TOPIC:

AFP is short for Alpha FetoProtein.

As the "feto" in the name suggests this is a protein we see in a fetus. In adults we switch off the genes that produce it so we don't see much (usually <12 units)

Hepatocellular Carcinoma (HCC) represents a loss of control over liver cell growth. These liver cells tend to become more primitive, like the liver cells in a fetus. What often happens is that the genes that produce AFP get switched on again, so instead of seeing <12 units of AFP we see more.

In pragmatic terms:

Most patients will have an AFP <12 and will not have HCC

Some cirrhotic patients will have a slightly elevated AFP in the range 12-24, despite not having HCC. We invariably see this fall during and after treatment. Sitting on my desk I have these results from a cirrhotic patient who is now at SVR



Most, but not all, patients who develop HCC will have a detectable rise of AFP, usually to a level of over 100

Here is a patient who had HCC in whom we treated the HCV and the HCC (with Sorafanib). Notice both the fall in AFP and the fact this lab uses <6 rather than <12 as the cutoff



Please note this: while most HCC expresses AFP and therefore can be detected by an AFP blood test it is possible to have HCC with a normal AFP. Rare but possible. High risk patients with cirrhosis should have 6 monthly screening with U/S (or CT or MRI)

Also note that if you have had HCV but have not developed cirrhosis then your risk of HCC is almost exactly the same as the general population. It happens, but it is rare. AFP screening is more than adequate. If you want to have a look use U/S or MRI as a CT carries about a 1:1000 risk of giving you a cancer (it might be a little lower than this but is does carry a real risk).

"Please note this: while most HCC expresses AFP and therefore can be detected by an AFP blood test it is possible to have HCC with a normal AFP. Rare but possible. High risk patients with cirrhosis should have 6 monthly screening with U/S (or CT or MRI)"

My AFP was 30 prior to treatment with DAA's from Oct 2015. It had been up for a long time before that and my GP asked me to get an ultrasound in 2012 which found a golf ball size HCC keeping me quiet company. The HCC developed after 2008 as I had a scan then.

Since DAA's, the AFP has been down; and since the HCC surgery I have been getting scans each 6 months - U/S and CT in turn.

In my case I think the AFP was a good marker for the HCC, and I always make sure it is included in the blood test referral and ask after. In fact raised AFP was the main reason I sought out generics in late 2015 - my reasoning was that if a raised AFP could indicate either active HCV or a HCC, then rid of the HCV.

I don't think it is really that simple though, between EOT last time round and subsequent HCV recurrence, the AFP was down. Maybe the liver repaired itself along the way?

Yours

Jeff

Still waiting for 12 weeks EOT second time round - will find out in June, fingers crossed.