Elevated Alpha Feta Protein Question

[TnHepGuy]

I've had Hep C for about 20 years now. Since about 1995, monitoring the level of alpha feta protein (a tumor marker) has been a regular part of my blood work. Last December (2002) I had my first elevated AFP reading - 9.1, with normal at this lab considered < 8. This past May I had my second elevated reading of 9.3. After questioning my gastro about the possible causes, he believed the high reading to be consistant with my hepatitis and is considered only very marginally elevated. I just received my most recent blood work results and the AFP reading is now at 20.4. Also, my viral quant level has been increasing over this same period of time. My results from last week show it has increased rather sharply - almost four-fold - to nearly 2.4 million. I have a schedualed appointment with my gastro three weeks from now (during the first week of December) to go over my results.

A few questions that come to mind:

- is it possible for elevated AFP results to be related to anything other than tumor?

- is it possible for the elevated reading to correlate directly to increased viral activity?

- has it been shown that combo tx can lower AFP back into the normal range?

- at what AFP level is tumor considered a probabilty?

Any other discussion or information about AFP will be very helpful and greatly appreciated.


Thank you to all those who have been kind enough to take the time to answer my questions in the past and to those who continue to help me now and into the future.

May God's blessings and mercy be upon us all.


Sincerely,

TnHepGuy

[ant140]

My son who is now 19 months old was born with a sacrococcogeal terratoma, which was successfully removed with surgery. Since then his alpha feta protein levels have dropped to below 8, until last month in which they had risen to 37. Any ideas as to why this would have occured.

Many thanks Anthony.

[ASD08]

treatable-UCLA-...........IVIG

[ASD08]

Ruled out hypogammagobulinanemia?

[troyluvsgod]

also have your HCG and beta HCG checked in conjunction with the AFP to isolate the possability of germ cell tumors. granted AFP is a good marker for these tumors you should have these levels tested as well to verify. our son was born with a 4 lb. germ cell tumor and he is now 3. wev'e been through the whole AFP rhymes and reasons. we have been through all the prescribed treatments and all failed exept prayer. we fund out today that his AFP has dropped by 50% to 66 in only 1 week. yes, a miricle from GOD.

[DoubleDose]

Interesting that the same sorts of 'addictions' have also been replacing my 'occult/persistent' obsession.  Trying to figure out the long term economic picture, so that we can intelligently invest all the IRA and Retirement savings when the time is right.  Currently in safe investments (CD's, Money Market Funds), and got out of the market in the last year, waiting for the impending recession.  Or maybe NOT recession.  Looking at potential retirement properties, and hoping the real estate market will take 'deep water' properties in the south-east down to pre-mania levels.  Another five or six years of running my business, and I am looking to be on the water, and enjoying every day to the maximum.

Physically, similar ups and downs from the immune system reconfiguration after interferon.  This is one of the 'good' weeks!  Overall, slowly getting better, very slowly, over the past four years.  Have a great weekend.

DoubleDose

[TnHepGuy_]

I did the same thing a few months back - welcoming HR back on a thread that was revived from last year ... hahahhaha .... (thankfully, we now have the opportunity to welcome him back in real-time).

My post-tx experience has been one of a new and modified immune system (thank you peg-interferon!!!) - one that I'm unfamiliar with and one I'm none-too-pleased with, either. I have a myriad of mostly smaller concerns the all seem to point to immune issues (though ANA and RA show normal). Not much to do at this point, other than try and lead a healthy lifestyle (easier said-than-done when you LOVE Italian cooking) and take some supplements that may help boost immune function. I'm not ready for much in the way of poking and probing - and certainly not ready for any bombs to be dropped on me for immune concerns (read: steroids). So, I just take things day-to-day and try to adjust, where possible - (and though I still keep an eye on all-things occult Hep C, I believe I've lessened my addiction in that area somewhat ... hahahahhaha ... Two of my 'replacement' addictions are things financial/retirement/mutual fund-related and Frank Lloyd Wright homes - new forums/playpens for me).


And just how are things with DD at the end of September, 2007???


TnHepGuy

[DoubleDose]

Boy, I must have been in outer space!!!!  I didn't look to see the 2003, and I already 'knew' you were SVR, but reading your post I thought maybe you must have relapsed, or something happened that I had not read about.  I am sure you are happy to NOT be in the year 2003, as your revived post had you, and I am sure glad I'm not there either!  I was just finishing my tx of 18 months, and freaking out about getting the SVR!

Sorry for my zomboid post, you must have gotten a kick out of the retro questions, and irrelevant concerns!  How are you feeling by the way, as far as SVR, and post-tx function?  Have you found the recovery to be a continually improving situation...or have there been any bumps or issues since you finished tx?

If you see any of my old posts pop up, prior to 2003, make sure to look at the year, and don't respond!  If you do, I might just have to tx again!!!

DoubleDose

[TnHepGuy_]

miracles do happen - you've been through quite a bit and have already come through so much. May God's blessings and mercy be upon you. AFP can rise as a result of Hep C alone (as was the case for me, for example), After having HCC, I'm certain you and your caregivers want to monitor things (e.g. - elevated AFP) as closely as possible. I don't know much about HCC, but if you are into sniffing around on the net and doing your own research here are some sites where you may find some of the latest info (though some of the sites are more hepatitis oriented):

http://www.gastrojournal.org/home

http://www.blackwell-synergy.com/loi/hep?cookieSet=1

http://www3.interscience.wiley.com/cgi-bin/jhome/106570044

http://www.ncbi.nlm.nih.gov/sites/entrez?DB%20PubMed=&cmd=Display

http://www.natap.org/

http://www.hivandhepatitis.com/hep_c.html

http://www.hcvadvocate.org/news/review.asp



DD - I appreciate you wanting me back doing the latest version of the Combo-Mombo, but I've been SVR for over 2 years now. So I'll leave that type of "Dancing With The Stars" to the Vegas showgirls. I finished my second round of tx'ing (first being in 1992) in January 2005.

