From the Guidelines
The primary blood test used for hepatocellular carcinoma (HCC) diagnosis and monitoring is alpha-fetoprotein (AFP), though it has limitations in sensitivity and specificity, as noted in the most recent study 1.
Blood Tests for HCC Diagnosis and Monitoring
The following blood tests are used:
- Alpha-fetoprotein (AFP) levels above 400 ng/mL are highly suggestive of HCC, but many early tumors don't produce elevated AFP 1.
- Additional biomarkers include des-gamma-carboxy prothrombin (DCP, also called PIVKA-II), AFP-L3 (a specific glycoform of AFP), and Glypican-3 1.
- Liver function tests such as ALT, AST, bilirubin, and albumin are routinely monitored as they reflect underlying liver disease severity, which impacts prognosis and treatment options 1.
- Complete blood counts help assess overall health status and treatment tolerability.
- Coagulation studies (PT/INR) are important as many HCC patients have cirrhosis with impaired clotting function.
Surveillance and Monitoring
These blood tests are used alongside imaging studies (ultrasound, CT, or MRI) for comprehensive HCC surveillance, diagnosis, and monitoring, as no single blood test is sufficiently accurate on its own 1. Regular monitoring every 3-6 months is recommended for high-risk patients, particularly those with cirrhosis or chronic hepatitis B 1. The combination of ultrasound and AFP may improve detection rates, but the increase in false positive results should be considered 1. A rising AFP over time, even if the level does not reach 400 ng/ml, is virtually diagnostic of HCC 1.
From the Research
Blood Tests for Hepatocellular Carcinoma (HCC)
- The diagnosis and monitoring of HCC involve various imaging techniques and blood tests, including:
- Alpha-fetoprotein (AFP) levels, which are commonly used to screen for HCC in patients with cirrhosis 2
- Other biomarkers such as hepatoma-specific gamma-glutamyl transpeptidase (HS-GGT), transforming growth factor (TGF)-beta1, and free insulin-like growth factor (IGF)-II, which may be more specific markers than total AFP level for early diagnosis of HCC 3
- The accuracy of AFP in diagnosing HCC is poor, regardless of the cutoff, and it is elevated in only 62% of patients with HCC 2
- Other blood tests, such as circulating genetic markers like AFP-mRNA, TGF-beta1-mRNA, and IGF-II-mRNA, may be useful in monitoring distal metastasis or postoperative recurrence of HCC 3
Imaging Techniques
- Imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, play a crucial role in the diagnosis and staging of HCC 4, 5, 6
- Dynamic multiphase contrast-enhanced CT or MRI is the current standard for imaging diagnosis of HCC 5
- Functional imaging techniques, such as perfusion CT and diffusion-weighted MRI, provide additional information about tumor angiogenesis that may be useful for treatment 5