What are the diagnostic indicators for liver cancer? Detailed explanation of the performance of alpha-fetoprotein in liver cancer patients

Alpha-fetoprotein (AFp), as the name suggests, was first detected in pregnant women. It is secreted by actively proliferating fetal cells. Later, it was found that it has a certain connection with actively proliferating liver cancer cells, so it is used as a screening indicator for early liver cancer (especially for patients with cirrhosis).

1. Performance of alpha-fetoprotein (AFp) in liver cancer

1. The alpha-fetoprotein (AFp) positivity rate in liver cancer patients is about 70-90%. If combined with imaging such as obvious enhancement rules on CT and a history of hepatitis B cirrhosis, liver cancer can be clinically diagnosed with an accuracy rate of about 98%.

2. Elevated alpha-fetoprotein (AFp) in patients with cirrhosis: It has a clear diagnostic significance only when combined with enhanced CT. Otherwise, pregnancy, liver inflammation (liver cells also proliferate actively during the repair process of liver damage, but usually below 400-800, and a few may exceed 1000) may increase

2. Description of Alpha-fetoprotein (AFp) for Liver Cancer

1. The false increase of alpha-fetoprotein (AFp) in patients with liver cirrhosis is temporary. After antiviral treatment, hepatitis turns from the active stage to the chronic stage, and alpha-fetoprotein (AFp) naturally decreases. If this high level continues to increase, it must be vigilant, such as B-ultrasound, CT enhancement, etc.

2. For patients with elevated alpha-fetoprotein (AFp) before liver cancer surgery, alpha-fetoprotein (AFp) after surgery can be used as an indicator for regular monitoring of tumor recurrence. Sometimes ultrasound or CT scans have not found liver recurrence, but metastatic lesions in the lungs, bones, and even brain, adrenal glands, and other parts of the body will secrete alpha-fetoprotein (AFp). It is recommended to perform lung CT scans plus enhanced liver CT scans, and PET examinations can also be considered (only available in some large tertiary hospitals, such as the First Affiliated Hospital of Zhejiang University, Zhongshan Hospital Affiliated to Fudan University, etc.; each scan costs about 10,000 yuan and is not covered by medical insurance)

3. The significance of regular check-ups is to find those "bad guys" who have woken up from their slumber and to deal with them in a timely manner. However, for liver cancer patients whose alpha-fetoprotein (AFp) is not high before surgery (indeed, 10-30% of liver cancer patients have low alpha-fetoprotein (AFp) before surgery), they may have lost a way to monitor recurrence. It is recommended to use regular recurrence B-ultrasound or even enhanced CT to monitor recurrence.

Alpha-fetoprotein (AFp) plays an important role in the diagnosis of liver cancer, but liver cancer cannot be diagnosed based solely on the increase of AFp.

Alpha-fetoprotein (AFp) is a special protein contained in the human blood during the embryonic period. It is synthesized by the rough intracellular ribonucleic acid granules in liver cells. After the fetus is born, the serum alpha-fetoprotein (AFp) concentration decreases and returns to normal within a few months to a year. Normal adult liver cells lose the ability to synthesize AFp, so the content in serum is extremely small (generally <20μg/L). In addition to hepatocellular carcinoma, which can increase significantly, pregnancy, embryonal cancers such as testicular cancer, ovarian cancer and a very small number of gastric, pancreatic, bile duct, and colorectal cancers can also increase, but the absolute value is not as high as hepatocellular carcinoma.

Elevated serum alpha-fetoprotein (AFp) is the most important marker for hepatocellular carcinoma, with a positive rate of 60-70%. If serum AFp remains above 400ng/ml for more than 4 weeks and transaminases are normal, liver cancer should be highly suspected. However, elevated alpha-fetoprotein (AFp) alone cannot confirm liver cancer, and a diagnosis of liver cancer cannot be made, because alpha-fetoprotein (AFp) has variants and can also be elevated in patients without liver cancer.

Elevated alpha-fetoprotein (AFp) caused by non-cancerous liver diseases can be identified by detecting alpha-fetoprotein (AFp) variants. Elevated concanavalin A-bound AFp can be seen in hepatocellular carcinoma and cirrhosis, elevated concanavalin M-unbound AFp is more common in embryonal carcinoma and liver cancer, and elevated lentil agglutinin-unbound AFp is more common in chronic hepatitis and cirrhosis. Elevated lentil agglutinin-bound AFp is more common in liver cancer.