Alpha-Fetoprotein (AFP) and AFP-L3

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The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.

Also known as: AFP and AFP-L3%, AlphaFetoprotein AFP and AFPL3

AFP

AFP is used as a tumor marker to help detect and diagnose cancers of the liver, testes, and ovaries. Though the test 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. If a person has been diagnosed with hepatocellular carcinoma or another form of AFP-producing cancer, an AFP test may be ordered periodically to help monitor the person's response to therapy and to monitor for cancer recurrence.

AFP-L3

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.
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The Alpha-Fetoprotein (AFP) and AFP-L3 test contains 1 test with 2 biomarkers.

Brief Description: The Alpha-Fetoprotein (AFP) and AFP-L3 test is a blood test that measures the levels of two forms of alpha-fetoprotein in the blood: AFP and AFP-L3. Alpha-fetoprotein is a protein produced primarily by the developing fetus during pregnancy, but it is also present in small amounts in adults. Elevated levels of AFP in adults can be indicative of certain conditions, including liver diseases and certain cancers. AFP-L3 is a specific form of AFP that is associated with hepatocellular carcinoma (HCC), the most common type of liver cancer. The test is primarily used to detect and monitor liver diseases, particularly HCC.

Also Known As: AFP Test, Total AFP Test, AFP-L3 Test, Alpha-Fetoprotein Tumor Markers, Alpha-Fetoprotein Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is an Alpha-Fetoprotein and AFP-L3 test ordered?

The AFP and AFP-L3 test may be ordered in several situations:

  1. Liver Cancer Screening: It is commonly used to screen individuals at high risk for liver cancer, especially those with chronic liver diseases such as hepatitis B or C, liver cirrhosis, or a history of liver cancer.

  2. Diagnosis and Monitoring: The test is used to diagnose hepatocellular carcinoma in patients with suspicious liver masses and to monitor the response to treatment in those already diagnosed with HCC.

  3. Liver Disease Evaluation: In certain liver diseases, such as cirrhosis, hepatitis, or alcohol-induced liver injury, AFP levels may increase, and the test can help assess liver function and disease progression.

What does an Alpha-Fetoprotein and AFP-L3 blood test check for?

Alpha-fetoprotein is a protein produced predominantly by the liver of a developing baby and the yolk cavity of a developing embryo. When a baby is born, AFP levels are usually high and then rapidly drop. Liver injury and certain malignancies can drastically raise AFP levels. This test determines the amount of AFP in your blood.

When the liver cells regenerate, AFP is generated. AFP can be continuously high in chronic liver illnesses such hepatitis and cirrhosis. Certain cancers can produce extremely high quantities of AFP. Because of this, the AFP test can be used as a tumor marker. Many persons with hepatocellular carcinoma and hepatoblastoma, a kind of liver cancer that affects babies, have elevated levels of AFP. They're also discovered in certain persons who have testicular or ovarian cancer.

There are various different types of AFP. The normal AFP test measures total AFP, which includes all of the AFP variations. In the United States, this is the most common AFP test.

One of the AFP variations is known as L3 because of its propensity to attach to a protein called Lens culinaris agglutinin in the lab. The AFP-L3 percent test compares the quantity of AFP-L3 to the total amount of AFP and is a relatively recent test. Increased L3 levels are linked to a higher likelihood of developing hepatocellular carcinoma in the near future, as well as a worse prognosis, because L3-related malignancies are more aggressive.

AFP-L3 can be higher in people with hepatocellular carcinoma than in those with benign liver disorders who have low total AFP. In Japan, tumor markers such as total AFP and AFP-L3 are utilized in conjunction with ultrasound to monitor hepatocellular carcinoma. This procedure differs from that in the United States and Europe, but healthcare practitioners in the United States occasionally order the two tests.

Lab tests often ordered with an Alpha-Fetoprotein and AFP-L3 test:

When these tests are ordered, they're often part of a broader evaluation of liver health and cancer screening. Here are some tests commonly ordered alongside them:

  1. Liver Function Test:

    • Purpose: To assess the health and function of the liver.
    • Why Is It Ordered: These tests help evaluate liver damage or dysfunction, which can be related to liver cancer or other liver diseases.

  2. Hepatitis B and C Tests:

    • Purpose: To test for hepatitis B and C viruses, which are risk factors for liver cancer.
    • Why Is It Ordered: Chronic hepatitis B and C infections are major risk factors for HCC.

  3. Complete Blood Count (CBC):

    • Purpose: Provides a broad picture of overall blood health.
    • Why Is It Ordered: To detect signs of anemia or other blood cell abnormalities that might be associated with liver disease or cancer.

  4. Prothrombin Time (PT/INR):

    • Purpose: To assess blood clotting function.
    • Why Is It Ordered: Liver damage, such as that caused by cancer, can affect the production of clotting factors.

  5. Des-Gamma-Carboxy Prothrombin (DCP):

    • Purpose: To test for another marker associated with HCC.
    • Why Is It Ordered: DCP is another tumor marker that can be elevated in cases of HCC and can be used in conjunction with AFP and AFP-L3 for screening and monitoring.

