Elevated Alpha- Fetoprotein
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Elevated Alpha- Fetoprotein

Elevated Alpha - Fetoprotein / Differential Diagnosis - Hepatocellular Carcinoma and Other Disorders


  • Hepatocellular carcinoma
  • Alpha-fetoprotein
  • Chronic hepatitis C virus infection
  • Chronic hepatitis B virus infection
  • Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein
  • Des-gamma-carboxy prothrombin


  1. The incidence of cirrhosis-related hepatocellular carcinoma (HCC) is rising in the United
  2. States, with the associated disease burden expected to grow through 2020.
  3. Surveillance with alpha-fetoprotein (AFP) in combination with abdominal ultrasonography every 6 months was once widely recommended for HCC surveillance.
  4. Increased AFP is seen in chronic liver disease without HCC, nonhepatic malignancies, and normal pregnancy; thus, AFP levels must be interpreted within the context of the clinical presentation.
  5. Results of cross-sectional HCC screening studies show the benefit of diagnosing additional cases of HCC with AFP, but highlight the lack of cost-effectiveness owing to the increased false-positive results.
  6. US Food and Drug Administration guidelines for HCC risk assessment include using Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) with des-gammacarboxy prothrombin (DCP), or the combination of AFP-L3 with AFP and DCP.

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