AFP

AFP (alpha-fetoprotein) is a protein produced in large amounts by the fetus during pregnancy, with very little in adult blood. As a tumour marker it helps a doctor monitor people at increased liver cancer risk and diagnose and monitor some testicular and ovarian tumours. AFP is not a test to detect cancer in healthy people.

Who the test is for

• people with liver cirrhosis and some people with chronic hepatitis B, alongside regular liver ultrasound,
• people whose ultrasound or other imaging shows a liver abnormality,
• men and women with testicular or ovarian germ cell tumours, before and after surgery and during monitoring,
• people whose AFP was raised before treatment, to monitor recurrence afterwards.

What AFP is and what it shows

AFP is produced in the fetal liver and yolk sac; after birth its blood level gradually falls during the first months of life, so it is physiologically higher in infants than adults. In adults it can rise when new liver cells form, for example with hepatitis or cirrhosis, and in some AFP-producing tumours. The most important are hepatocellular carcinoma (the most common primary liver cancer) and some testicular and ovarian germ cell tumours.

Raised AFP does not by itself mean a tumour is present, and normal AFP does not exclude one. Some liver cancers, particularly early ones, do not raise AFP.

For people with cirrhosis and some with chronic hepatitis B, professional guidelines recommend checks every six months. Liver ultrasound is the basis, often with AFP measured alongside it. AFP alone without ultrasound is insufficient. In testicular and ovarian germ cell tumours, AFP is measured together with beta HCG and LDH. If AFP was raised before treatment, a new rise may be the first sign of recurrence.

Read more about when tumour markers are and are not useful in the article Tumour markers. Symptoms and risks are discussed in Early signs of liver cancer.

Why AFP is not a test for early cancer detection

Liver cancer is rare in a healthy person without liver disease, while AFP may be mildly raised without a tumour. Results would then more often cause unnecessary concern and further tests than detect disease. AFP is therefore not used to screen healthy people, but only in higher-risk groups alongside ultrasound and to monitor known disease.

What can raise AFP besides a tumour

• pregnancy: AFP normally rises because the fetus produces it, so a tumour-marker result is not interpreted in the usual way during pregnancy;
• acute and chronic hepatitis and liver cirrhosis;
• liver recovery after injury, when new cells form;
• rare inherited diseases such as tyrosinaemia and ataxia-telangiectasia.

With hepatitis and cirrhosis, AFP is usually only mildly raised. In these patients, the trend over time therefore matters more than one measured value.

Save with a panel

Test AFP is also included in this panel.

Tumour marker panel – menCEA, CA19-9, PSA, AFPPrice of individual tests: 80.00€72.00€ Original price was: 72.00€.50.40€Current price is: 50.40€.Details ›

Preparation and sample

AFP uses a venous blood sample. Fasting is unnecessary unless other tests requiring it, such as glucose or blood lipids, are performed the same day. Mention pregnancy during collection. If monitoring AFP over time, use the same laboratory and bring previous results because different methods can produce differing results.

How to interpret an AFP result

AFP is expressed in ng/mL or IU/mL. The adult reference value depends on method and is printed on your report.

• Normal result in someone undergoing regular liver monitoring does not exclude a tumour, so ultrasound continues as agreed with the doctor.
• Mildly raised result most often reflects hepatitis or cirrhosis. A doctor compares it with earlier results and decides whether to repeat it or request liver imaging.
• High or rising result requires further investigation, usually liver CT or magnetic resonance imaging, and testicular or ovarian examination depending on age and sex.

After successful surgery or treatment, AFP falls gradually because it disappears slowly from blood (its half-life is around five to seven days). A doctor therefore follows changes over several weeks.

AFP is interpreted alongside examination, imaging and other findings, such as hepatitis markers and liver enzymes.

How to arrange testing

You can have blood taken without an appointment or referral at one of our branches across Croatia (listed under Contact). Prices for all tests and panels are available in the service price list. AFP is also part of the men’s tumour marker panel, alongside CEA, CA 19-9 and PSA.

Frequently asked questions

Can AFP detect liver cancer in time?

Not reliably on its own. People with cirrhosis and some with chronic hepatitis B have ultrasound monitoring every six months, with AFP as an addition. Some early tumours do not raise AFP.

My AFP is mildly raised. Should I worry?

Mildly raised AFP most often accompanies hepatitis or cirrhosis, while a rise is expected during pregnancy. A raised marker does not necessarily mean cancer; changes over time matter more than a single result.

Why is AFP measured during pregnancy?

In pregnancy AFP is part of some prenatal screening tests, interpreted according to pregnancy week and specific rules. This page describes AFP as a tumour marker; a gynaecologist interprets prenatal screening results.