October 21, 2011

AFP-Negative Hepatocellular Carcinoma

An US image of the liver shows a 2 cm solid nodule in a cirrhotic liver.

CT images of the liver in arterial and portovenous phases show arterial contrast enhancement with rapid washout of the nodule.

Facts: Serum AFP & Hepatocellular Carcinoma (HCC)
  • First detection of AFP in serum of HCC patients in 1970s
  • Currently, it is the only widely used serologic marker for diagnosing HCC. Additional useful markers in use are AFP-L3 and DCP
  • Normal range 10-20 ng/mL
  • AFP greater than 400 ng/mL generally considered a point of discriminating HCC from other chronic liver disease
  • Problem: about 60% of patients with HCC have AFP below 200, up to 20% have normal AFP (AFP-negative HCC; AFP below 20)
Clinical Features of AFP-negative HCC
  • Less likely to be hepatitis B positive
  • Tend to have a lower level of ratio of serum glutamic oxaloacetic transaminase (AST)/pyruvic transaminase (ALT)

1. Law WY. Hepatocellular Carcinoma, 2007.
2. Nomura F, Ohnishi K, Tanabe Y. Clinical features and prognosis of hepatocellular carcinoma with reference to serum alpha-fetoprotein levels. Analysis of 606 patients. Cancer 1989;64:1700-1707.

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