As far as my AFP, it went back back to normal right after I began treatment (February 2004) and has remained that way ever since.


TnHepGuy

(btw - this thread is from 2003. I asked this question two months after I first found the site)

[DoubleDose]

What's your latest position regarding another round of tx?  What were the stats on your last tx...drugs used, quantities, length of tx, dates to undet. etc.  

It strikes me as a potentially good time to consider some sort of aggressive trial using three or more agents.  VX, Peg, high Riba, and extend...etc.  I do not remember how your prior tx ended, and what your response curve looked like, but I would think doing something to potentially knock out the virus, or to at least roll back some of the progression, might put your mind more at ease, than just monitoring the AFP levels.  I agree with Mike, that your levels seem very mildly elevated, and porbably not indicative of impending HCC....but I know you view this marker as a negative sign.  I would take action.

DoubleDose

[miracles do happen]

Hi - I have hepC and developed hcc which was diagnosed from MRIs, CT scans etc.  I had a liver resection about 8 months ago.  It was a huge cancer - over 9cm.  I almost died after the surgery as I went into liver failure but God pulled me through.  I had ct scan in May 07 and tumor marker was 16 with no sign of cancer on scan.  I just had another ct scan which the doc said looked good but the tumor marker is now 43.  Have to retake afp in 6 weeks.  Was told hepC can flare up causing the afp to elevate.  Also, I have to get checked every 3 months so if C doe recur they can catch it in time, and they think it will years down the line.  I am trying to stay as positive as I can.  Would appreciate any input if you'd like.  Thanks.

[TnHepGuy_]

Interesting that you've resurrected an early post of a question of mine (with a fine answer by mikesimon, I might add) - from nearly four years ago!

But to try and answer your question, I've since learned that a slightly elevated AFP (e.g. < 50) can sometimes be attributed to the Hep C itself - it's believed to be a possible indicator of ongoing and/or increasing progression. In a case such as yours, though, where cirrhosis is present - much more attention should be paid to whether or not the elevated AFP is an indicator of tumor. I would speak to your doctor to ask what more testing they can do (e.g. - CAT scan w/ contrast, etc.) to try and pin down if this truly is an hepatic cancer. You might also consider getting a referral to see a hepatologist for a second opinion.

May God's blessings and mercy be upon you, your family and your caregivers.


TnHepGuy

[aleta richardson]

my name is alet richardson my e-mail adress is ***@****. i was at the dr today for my liver disease. i have hep c cirrossis, ascities. i was told that my alpha feta proteien was elevated. and i might have some cancer begginnning. i was told told that the least little thing could trigger this test. do you know of any other reasons this can happen. i it is cancer the dr said it can be removed because they caught it early. i am scared to death, can you share anything with me about this. looking to hear from you

[TravelGrl]

Hi Deb,
  Thank you so much for thinking of us...as always...
  Things are not good.  Amanda just stopped all her meds.  Nothing was working.  Her last attempt was daily infergen and zadaxin..no response..We decided to give her body a rest for a month or two...Our next try will be alpha/gamma combo.  I here the results are quite promising...Anything is worth a shot at this point.  Amanda had a biopsy in September, it showed some fat, some copper and alot of scarring..cirrhosis.  We don't know why there was fat on her liver.  she is a thin girl.  Her tryglycerides are high and that may be the reason, so I think we will treat them.  The problem is finding a safe lipid lowering drug.  Anyone know of any?  I think Welchol may be one.  So that is the story..I haven't posted much lately, too depressing but still not giving up...Somewhere, something will work and we will find it..and when we do, we will share it with everyone..
  How are you doing?? Please let me know...My emial address is:
***@****   drop me a line..

Hope all is well,
Jodi

[whybabe]

Sorry to butt in, however, I was hoping Travelmom would see this and let me know how Amanda was doing. I hope your family is well!!!
God Bless!
Deb

[mikesimon]

The following is from: http://www.medicinenet.com/Alpha-fetoprotein_Blood_Test/article.htm

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. In fact, the blood level of AFP loosely relates to (correlates with) the size of the HCC. Finally, in patients with HCC and abnormal AFP levels, the AFP may be used as a marker of response to treatment. For example, an elevated AFP is expected to fall to normal in a patient whose HCC is successfully removed surgically (resected).

There are a number of other HCC tumor markers that currently are research tools and not generally available. These include des-gamma-carboxyprothrombin (DCP), a variant of the gamma-glutamyltransferase enzymes, and variants of other enzymes (e.g., alpha-L-fucosidase), which are produced by normal liver cells. (Enzymes are proteins that speed up biochemical reactions.) Potentially, these blood tests, used in conjunction with AFP, could be very helpful in diagnosing more cases of HCC than with AFP alone.

To read more about Hepatocellular Carcinoma (HCC), please read the MedicineNet.com Liver Cancer (Hepatocellular Carcinoma) article.

Medical Author: Tse-Ling Fong, M.D.
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

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I hope this helps a little. It would seem that your level is not high enough to indicate HCC but I can easily understand your concern. Stay on top of it and hopefully your doctor will be able to answer your questions and alleviate your anxiety. Good luck. Mike