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Alpha Feto Protein (AFP)

Cancer
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Report in 4Hrs

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No Fasting Required

Details

Tumor marker for hepatocellular carcinoma and germ cell tumors; also monitored during pregnancy.

₹499₹750

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Alpha Feto Protein (AFP) - Comprehensive Medical Test Guide

  • Why is it done?
    • Test Measurement: AFP measures the level of alpha-fetoprotein, a protein produced primarily by the fetus during pregnancy and by the liver and germ cell tumors in non-pregnant individuals.
    • Prenatal Screening: Used in second trimester (15-20 weeks) as part of maternal screening to detect Down syndrome, Edwards syndrome, and neural tube defects. Combined with other markers (hCG, estriol, inhibin A) for improved accuracy.
    • Hepatocellular Carcinoma Detection: Screening and surveillance in high-risk patients (chronic hepatitis B, cirrhosis, hepatitis C) for early detection of liver cancer.
    • Germ Cell Tumor Monitoring: Diagnosis, prognosis assessment, and treatment monitoring of testicular and ovarian germ cell tumors.
    • Other Malignancies: Detection and monitoring of gastric, pancreatic, and biliary tract cancers.
    • Liver Disease Assessment: Evaluation of chronic hepatitis, cirrhosis severity, and liver regeneration after transplantation.
  • Normal Range
    • Non-Pregnant Adults: Less than 10-20 ng/mL (nanograms per milliliter). Most laboratories use <10 ng/mL as the upper limit of normal. Values up to 20 ng/mL are considered borderline normal in some laboratories.
    • Pregnant Women (Second Trimester): 10-150 ng/mL (approximately). Values are heavily dependent on gestational age. At 15-20 weeks, typical range is 15-60 ng/mL. Each laboratory establishes gestational age-specific reference ranges.
    • Units of Measurement: ng/mL (nanograms per milliliter) or IU/mL (International Units per milliliter).
    • Clinical Interpretation: In non-pregnant individuals, elevated AFP is abnormal and warrants investigation. In pregnant women, results are interpreted using multiples of the median (MoM) in conjunction with other markers (double, triple, or quad screening). Levels >2.5 MoM may indicate increased risk of chromosomal abnormalities or neural tube defects.
  • Interpretation
    • Mildly Elevated (20-100 ng/mL) in Non-Pregnant Adults: May indicate chronic liver disease, cirrhosis, hepatitis B or C infection, benign liver conditions, or early stage malignancy. Repeat testing recommended.
    • Moderately Elevated (100-1000 ng/mL): Strong indicator of hepatocellular carcinoma or germ cell tumors. Imaging studies (ultrasound, CT, MRI) typically recommended. May also occur in advanced cirrhosis.
    • Markedly Elevated (>1000 ng/mL): Highly suggestive of hepatocellular carcinoma or advanced germ cell tumors. Requires urgent investigation with imaging and oncology consultation.
    • Prenatal Interpretation (Elevated in Pregnancy): >2.5 MoM suggests increased risk of neural tube defects (spina bifida, anencephaly), abdominal wall defects, or chromosomal abnormalities. Requires detailed ultrasound and possibly amniocentesis for confirmation.
    • Prenatal Interpretation (Low in Pregnancy): <0.5 MoM combined with other markers may indicate increased risk of Down syndrome (Trisomy 21) and Edwards syndrome (Trisomy 18).
    • Declining Levels During Treatment: Favorable prognostic indicator in cancer patients; suggests effective treatment response.
    • Rising Levels During Treatment: May indicate treatment failure, disease progression, or recurrence.
    • Factors Affecting Results: Gestational age (critical in pregnancy), laboratory methodology, patient's smoking history, benign conditions (hepatitis, cirrhosis without cancer), timing of blood draw relative to treatment.
  • Associated Organs
    • Primary Organs: Liver (hepatic source in non-pregnant individuals), placenta and fetus (in pregnancy).
    • Hepatocellular Carcinoma (HCC): Elevated AFP in patients with chronic hepatitis B, hepatitis C, cirrhosis, or fatty liver disease indicates heightened risk of malignant transformation. Used for surveillance in at-risk populations.
    • Cirrhosis and End-Stage Liver Disease: Elevated AFP common in cirrhosis from any cause; may reflect hepatic regeneration or subclinical HCC.