  6. CA 19-9:

    • Purpose: To measure the level of CA 19-9, a tumor marker that can be elevated in gastrointestinal cancers, including some types of liver cancer.
    • Why Is It Ordered: To evaluate the possibility of other types of cancers or to provide additional information in cases of HCC.

  7. Alpha-1 Antitrypsin and Ferritin:

    • Purpose: To assess levels of these proteins, which can be associated with liver disease.
    • Why Is It Ordered: Alpha-1 antitrypsin deficiency and high ferritin levels can be risk factors or indicators of liver disease.

These tests, when ordered alongside Alpha-Fetoprotein and AFP-L3, provide a comprehensive view of liver health and are essential in the screening, diagnosis, and monitoring of hepatocellular carcinoma and other liver conditions. The specific combination of tests will depend on the individual’s risk factors, symptoms, and the results of initial screenings.

Conditions where an Alpha-Fetoprotein and AFP-L3 test is recommended:

The AFP and AFP-L3 test is particularly useful in the detection and monitoring of hepatocellular carcinoma (HCC), the most common type of liver cancer. Elevated AFP levels, especially when AFP-L3 is also increased, can indicate a higher risk of HCC. However, elevated AFP levels can also be associated with other liver diseases, such as cirrhosis, hepatitis, and noncancerous liver tumors.

How does my health care provider use an Alpha-Fetoprotein and AFP-L3 test?

The tumor marker alpha-fetoprotein is used to detect and diagnose malignancies of the liver, testicles, and ovaries. Despite the fact that the test is frequently done to monitor persons with chronic liver illnesses including cirrhosis, chronic hepatitis B, or hepatitis C who have an elevated lifetime risk of developing liver cancer, most current guidelines do not advocate it. An AFP test, together with imaging studies, may be ordered by a healthcare provider to try to diagnose liver cancer in its earliest and most treatable stages.

If a person has been diagnosed with hepatocellular carcinoma or another type of AFP-producing cancer, an AFP test may be done on a regular basis to assess treatment response and disease recurrence.

When comparing the amount of the AFP variation AFP-L3 to the total amount of AFP, an AFP-L3 percent is occasionally ordered. The AFP-L3 percent test is not extensively used in the United States, but it is becoming more popular in other nations, such as Japan. The test is used to assess the risk of developing hepatocellular carcinoma, particularly in people with chronic liver disease, as well as the response of the cancer to treatment.

What do my Alpha-fetoprotein test results mean?

Increased AFP levels can suggest the presence of cancer, such as liver cancer, ovarian cancer, or testicular germ cell tumors. However, not all cancers of the liver, ovary, or testicles produce substantial amounts of AFP.

Other malignancies, such as stomach, colon, lung, breast, and lymphoma, might sometimes have elevated levels, but it is rarely ordered to check these illnesses. Cirrhosis and hepatitis are two disorders that can generate elevated levels.

When using AFP as a monitoring tool, lower levels suggest a therapeutic response. If concentrations do not considerably drop after cancer therapy, usually to normal or near-normal levels, some tumor tissue may still be present.

If AFP levels start to rise, the cancer is most likely to return. However, because AFP levels can be deceiving in hepatitis or cirrhosis, AFP levels can be misleading. If AFP levels are not raised prior to therapy, the test will not be useful in monitoring treatment effectiveness or detecting recurrence.

People with chronic liver disease have a higher chance of getting liver cancer when their AFP levels rise from normal to moderately raised to significantly elevated. When total AFP and AFP-L3 percent are highly higher, the person is more likely to develop or have hepatocellular carcinoma in the next year or two. In persons with chronic hepatitis and cirrhosis, however, both AFP and AFP-L3 percent concentrations might be increased and fluctuate. In these circumstances, a significant increase in AFP is more essential than the test result's numerical value.

Most Common Questions about the Alpha-Fetoprotein and AFP-L3 test:

Understanding the Alpha-Fetoprotein (AFP) and AFP-L3 Tests

What is the Alpha-Fetoprotein test?

The Alpha-Fetoprotein (AFP) test is a blood test that measures the level of AFP in a person's blood. AFP is a protein produced by the liver and yolk sac of a developing fetus. In adults, elevated levels of AFP can be associated with liver disease or certain types of cancer, particularly hepatocellular carcinoma.

What is the AFP-L3% test?

The AFP-L3% test measures the percentage of total AFP that is a specific variant known as AFP-L3. This variant is produced by malignant cells and may be present in higher percentages in individuals with hepatocellular carcinoma, a type of liver cancer.

Why are the AFP and AFP-L3 tests ordered?

The AFP and AFP-L3 tests are typically ordered when a person has a chronic liver disease such as cirrhosis and is at a higher risk of developing liver cancer. These tests can help detect liver cancer at an early stage.

What conditions can the AFP and AFP-L3 tests help diagnose?

The AFP and AFP-L3 tests can help diagnose liver cancer, especially hepatocellular carcinoma. They can also be used to monitor the effectiveness of treatment in patients with diagnosed liver cancer.

