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Prepared by: Abdo A Elfiky

 AFP is used as a tumor marker to help detect and diagnose cancers of the liver, testes, and ovaries.  It 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.

 A doctor recommends to order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest and most treatable stages.  It is also used to monitor the person's response to therapy and 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 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.

 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.

 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

 Motawa E. El-Houseini, PhD, Mohammed S. Mohammed, PhD, Wael M. Elshemey, PhD, Tarek D. Hussein, PhD, Omar S. Desouky, PhD, and Anwar A. Elsayed, PhD  October 2005, Vol. 12, No. 4

 Tumor markers in the early detection of tumors are promising tools that could improve the control and treatment of tumors.  Alpha-fetoprotein (AFP) is a commonly used tumor marker in the detection of hepatocellular carcinoma (HCC),  The sensitivity and specificity of AFP are insufficient to detect HCC in all patient samples.

 They compared AFP with serum levels of vascular endothelial growth factors (VEGF and VEGF-A), insulinlike growth factor-2 (IGF-II), and the activity of the lysosomal enzyme alpha-L-fucosidase (AFU) in the sensitivity of detection of HCC and cirrhosis in Egyptian patients.

 The sensitivity of tumor detection using AFP was 68.2%. This level of detection was increased to 88.6% when AFP was evaluated in conjunction with AFU.  The combined use of AFP and VEGF increased the sensitivity of detection to 95.5% in patients with HCC.  The combination of the three markers yielded 100% detection sensitivity. AFP 68% AFP AFU 89% AFP VEGF 96% AFP AFU VEGF 100%

 VEGF-A showed a low specificity (20%), and IGF-II showed extremely low sensitivity (4.5%).

 They suggested that AFU or VEGF or both be measured with AFP to improve the detection sensitivity of HCC.