    • Chronic Viral Hepatitis (HBV and HCV): Can cause mild to moderate AFP elevation independent of malignancy. Requires differentiation from HCC through imaging and alpha-fetoprotein isoform testing.
    • Germ Cell Tumors: Testicular non-seminomatous germ cell tumors, ovarian tumors, and mediastinal/extragonadal germ cell tumors frequently produce AFP. Levels often dramatically elevated (>1000 ng/mL). Used for diagnosis, staging, and prognosis.
    • Gastrointestinal Cancers: Gastric cancer, pancreatic adenocarcinoma, cholangiocarcinoma, and biliary tract cancers can produce elevated AFP. Associated with poorer prognosis when elevated.
    • Potential Complications of Malignancy: Metastatic disease, hepatic encephalopathy, portal hypertension, variceal bleeding, hepatorenal syndrome, tumor rupture/hemorrhage (in HCC), sepsis, disseminated disease.
    • Obstetric/Fetal Complications Associated with Abnormal AFP: Neural tube defects (spina bifida, anencephaly), abdominal wall defects (gastroschisis, omphalocele), chromosomal abnormalities (Down syndrome, Edwards syndrome, Patau syndrome), multiple gestations, intrauterine fetal demise.
  • Follow-up Tests
    • For Elevated AFP in Non-Pregnant Adults: Abdominal ultrasound or CT imaging to evaluate for hepatocellular carcinoma; liver function tests (AST, ALT, bilirubin, albumin); hepatitis B surface antigen and hepatitis C antibody/RNA if not previously done; repeat AFP in 4-8 weeks if initially mildly elevated to assess trend; AFP isoform testing (L3 or L4 forms); consideration of MRI of abdomen for inconclusive findings.
    • For Suspected Hepatocellular Carcinoma: Contrast-enhanced CT or MRI for lesion characterization; AFP-L3 fraction; des-gamma-carboxyprothrombin (DCP); liver biopsy if diagnosis uncertain; baseline imaging for staging; baseline laboratory studies including prothrombin time, platelet count, creatinine.
    • For Germ Cell Tumors: Beta-human chorionic gonadotropin (β-hCG); lactate dehydrogenase (LDH); imaging of primary site (scrotal ultrasound, pelvic MRI); chest imaging (CT chest); abdominal/pelvic imaging; tumor marker monitoring during and after chemotherapy at regular intervals.
    • For Abnormal Prenatal AFP Screening: Detailed ultrasound by maternal-fetal medicine specialist to evaluate fetal anatomy and confirm gestational age; consideration of cell-free fetal DNA testing (non-invasive prenatal testing - NIPT); amniocentesis for karyotype and microarray analysis if indicated; consultation with obstetrics and maternal-fetal medicine.
    • Surveillance Monitoring: For patients with cirrhosis or chronic hepatitis B: AFP and ultrasound every 3-6 months; repeat AFP testing 4-12 weeks after diagnosis in cancer patients to confirm elevation; serial AFP monitoring during treatment; AFP levels at predetermined intervals (typically every 2-4 weeks) during chemotherapy; final AFP measurement 3-6 months after treatment completion to assess cure.
    • Complementary Tumor Markers: Carcinoembryonic antigen (CEA) for gastric and pancreatic cancers; CA 19-9 for pancreatic and biliary cancers; Des-gamma-carboxyprothrombin (PIVKA-II) for hepatocellular carcinoma diagnosis.
  • Fasting Required?
    • Fasting Requirement: NO - Fasting is not required for AFP testing. The test can be performed on a non-fasting blood sample at any time of day.
    • Blood Draw Instructions: A single venous blood sample (typically 5-10 mL) is collected by venipuncture into a standard collection tube. No special collection tubes are required.
    • Medication Considerations: No medications need to be discontinued or avoided before AFP testing. Continue all routine medications as prescribed.
    • Pre-Test Preparation: Patient should remain seated or lying down for 5 minutes before venipuncture to ensure accurate results; inform phlebotomist of pregnancy status if applicable; avoid strenuous exercise immediately before blood draw.
    • Timing Considerations: For prenatal screening, timing is critical - test should be performed between 15-20 weeks of gestation (optimal 16-18 weeks) to ensure proper interpretation. For cancer monitoring, consistent timing relative to treatment schedule is important for meaningful trend assessment.
    • Sample Handling: Blood sample should be processed and separated from serum within 1-2 hours; serum is typically stored at room temperature or refrigerated until analysis; results are usually available within 24-48 hours.

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