital bilirubin disorders[edit]
About 5% of the population has Gilbert's syndrome, a
mutation (or variation) in the UDP-glucuronyl-transferase
promotorthat manifests itself as jaundice when the individual
is stressed (i.e. starves). Autosomal recessive knockouts
of UDP-glucuronyl-transferase can lead to Crigler-Najjar
syndrome and elevations of unconjugated bilirubin. Defects in
CMOAT (MRP2) results in Dubin-Johnson syndrome and
elevations of conjugated bilirubin.
High bilirubin in neonates[edit]
Neonates are especially vulnerable to high bilirubin levels due
to an immature blood-brain barrier that predisposes them to
kernicterus/bilirubin encephalopathy, which can result in
permanent neurological damage. Neonates also have a low
amount of functional UDP-glucuronyl-transferase and can
have elevated unconjugated bilirubin, since conjugation is
limited. So, newborns are often treated with UV light to turn
the hydrophobic, albumin-binding unconjugated bilirubin into a
form that is more hydrophilic and able to be secreted in urine,
sparing the neonate's brain.
Gamma glutamyl transpeptidase[edit]
Reference range
Although reasonably specific to the liver and
a more sensitive marker for cholestatic
damage than ALP,gamma glutamyl transpeptidase (GGT)
may be elevated with even minor, subclinical levels of liver
dysfunction. It can also be helpful in identifying the cause of
an isolated elevation in ALP (GGT is raised in chronic alcohol
toxicity).
INR[edit]
Prothrombin time (PT) and its derived measures of
prothrombin ratio (PR) and international normalized
ratio (INR) are measures of the extrinsic
pathway of coagulation. This test is also called "ProTime INR"
and "INR PT". They are used to determine the clotting
tendency of blood, in the measure of warfarin dosage, liver
damage, and vitamin K status.
Other tests commonly requested alongside LFTs[edit]
5' Nucleotidase[edit]
5' Nucleotidase (5'NTD) is another test specific for cholestasis
or damage to the intra- or extrahepatic biliary system, and in
some laboratories, is used as a substitute for GGT for
ascertaining whether an elevated ALP is of biliary or
extrabiliary origin.
Coagulation test[edit]
0 to 42 IU/L
[8]

The liver is responsible for the production
of coagulation factors. INR measures the speed of a particular
pathway of coagulation, comparing it to normal. Increased
levels of INR means blood is taking more time than usual to
clot. The INR increases only if the liver is so damaged that
synthesis of vitamin K-dependent coagulation factors has
been impaired; it is not a sensitive measure of liver function.
It is very important to normalize the INR before operating on
people with liver problems (usually by transfusion with blood
plasma containing the deficient factors), as they could bleed
excessively.
Serum glucose[edit]
The serum glucose test, abbreviated as "BG" or "Glu",
measures the liver's ability to produce glucose
(gluconeogenesis); it is usually the last function to be lost in
the setting of fulminant liver failure.
Lactate dehydrogenase[edit]
Lactate dehydrogenase (LDH) is found in many body tissues,
including the liver. Elevated levels of LDH may indicate liver
damage.
[citation needed]
LDH isotype-3 (or cardiac) is used for
estimating damage to cardiac tissue, although troponin and
creatine kinase tests are more preferred.
[9]

See also[edit]
Reference ranges for blood tests
Elevated transaminases
Liver disorders
Child-Pugh score
References[edit]
1. Jump up^ Lee, Mary (2009-03-10). Basic Skills in Interpreting
Laboratory Data. ASHP. pp. 259. ISBN 978-1-58528-180-0.
Retrieved 5 August 2011.
2. Jump up^ Johnston DE (1999). "Special considerations in
interpreting liver function tests". Am Fam Physician 59 (8):
222330.PMID 10221307.
3. Jump up^ McClatchey, Kenneth D. (2002). Clinical laboratory
medicine. Lippincott Williams & Wilkins. pp. 288. ISBN 978-
0-683-30751-1. Retrieved 5 August 2011.
4. Jump up^ Mengel, Mark B.; Schwiebert, L. Peter
(2005). Family medicine: ambulatory care & prevention.
McGraw-Hill Professional. pp. 268. ISBN 978-0-07-142322-9.
Retrieved 5 August 2011.
5. Jump
up^ "http://www.gpnotebook.co.uk/simplepage.cfm?ID=32224
0579"
6. Jump up^ Nyblom H, Berggren U, Balldin J, Olsson R (2004).
"High AST/ALT ratio may indicate advanced alcoholic liver
disease rather than heavy drinking". Alcohol Alcohol. 39 (4):
336339. doi:10.1093/alcalc/agh074. PMID 15208167.
7. Jump up^ Nyblom H, Bjrnsson E, Simrn M, Aldenborg F,
Almer S, Olsson R (September 2006). "The AST/ALT ratio as
an indicator of cirrhosis in patients with PBC". Liver Int. 26 (7):
840845. doi:10.1111/j.1478-
3231.2006.01304.x. PMID 16911467.
8. ^ Jump up to:
a

b
MedlinePlus Encyclopedia Liver function tests
9. Jump up^ Nageh T, Sherwood RA, Harris BM, Byrne JA,
Thomas MR (2003). "Cardiac troponin T and I and creatine
kinase-MB as markers of myocardial injury and predictors of
outcome following percutaneous coronary
intervention". International journal of cardiology 92 (23): 285
293. doi:10.1016/S0167-5273(03)00105-0. PMID 14659867.
External links[edit]