What are the implications of elevated Alpha-Fetoprotein (AFP) levels?

From the Guidelines

Elevated alpha-fetoprotein (AFP) requires prompt medical evaluation as it may indicate several serious conditions, and the most recent guidelines recommend using AFP in conjunction with imaging studies for diagnosis and surveillance of hepatocellular carcinoma (HCC) 1. If you have an elevated AFP level, consult with a healthcare provider immediately for further diagnostic testing. AFP is a protein produced primarily by the fetal liver and yolk sac, with levels normally decreasing after birth. In adults, elevated AFP may suggest liver disease (such as hepatitis, cirrhosis, or liver cancer), certain germ cell tumors (especially testicular cancer), or hepatocellular carcinoma. During pregnancy, high maternal serum AFP may indicate neural tube defects, abdominal wall defects, or multiple gestation. The appropriate follow-up typically includes imaging studies like ultrasound, CT scan, or MRI of the liver or affected area, and possibly tissue biopsy depending on initial findings. The normal range for adults is generally below 10 ng/mL, though reference ranges vary by laboratory. The degree of elevation often correlates with disease severity or tumor burden. Regular monitoring of AFP levels may be recommended to track disease progression or treatment response in conditions where AFP serves as a tumor marker.

Some key points to consider:

• The combination of AFP and ultrasound can increase detection rates, but also increases costs and false-positive rates 1.
• AFP-only surveillance had a 5.0% false-positive rate, ultrasound alone had a 2.9% false positive rate, but in combination the false-positive rate was 7.5% 1.
• The use of CT scanning as a screening test for HCC is problematic due to high false-positive rates and significant radiation exposure 1.
• The most recent guidelines recommend using AFP in conjunction with imaging studies for diagnosis and surveillance of HCC, and consider an imaging finding of classic enhancement to be more definitive in the diagnostic setting compared with AFP level alone 1.

It is essential to consult with a healthcare provider to determine the best course of action for elevated AFP levels, as the approach may vary depending on individual circumstances and the presence of underlying liver disease or other conditions.

From the Research

Elevated Alpha Fetoprotein

Elevated alpha fetoprotein (AFP) levels can be associated with various conditions, including:

• Hepatocellular carcinoma (HCC) 2, 3, 4
• Fetal neural tube defects 5
• Germ cell tumors (GCTs) 6
• Hepatoblastoma 6
• Chronic liver disease 6
• Fetal kidney diseases 5
• Liver diseases 5
• Fetal anemia 5

Diagnosis and Prognosis

AFP levels can be used for:

• Diagnosis of HCC 2, 3, 4
• Prognosis of HCC patients 4
• Surveillance for disease recurrence 6
• Monitoring treatment response 6
• Transplant selection for HCC patients 4

Screening and Detection

AFP levels can be measured in:

• Maternal serum for fetal screening 5, 6
• Serum for detection of malignant diseases in infants and older children 6
• Cerebrospinal fluid for suspected intracranial GCTs 6
• Ultrasound and AFP measurement can be used for early detection of HCC in patients with cirrhosis 3