Hepatitis B-cirrhosis-liver cancer is a well-known hepatitis B trilogy for many patients with hepatitis B.
The risk of liver cancer in patients with hepatitis B is greatly higher than that of normal people. Alpha-fetoprotein is a traditional marker of liver cancer.
The clinical significance of the increase in alpha-fetoprotein is also different for patients with different HBV infection-related diseases. Although high alpha-fetoprotein may indicate the occurrence of liver cancer, for patients with asymptomatic HBV-carrying status, even if the increase in alpha-fetoprotein is not large, the possibility of liver cancer should be warned.
Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the fetal liver and yolk sac during pregnancy, and serum AFP concentrations are usually elevated in patients with primary liver cancer.
Serum AFP levels are not well correlated with other clinical features of primary liver cancer, such as size, staging, or prognosis.
Clinically elevated serum AFP may be seen during pregnancy, gonadal origin (both germ cell and non-germ cell), and a variety of other malignancies (of which gastric cancer is most common).
Patients with liver cancer will experience an increase in alpha-fetoprotein due to the active regeneration of diseased hepatocytes.
But beware:
Not all liver cancers secrete AFP, and up to 40% of patients with small liver cancer have serum AFP concentrations within the normal range.
Patients with liver cancer caused by viral hepatitis are more likely to have elevated serum AFP than patients with liver cancer caused by alcoholic liver disease.
Patients with cirrhosis with persistently elevated AFP are at higher risk of developing liver cancer than those with fluctuating or normal levels of AFP.
Of course, not all alpha-fetoprotein heights are primary liver cancers.
Patients with chronic liver disease but no primary liver cancer (eg, acute or chronic viral hepatitis) may also present with elevated serum AFP.
Patients with hepatitis C-induced cirrhosis may present with mild elevation of AFP.
If serum AFP is elevated in patients with cirrhosis or hepatitis B, attention should be paid to whether primary liver cancer has progressed.
Serum AFP greater than 500 μg/L (10-20 μg/L in most laboratory norms) is generally considered diagnostic for HCC in high-risk patients.
At present, the Chinese Anti-Cancer Association recommends that the criteria for diagnosing liver cancer based on elevated alpha-fetoprotein are:
Alpha-fetoprotein greater than 500 μg/ L for 4 weeks;
Alpha-fetoprotein is gradually increased by low concentrations and does not decrease;
Medium levels of alpha-fetoprotein above 200 μg/L for 8 weeks;
If a positive alpha-fetoprotein concentration is low for 2 months or more, and Alanine aminotransferase is normal, special vigilance should be given to the presence of subclinical liver cancer.
In addition to this, it is important to note that alpha-fetoprotein is elevated but not liver cancer:
1) Pregnant women and newborns
Women with normal pregnancies also experience a temporary increase in alpha-fetoprotein, but not as high as in liver cancer. Fetal alpha-fetoprotein is produced by the yolk sac of pregnant women and the fetal liver, which is a normal plasma protein component of the fetus and is the main protein in the early embryonic stage. Women during pregnancy will be significantly elevated alpha-fetoprotein, generally in the first 3 months of pregnancy, alpha-fetoprotein is significantly elevated, to 7-8 months of maternal blood in the maternal blood of the highest peak and relatively stable, but it is still less than 400 ng / ml, about 3 weeks after the postpartum gradually return to normal levels. Related to fetal liver development, neonatal growth and development are more active, and there will also be an increase in alpha-fetoprotein.
2) Sudden/chronic hepatitis, liver hardening
Serum alpha-fetoprotein may be elevated in patients with acute/chronic hepatitis, convalescent periods of severe hepatitis, or cirrhosis, but usually by a smaller magnitude and for a shorter duration.
