Alpha-Fetoprotein (AFP)

Alpha-fetoprotein (AFP) is a glycoprotein that is similar to albumin in its physical and

chemical properties. It is classified as an oncofetal antigen because it is synthesized by the fetal
liver and yolk sac and is abundant in fetal serum, but declines to low levels (10-20 ug/L) by 12
months of age. AFP is frequently elevated in patients with primary hepatocellular carcinoma
(HCC) and nonseminomatous testicular cancer, but can also be elevated in other types of
cancers and in nonmalignant conditions such as pregnancy and hepatitis.

AFP is the most widely used tumor marker for HCC, serving as a tool in diagnosis,
staging, prognosis, and monitoring patients undergoing therapy. Studies have shown that
diagnostic utility of AFP may be improved by testing specifically for the isoform AFP-L3, which
has a stronger correlateon with HCC, and by combining AFP with other laboratory markers,
such as DCP, the luver enzyme ALT , and platelet count. In addition, high levels of AFP are
associated with a poor prognosis in patients with HCC, whereas decreasing levels over time
indicate a good response to therapy.

AFP is also an established tutor marker for nonseminomatous germ cell cancers of the
testes (NSGCT). This marker, along with other markers such as human chorionic gonadotropin
and lactate dehydrogenase, plays an important role in patient diagnosis, tutor staging,
therapeutic monitoring, and detection of relapse.

In addition to its applications as a tutor marker, AFP is widely used as a marker to detect
abnormalities in the fetus. An increased level of AFP in the serum or amniotic fluid of a
pregnant woman is seen with open near tube defects such as spina bifida, whereas low levels of
AFP are associated with Down syndrome.