ARE THE ALPHA FETO PROTIEN MARKERS FOR LIVER CANCER A RELIABLE INDICATION?

[DragonTamer]

I was wondering if any one out there have/had Alpha Feto protein markers in the 30 range.
I was recently told mine was 30.6. I know the average should be around 8.   So mine is high but my doctor said not that high. But is still pushing for the liver biopsy. I had the alternative biopsy test, Fibrospect II
They came back with a reading of  88.  But of course their levels and methods are different. My doc is not a big fan.
Has anyone had a AFPmarker around this level say up to 50... and
found out they did indeed have liver cancer?

I am just going back and fourth on having the traditional biopsy or not.

Would greatly appreciate any info.
Thanks!
Dragon Tamer

[willing]

High AFP is a marker for advanced fibrosis as well as hcc. See for example
Clinical significance of elevated alpha-fetoprotein (AFP) in patients with chronic hepatitis C, but not hepatocellular carcinoma.

Am J Gastroenterol. 2004 May;99(5):860-5.
PMID: 15128351
http://0-www.ncbi.nlm.nih.gov.catalog.llu.edu/pubmed/15128351

(note the 15 to 24 to 42 progression; the sensitivity/specificity of 22/94 basically tells  you one can quite easily have cirrhosis  and in-range afp but it's very unlikely for one to have high afp and no fibrosis/hcc). The blood-based markers are not very reliable indicators. On the strength of that 88 and the afp checking other fibrosis indicators (platelets, wbc, pro-thrombin inr) and scheduling a bx seems prudent - best wishes.

See also:
Clinical significance of elevated alpha-fetoprotein in Alaskan Native patients with chronic hepatitis C.
J Viral Hepat. 2008 Mar;15(3):179-87.
PMID: 18233991
http://0-www.ncbi.nlm.nih.gov.catalog.llu.edu/pubmed/18233991

[FloridaMouse]

Heppers are famous for running high AFP's.   I've been through 2 CT scans because of my AFP and everything has been fine.   My GI told me that the "jury is still out" on how reliable the AFP's are for heppers and he said that was even discussed at the AASLD conference this past November.   My GI's thought with me is to go ahead and run the AFP on me every 6 months and if there is a major fluctuation then he will run another CT scan.  It's kind of a better safe than sorry thing.

From what I've seen with other heppers with high AFP's ... things more often than night turn out fine.

Think positive.

Mouse

[copyman]

when the AFP results are in the hundreds then there is a good chance of liver cancer. AFP has a tendency to be higher with cirrhosis. do you have hepatitis? it can also be higher with hepatitis. your fibrospect score of 88 suggests cirrhosis. these tests are usually fairly accurate on the low end (no damage) and high end (cirrhosis). I would get the biopsy ASAP. Best of luck

[DragonTamer]

Whoops sorry to mention yes I have Hep C  geno 2b.  The 88 from fibrospect did worry me...but my doc said the 30.6 is low compared to most people with chronic Heb C. He sugggested a regular biopsy, but I start tx in June for the Hep. And I asked him, "if I find out my liver is damaged to some extent (it can't be that bad I have no symptoms what so ever) would my treatment be any different?" He said "no. We would treat with the Peg/Ribav  just the same."   So my feelings are, what I don't know about my liver at this point will only make me stronger and more positive to fight the hep and then deal with the side effects.  THEN...IF....there is a liver issue, which I know by the ultrasound there is some fatty tissue but no "sign" of scarring, I can deal with that after I am cleared of the virus. ( I pray)

If this sounds like a bad plan, by all means jump in and be honest...or if anyone wants to share their experience.  For example I wonder is there anyone out there who actually had cirrhosis/liver cancer with such a low AFP count of 30.6??  
The liver biopsy just frightens me. Because of what could go wrong and has with many people....When I heard there was an alternative I just went for that.
Go a head call me a chicken!

Thanks for all your advice!
D.T

[willing]

you might want to read the full text for that study out of UC Irvine above as it's fairly recent and based on a  large (357) group. Elevated  AFP on its own does not prove a problem, can be associated with other, less worrisome factors, like fatty liver,  and can fluctuate. However, in combination, that 88 and the 30, suggest looking in more detail. At a minimum this would mean checking all your other liver indicators (enzymes, inr, platelets, bilirubin, etc.) and a ct/us to specifically look for signs of portal hypertension (the US can't reliably detect scarring/fibrosis).  

BXs for 2s are not part of the usual protocol because the thinking is the patient is going to tx anyway. However, the prospect that you might miss important information by not having the bx would seem quite a bit scarier than a needle jab...

[JennyPenny]

Ultrasound does not show scarring. It looks at the architecture of the liver and whether there are lesions (tumors, cycts, etc.) present. It also measures the size of the liver and spleen. Your AFP is not that high but it does sound like you definitely have cirrhosis. That would put you at risk for developing HCC at some point. An AFP with ultrasound or CT scan every 6 months is standard of care for those with cirrhosis.