For example, the serum alpha-fetoprotein concentration in patients with cirrhosis of the liver is mostly between 25 and 200 ng/ml, which generally decreases with the improvement of the condition within 2 months, most of which do not exceed 2 months; at the same time, accompanied by elevated transaminases, when the aminotransferens decrease, the alpha-fetoprotein concentration is often parallel to the aminotransferrin. If alpha-fetoprotein concentrations are at high levels for a long time (above 500 ng/ml) or are progressively elevated, the development of liver cancer should be vigilant.
3) Germ cell tumors
Germ cell tumors are tumors that occur in the gonads or outside the gonadal glands. These include teratomas, yolk cysts, germ cell tumors such as seminal cell carcinoma, etc.
High alpha-fetoprotein may be associated with germ cell tumors, and approximately 50% of patients with germ cell tumors are AFP positive.
4) Tumors of the digestive system:
Alpha-fetoprotein-producing gastric cancer (AFPGC) is a relatively rare type of stomach cancer, and stomach cancers with high AFP levels are called AFPGC, accounting for about 2.7 to 8% of stomach cancers.
AFPGC refers to gastric cancer that is confirmed by pathological or histological examination, accompanied by elevated serum AFP, and can exclude other diseases such as hepatitis, cirrhosis, hepatocellular carcinoma, and germ cell malignancies.
For example, stomach cancer, pancreatic cancer, colon cancer and so on.
5) Other reasons
Patients with liver injury, congestive hepatomegaly, telangiectasia, congenital tyrosine disease, testicular or ovarian embryonic tumors, some other gastrointestinal tumors, pancreatic cancer, etc. may also have varying degrees of elevated alpha-fetoprotein.
Although there are inherent problems with the clinical use of AFP to diagnose HCC, it has become an important prognostic indicator, especially for patients undergoing hepatic resection and considering liver transplantation. Regardless of tumor size, patients with AFP levels > 1000 μg/L are at extremely high risk of recurrence after liver transplantation.
Proactively screen for liver cancer by doing this:
1、AFP
Serum alpha-fetoprotein is routinely used for hepatocellular carcinoma (HCC) screening and clinical diagnosis. However, due to the increasing proportion of small liver cancer diagnoses, the sensitivity of AFP gradually decreased. The 2011 American Academy of Hepatology HCC Guidelines no longer use AFP as a screening indicator for HCC. However, since the cause of HCC in mainland China is mostly hepatitis B, AFP is still of great significance as an early screening method for HCC. In high-risk populations with normal or mildly elevated serum AFP, dynamic observation and comprehensive evaluation of hepatic biochemistry, imaging, and hepatic puncture biopsy results are required.
For patients treated with liver cancer
In the treatment of liver cancer patients, the change in alpha-fetoprotein levels is also of great significance. For example, after surgery or radiofrequency ablation, the level of alpha-fetoprotein will gradually return to normal in patients with good efficacy in liver cancer patients with good efficacy, while alpha-fetoprotein will gradually return to normal in 1 to 2 months after surgery; while alpha-fetoprotein is not reduced, it often indicates that treatment is incomplete; alpha-fetoprotein is reduced and then increased, indicating the possibility of liver cancer recurrence.
2. Ultrasonic examination
With the continuous development of medical imaging, the perspective ability of our "eyes" is also getting stronger and stronger. Abdominal ultrasonography is one of the manifestations of advances in medical imaging. Because of its simple, convenient and harmless to patients, this test is used by hospitals as the most commonly used HCC screening and detection method.
3. Computed tomography (CT)
The guidelines of major societies such as the American Society of Liver Disease and the European Society of Liver Disease have made CT one of the routine examinations for liver cancer. The sensitivity and specificity of enhanced CT diagnosis of liver cancer were 71% and 87%, respectively, and the diagnostic accuracy of the tumor diameter > 2cm group was higher than that of the diameter 1-2cm and < 1cm diameter group.
4. Magnetic resonance imaging (MRI)
Studies have shown that MRI can accurately show liver cancer and can be used to find lesions that cannot be shown by other tests (e.g., CT, etc.). However, its shortcomings are that the display effect on liver cancer foci and cirrhosis complicated by liver cancer in <1 cm is not ideal.