How often should I have the AFP and AFP-L3 tests?

The frequency of the AFP and AFP-L3 tests may vary depending on the person's risk factors for liver cancer. Typically, these tests may be ordered every 6 to 12 months for individuals at high risk.

Interpreting AFP and AFP-L3 Test Results

What does a high AFP level indicate in the AFP test?

A high level of AFP in the blood can indicate liver disease, pregnancy, or cancers such as liver cancer or germ cell tumors. However, a high AFP level alone is not diagnostic for any particular condition and further tests are usually necessary.

What does a high AFP-L3% indicate in the AFP-L3 test?

A high AFP-L3% (greater than 10%) can indicate a higher likelihood of hepatocellular carcinoma. This is because AFP-L3 is a specific variant of AFP produced by malignant cells.

What does a low AFP level indicate in the AFP test?

In adults, a low AFP level is normal as this protein is typically only produced in significant amounts during fetal development.

What does a low AFP-L3% indicate in the AFP-L3 test?

A low AFP-L3% (less than 10%) typically indicates a lower likelihood of hepatocellular carcinoma. However, results should be interpreted within the context of a person's overall health, history, and risk factors.

Can AFP and AFP-L3 tests be used to monitor treatment for liver cancer?

Yes, these tests can be used to monitor the effectiveness of treatment for liver cancer. Decreasing levels of AFP and AFP-L3% may indicate that treatment is working.

AFP and AFP-L3 Tests and Specific Conditions

Can the AFP and AFP-L3 tests diagnose liver cirrhosis?

While levels of AFP can be elevated in liver cirrhosis, these tests are not used to diagnose cirrhosis. Other tests are needed for that diagnosis.

Can the AFP and AFP-L3 tests predict the risk of liver cancer?

Yes, these tests can help predict the risk of liver cancer, especially in individuals with chronic liver diseases. An increase in AFP levels or a high AFP-L3% can indicate an increased risk.

Can the AFP and AFP-L3 tests diagnose other types of cancer?

AFP can be elevated in certain types of germ cell tumors, such as testicular cancer and ovarian cancer. However, these tests are primarily used to aid in the diagnosis of liver cancer.

Can the AFP and AFP-L3 tests be used to monitor pregnancy?

In pregnancy, AFP is produced in high levels by the fetus. However, the AFP and AFP-L3 tests are not typically used to monitor pregnancy. A different test, the maternal serum AFP, is used to screen for certain developmental abnormalities in the fetus.

Can the AFP and AFP-L3 tests diagnose hepatitis?

While levels of AFP can be elevated in chronic hepatitis, these tests are not used to diagnose hepatitis. Other tests, such as viral hepatitis panels, are used for that purpose.

General Questions About the AFP and AFP-L3 Tests

Can the AFP and AFP-L3 tests predict prognosis in liver cancer?

Higher levels of AFP or a high AFP-L3% are generally associated with a poorer prognosis in liver cancer. However, prognosis depends on many factors and should be discussed with a healthcare provider.

Can the AFP and AFP-L3 tests be used to screen for liver cancer in the general population?

These tests are not typically used to screen for liver cancer in people without risk factors due to their low specificity, which means they can give false positive results.

Can the AFP and AFP-L3 tests diagnose non-cancerous liver conditions?

While AFP can be elevated in non-cancerous liver conditions like cirrhosis and hepatitis, it is not specific enough to diagnose these conditions. Other tests are necessary.

Can the AFP and AFP-L3 tests be used to evaluate the risk of liver cancer recurrence?

Yes, these tests can be used to monitor for recurrence of liver cancer after treatment. Rising levels can indicate potential recurrence.

Can the AFP and AFP-L3 tests be used in pediatrics?

In children, elevated AFP can be seen in certain types of cancer like hepatoblastoma, a type of liver cancer that usually affects children under 3 years old. However, these tests are not typically used in routine pediatric care.

Can the AFP and AFP-L3 tests be used to monitor alcohol-related liver disease?

While AFP levels can be elevated in chronic liver diseases, including those caused by alcohol, these tests are not specifically used to monitor alcohol-related liver disease.

Can the AFP and AFP-L3 tests be used to diagnose liver damage from medication?

These tests are not typically used to diagnose liver damage from medication. Other liver function tests are more commonly used.

Can the AFP and AFP-L3 tests be used to monitor liver transplant rejection?

These tests are not typically used to monitor for liver transplant rejection. Liver function tests and other monitoring techniques are more commonly used.

Can the AFP and AFP-L3 tests be used in conjunction with imaging tests?

Yes, these tests are often used in conjunction with imaging tests like ultrasound, CT, or MRI to aid in the diagnosis of liver cancer.

Can the AFP and AFP-L3 tests be used to determine the need for a liver biopsy?

While these tests can help indicate the possibility of liver cancer, a liver biopsy is usually needed to confirm the diagnosis. Elevated AFP or AFP-L3% levels might prompt a healthcare provider to order a biopsy.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

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