I have cirrhosis and my AFP runs about 12. My ultasound is normal.

[HectorSF]

Here is some general info on AFP and HCC (it may be a few years old). Please check willing's info as he has some newer data.

The AFP tests are not diagnostic; they are indicators. They must be used in conjunction with imaging studies to look for malignant tumors when monitoring the patient, or when a doctor suspects that a cancer is present.

If a patient has chronic liver disease and their AFP is significantly elevated, then the patient has an increased risk of having or developing hepatocellular carcinoma in the next year or two. AFP can be elevated, and fluctuate, in patients with chronic hepatitis and cirrhosis.
In these patients, a significant increase in AFP is more important than the actual numerical value of the test result.
Alpha-fetoprotein (AFP) Blood Test
The most widely used biochemical blood test for liver cancer -  hepatocellular carcinoma (HCC) is alpha-fetoprotein (AFP), which is a protein normally made by the immature liver cells in the fetus. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. Also, pregnant women carrying babies with neural tube defects may have high levels of AFP. (A neural tube defect is an abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.)
In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
· HCC
· Germ cell tumors (cancer of the testes and ovaries)
· Metastatic cancer in the liver (originating in other organs)
Several assays (tests) for measuring AFP are available. Generally, normal levels of AFP are below 10 ng/ml. Moderate levels of AFP (even almost up to 500 ng/ml) can be seen in patients with chronic hepatitis. Moreover, many patients with various types of acute and chronic liver diseases without documentable HCC can have mild or even moderate elevations of AFP.

The sensitivity of AFP for HCC is about 60%. In other words, an elevated AFP blood test is seen in about 60% of HCC patients. That leaves 40% of patients with HCC who have normal AFP levels. Therefore, a normal AFP does not exclude HCC. Also, as noted above, an abnormal AFP does not mean that a patient has HCC. It is important to note, however, that patients with cirrhosis and an abnormal AFP, despite having no documentable HCC, still are at very high risk of developing HCC. Thus, any patient with cirrhosis and an elevated AFP, particularly with steadily rising blood levels, will either most likely develop HCC or actually already have an undiscovered HCC.
An AFP greater than 500 ng/ml is very suggestive of HCC.

DragonTamer, my AFP is 150 currently. If you have cirrhosis like myself you have an increased risk of developing HCC. You should be tested every 6 months with a scan and of course liver blood tests. I just had a scan today.

Hope this helps!
Hector

[sldb]

I have stage 4 cirrhosis, afp in the 20's and 30's pre and during tx. svr now 1st post tx afp 5.8 and has remained normal for almost 2 yrs post tx.

[GoofyDad]

Like Jenny, I have cirrhosis and run a normal AFP and UltraSound. Advanced fibrosis/cirrhosis can look like fatty liver on the US. It's a change in texture, a firmness, and the US doesn't do a good job of distinguishing one from the other.  

[eureka254]

"it can't be that bad I have no symptoms what so ever"
---------------------------
Unfortunately, that's what makes this disease so deadly... my husband also had "no symptoms whatsoever"... and by the time he was diagnosed w/HCV, his liver was cirrhotic.  Many people have symptoms, but a larger number don't until their liver has sustained significant damage.

My husband also had a sizable liver cancer diagnosed at the same time as Hep, and his AFP at the time of diagnosis was over 2,000 IU/ml.  The docs stated that it's not unusual for Hepatitis C patients to have AFP levels that fluctuate, but ranges from 200 on up should be watched closely, and 400 and up is 'highly indicative' of tumor.  (But as some people mentioned before, high AFP levels are present in other kinds of tumors, and some liver tumors do not excrete AFP. )  When looking at AFP it's important to remember it's not a highly sensitive or diagnostic test.  

Also, don't sweat the biopsy -- my husband lost sleep for days thinking about it, and it "was a walk in the park" according to him now :).  (It was done with a light sedative, and he just about slept thru it.)  Although good screening is important (ultrasound, blood tests, etc.), biopsy is still currently the most accurate method to obtain information on "liver damage."

[DragonTamer]

Happy Mothers day to all the mommys out there!!...and thank you all for all the thoughtful folks who shared this info with me....just wanted to let you know I just got the second  AFP results back....it was 13.3 !!!!    Down from 30.6.    Like many of you mentioned it can fluxuate....   My doc said the same thing but I was hoping for an at least "this is better than 30"   from him. Was kind of a downer he didn't encourage that....  oh well... but  isn't this some little bity sign I am doing something right????  Jeeezzeeee :)   Well whatever I will take my 13 and embrace it and I am as happy as can be that it at least didn't go up!!!

