AFP (Alpha-Fetoprotein) – Tumor Marker and Prenatal Test
AFP (alpha-fetoprotein) is a blood protein used as a tumor marker and in prenatal diagnostics. Elevated levels may indicate liver disease, certain cancers, or fetal developmental abnormalities.
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AFP (alpha-fetoprotein) is a blood protein used as a tumor marker and in prenatal diagnostics. Elevated levels may indicate liver disease, certain cancers, or fetal developmental abnormalities.
What is AFP (Alpha-Fetoprotein)?
AFP stands for alpha-fetoprotein, a glycoprotein (a protein with sugar components) primarily produced in the fetal liver, yolk sac, and gastrointestinal tract of the unborn child. In healthy adults, AFP levels in the blood are very low. Significantly elevated levels, however, can indicate certain medical conditions and are therefore of clinical importance.
Biological Function
During pregnancy, AFP plays a role in the fetus similar to that of albumin in adults: it transports fatty acids, hormones, and other substances through the blood. After birth, AFP levels drop rapidly and remain very low throughout adulthood.
AFP as a Tumor Marker
In adults, AFP is primarily used as a tumor marker -- a substance that can be detected in elevated concentrations in the blood in association with certain cancers.
- Hepatocellular carcinoma (HCC): Liver cell cancer is the most common cause of significantly elevated AFP levels in adults. AFP is used for early detection, diagnostic support, and monitoring of treatment response.
- Germ cell tumors: Certain tumors of the testes or ovaries (e.g., non-seminomatous germ cell tumors) can also lead to elevated AFP levels.
- Liver metastases and other liver tumors: Secondary liver tumors may also influence AFP levels.
An elevated AFP value alone is not proof of cancer. Further investigations such as imaging (ultrasound, CT, MRI) and biopsy are required for a definitive diagnosis.
AFP in Prenatal Diagnostics
AFP plays an important role in prenatal screening. During the second trimester of pregnancy, AFP levels in the maternal blood or amniotic fluid are measured to assess the risk of certain fetal abnormalities:
- Elevated AFP levels in maternal blood may indicate neural tube defects (e.g., spina bifida, anencephaly) or abdominal wall defects in the fetus.
- Low AFP levels may, in the context of the triple test or quadruple test, suggest an increased risk of Trisomy 21 (Down syndrome) or other chromosomal disorders.
AFP test results are always interpreted alongside other parameters and gestational age.
Diagnosis and Testing
AFP levels are measured through a simple blood draw. The serum is then analyzed in a laboratory using an immunoassay. In prenatal diagnostics, AFP can also be measured from amniotic fluid (amniocentesis). Reference ranges vary depending on age, sex, and gestational week.
Causes of Elevated AFP Levels
- Hepatocellular carcinoma (liver cell cancer)
- Germ cell tumors (testes, ovaries)
- Liver cirrhosis and chronic hepatitis (mildly to moderately elevated)
- Neural tube defects and abdominal wall defects in the fetus
- Multiple pregnancies
- Physiologically elevated in newborns and infants
References
- European Association for the Study of the Liver (EASL): Clinical Practice Guidelines -- Management of hepatocellular carcinoma. Journal of Hepatology, 2018.
- Strachan T, Read AP. Human Molecular Genetics. 4th ed. Garland Science; 2011.
- World Health Organization (WHO): Cancer fact sheets -- Liver cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer (accessed 2024).
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