Elevated AFP Levels with Normal Ultrasound: What Could It Mean?

Elevated AFP levels persist, and abdominal ultrasound shows no abnormalities?

On May 25, I underwent a comprehensive health check-up.
On June 21, I received the report indicating that my Alpha-Fetoprotein (AFP) level, which is a marker for liver cancer, was elevated at 19.3.
On June 22, during an outpatient visit, the test result showed a value of 22.4.
Over the past few years, all liver function tests in my health check reports have been normal (stable with no fluctuations), and I have no history of hepatitis, no family history of liver cancer, no fatty liver, and no history of alcohol abuse.

P.S.
There is a family history of gastric cancer in my direct relatives, but no other cancer history in third-degree relatives.
The abdominal and gynecological ultrasounds during the health check-up showed no abnormalities, and I am not pregnant.
A subsequent outpatient ultrasound also showed no abnormalities.

When I initially found the elevated values in my health report, I searched for literature on PubMed.
I found studies indicating that AFP levels in hepatocellular carcinoma (HCC) patients typically rise by about 5±11 ng/mL over 90 days, and my current rate of increase is approximately double that.
The outpatient physician classified my condition as "primary malignant liver tumor, unspecified type" in the health insurance system.
A CT scan has been scheduled, but I won't know the results for some time.

I am currently feeling extremely anxious and concerned that even if liver cancer is detected at an early stage, the recurrence rate post-surgery is quite high.
I am considering self-paying for a PIVKA-II test and would like to ask if, aside from liver cancer, there are other benign conditions that could explain my situation.
[Currently, I am confirmed not to be pregnant, my ovarian ultrasound is normal, and other liver blood tests are normal (including bilirubin, albumin, etc.)].

Are there any other tests or consultations you would recommend that could help alleviate my anxiety? Thank you.

Faye, 30~39 year old female. Ask Date: 2024/06/25

Dr. Chen Sirong reply Oncology

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Faye / 30 years old / Female
Hello.
I apologize for the delayed response as I was abroad.

1.
I would like to ask if there are any other benign conditions, aside from liver cancer, that could be possible given my current status?
A: 1.1 There are a few individuals who naturally have higher alpha-fetoprotein (AFP) levels.
With repeated testing and monitoring, if the levels remain stable, it may indicate this condition, which is not harmful.

1.2 Measuring AFP can help detect early liver cancer, with an accuracy of about 60-70%.
Therefore, there is still a 30% chance that patients may not have liver cancer.

1.3 Regarding your statement (I found literature indicating that HCC patients have an AFP increase of about 5±11 over 90 days; my increase is currently twice as fast as reported), it may be more accurate to measure it monthly.

2.
Are there any other tests or consultations you would recommend to help reduce my anxiety?
A: Please wait for the CT scan report.
Currently, more advanced imaging such as liver MRI and PET scans are being conducted, which should follow the CT scan.
So, we can wait for the CT results before proceeding further.

3.
I also have patients whose cancer markers have increased, but upon examination, everything was fine.
Their levels rose to 50-60 after monthly blood draws but then decreased, without a continuous rise.
Follow-ups over the past 2-3 years have also been fine.

Wishing you mental and physical well-being.

Taoyuan Hospital, Chen Si-Rong.
Thank you.

Reply Date: 2024/06/25

More Info

Elevated alpha-fetoprotein (AFP) levels can be concerning, especially when they are associated with the potential for liver cancer (hepatocellular carcinoma, HCC). However, it is important to interpret these findings in the context of your overall health, medical history, and the results of imaging studies.

In your case, you have reported an elevated AFP level of 19.3, which increased to 22.4 shortly thereafter. While elevated AFP levels can be indicative of liver cancer, they can also be associated with other conditions. For instance, benign liver diseases such as hepatitis, cirrhosis, or liver regeneration after injury can lead to increased AFP levels. Additionally, certain non-liver-related conditions, such as germ cell tumors or pregnancy, can also elevate AFP levels. However, since you have confirmed that you are not pregnant and have normal gynecological ultrasound results, these possibilities are less likely.

Your history of normal liver function tests and the absence of liver disease symptoms are reassuring. The fact that you have no history of hepatitis, alcohol abuse, or family history of liver cancer further reduces the likelihood of a malignant process. It is also worth noting that AFP can be elevated in individuals with chronic liver disease, even in the absence of malignancy.

The rapid increase in your AFP levels, as you mentioned, is concerning and warrants further investigation. The upcoming CT scan will be crucial in evaluating the liver for any masses or lesions that could indicate cancer. It is also wise to consider additional tests, such as PIVKA-II (Protein Induced by Vitamin K Absence or Antagonist-II), which can be a useful marker in the diagnosis of HCC, especially when used in conjunction with AFP levels.

While waiting for your CT results, it is understandable to feel anxious. Here are some suggestions to help manage your anxiety and ensure thorough evaluation:
1. Follow-Up Testing: Continue with the planned imaging studies and consider discussing the PIVKA-II test with your healthcare provider. This can provide additional information regarding the risk of HCC.

2. Regular Monitoring: If your healthcare provider agrees, regular monitoring of AFP levels and liver function tests may help track any changes over time.

3. Consult a Specialist: If you haven’t already, consider consulting a hepatologist or an oncologist who specializes in liver diseases. They can provide more tailored advice and management options based on your specific situation.

4. Lifestyle Modifications: Maintaining a healthy lifestyle can be beneficial. This includes a balanced diet, regular exercise, and avoiding alcohol, which can help support liver health.

5. Mental Health Support: Consider speaking with a mental health professional or joining a support group. Sharing your concerns and experiences with others can be very helpful in managing anxiety.

6. Educate Yourself: While it’s important to avoid excessive internet searching that can lead to increased anxiety, being informed about your health condition can empower you. Focus on reputable sources and discuss any findings with your healthcare provider.

In conclusion, while elevated AFP levels can be alarming, they do not automatically indicate liver cancer, especially in the absence of other risk factors and with normal imaging results. It is essential to continue with the diagnostic process and maintain open communication with your healthcare team. They will guide you through the next steps and help address your concerns. Remember, early detection and intervention are key in managing any potential health issues.

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