Thanks again everyone and have a fabulous day!!!!
Dragon Tamer

[willing]

great news - congratulations!
(but you still might want to listen to your Dr's recommendation on  that bx -  "what I don't know about my liver at this point will only make me stronger " is kinda thin ice..)

[DragonTamer]

Well, I guess I just don't understand what difference it would make at this point....if he said he would still treat excatly the same, no matter what condition my liver is in. So my thought on this as I said above, is fight one demon first... then the other, IF indeed there is another. My liver might be somewhat compromised but he doesn't seem to think it is that bad due to other lab tests and factors. Again he is not pushing hard for it...he did say if need be I could have it while i'm on tx but that is a bit more risky because of infection.

Oh I just don't know what to do to be honest... right now I feel good about the AFP results...and aside from some fatigue, which very well could be from stress at  work....I feel fine.  

That is my biggest issue with starting treatment in general....it is odd to me to think I feel fine now, just a wee bit tired... but then I am going to take meds that could devastate my health.... and for how long...and how bad??? :( I know know can answer this it is different with everyone.

Usually people FEEL sick when they take meds, so it is a whole other ball game.
Any way.... I am still going for tx...and will cross the biopsy test when I come to it.
I am so appreciative of your thoughts....   Would you /anyone mind giving me a couple good reasons why I should have it NOW rather than later...maybe that will help make this decision easier...I just can't think of any and my Dr. is vague about the urgency of it as well. ????? I understand all you have said above, but if I do have cirrhosis is there "anything" else they  can do untill I have cleared the virus??

Thanks all   Hope your day has been kind to you!
Dragon Tamer

[willing]

I've got to say I really like your attitude - thinking about *why* you want the result should be a prerequisite for any test.

Here's a few reasons why you may want that bx

- yes, AFP fluctuates and that 30 may have been an insignificant spike, but in conjunction with a fibrospect of 88 you want to know how far fibrosis has progressed

- as a g2, your outlook is excellent on a standard 800 rbv/24week regime, but should the bx staging come in at F3/F4 you might want to coordinate a more aggressive plan with your Dr - eg weigh-based or higher rbv, and a longer duration in the absence of rvr

- knowing you fibrosis is advanced is a powerful motivator to have tx succeed and to avoid any alcohol/diet that may compromise the liver

- HR, a physician who occasionally contributes here, has emphasized that a molecule as, if not more, dangerous to the participants on this forum than HCV-RNA is tgf-beta (transforming growth factor beta) the key player in activating the liver's stellate cells into collagen producers. The good news is that recent evidence suggests this process is reversible unless things are too far gone. His list of evidence-supported potential anti-fibrotics is regularly discussed here. If you find your fibrosis is already advanced you may want to consider taking some of these in addition to shooting for SVR. A detailed and free-access discussion of what promotes and reverses fibrosis is here:

http://www.****.nlm.nih.gov/pubmed/17663771

All the best.

[Harry Potter]

My AFP has ranged (in nanograms, not IU's as some labs use) from a high of 21.9 to what it is now, 11.5; many months it was 15-20 or so.  From what I gather, it can fluctuate, and as long as it's only mildly elevated (my lab regards 15.0 or lower as acceptable/"normal"), the AFP, in and of itself, shouldn't be a cause for worry, but should be monitored.  My doctor is having me do bloodwork every 6 months; I had an ultrasound about a year ago as well (everything came back normal).

So, stay on top of it, but don't obsess over it--the stress can be bad for your health too!

[chronicpain7years]

Go ahead and get the biopsy. I did-it doesn't hurt, and make sure your followed on the AFP with bloodwork every 6 months and a CT every year! Better safe than sorry! Good luck. Mine have been pretty elevated too.

[gracie2142]

Hi...i am also positive hep c, with stage 4 cirrhosis. My Afp ranges from 8-12.6, I have an ultrasound every 3 months and a ct scan about every 6-9 months, and thank God no presence of HCC! I have had 4 liver biopsies in the last 15 years, it does hurt a little but it is do-able, The reason I had 4 biopsies were for staging the disease progression and as a requirement for 2 possible clinical trials.
I have genotype 1a, I have been on three different treatments, without success, however, my understanding is that my genotype is more resistant to treatment.
Wishing you the Best!
Gracie

[pitola]

hi everybody
my aunt has hepatitis c with viral count about 2 millions,,,,her AFP is 29 with no focal masses in the liver in CT scan..
no ascities,, mild lower limb edema
normal bilirubin and albumin
so what do u think ???does she have HCC or no???

[Bill1954]

HCC is very rare outside of cirrhosis; what would make you think your aunt has it? Low levels of AFP are routine in Hep C patients… there’s nothing in an AFP result of 29 to be concerned about. The CAT scan doesn’t indicate any problems; I don’t understand your concern—

Bill