Elevated AFP Levels: Potential Causes and Next Steps

Abnormal elevation of AFP levels?

Hello, I underwent a physical examination on May 25th, where it was found that my alpha-fetoprotein (AFP) level was elevated at 19.3.
Other liver function tests, including GOT, GPT, alkaline phosphatase, bilirubin, and albumin, were all normal.
An abdominal ultrasound performed on the same day showed no significant abnormalities.
On June 21st, I visited the hepatobiliary and gastroenterology outpatient clinic for follow-up tests, and my AFP level continued to rise to 22.4.
A repeat ultrasound examination still showed no significant abnormalities, and the doctor has arranged for a computed tomography (CT) scan, for which I am currently awaiting results.

After learning about this situation, I searched for related literature on PubMed and found that, on average, the rate of AFP increase in liver cancer patients is approximately 5 ± 11 within 90 days.
Based on my current test data, my rate of increase is significantly higher than what is reported in the literature.
I have no history of hepatitis, no history of alcohol abuse or drinking habits (less than or equal to once a month), and I do not take any medications (I take vitamin C, D, B complex, and fish oil).
I have a thyroid nodule, but my T3 and T4 levels are normal, and I only undergo regular monitoring of thyroid function and anti-TPO levels.
There is no history of liver cancer in my third-degree relatives (though there is a history of stomach cancer in second-degree relatives).
My abdominal and gynecological ultrasounds during the physical examination showed no abnormalities, and I have confirmed that there is no possibility of pregnancy.

Given that the gynecological ultrasound showed no abnormalities and confirmed no pregnancy, is there a possibility of other benign diseases aside from liver cancer? I am currently quite anxious about the possibility of illness.
If the CT scan shows no abnormalities, what additional tests (which I can pay for out of pocket) would you recommend to identify the cause?

Faye, 30~39 year old female. Ask Date: 2024/06/27

Dr. Chen Sirong reply Oncology

Faye / 30 years old / Female
Hello,
1.
Please refer to the first response.
2.
If the CT scan still shows no abnormalities, what additional tests (which can be self-paid) are recommended to identify the cause?
A: A whole-body positron emission tomography (PET) scan can be considered as a self-paid option.
3.
Monthly blood tests for monitoring over a period of time can also be beneficial.
Wishing you good health,
Taoyuan Hospital, Dr.
Chen Sih-Rong

Reply Date: 2024/06/27

More Info

Elevated Alpha-Fetoprotein (AFP) levels can be a source of significant concern, particularly when they are detected during routine health screenings. In your case, the initial AFP level of 19.3, which increased to 22.4 within a month, raises questions about potential underlying conditions. While AFP is commonly associated with liver cancer, it is essential to consider other benign causes as well.

Potential Causes of Elevated AFP Levels
1. Liver Disease: Although your liver function tests (GOT, GPT, alkaline phosphatase, bilirubin, and albumin) are normal, certain liver conditions can still lead to elevated AFP levels. Conditions such as cirrhosis, hepatitis, or fatty liver disease can cause an increase in AFP, even if liver function tests appear normal.

2. Germ Cell Tumors: AFP is also a tumor marker for certain types of germ cell tumors, which can occur in the testicles or ovaries. Given that you are female, this could be a consideration, although it is less common.

3. Pregnancy: AFP levels naturally rise during pregnancy, but since you have confirmed that you are not pregnant, this is not a factor in your case.

4. Other Benign Conditions: Conditions such as chronic inflammation, certain infections, or even benign liver tumors (like hepatic adenomas) can lead to elevated AFP levels.

Next Steps in Evaluation
Given your situation, the following steps are advisable:
1. Imaging Studies: You mentioned that a CT scan has been scheduled. This is an excellent next step, as it can help visualize the liver and surrounding structures to identify any masses or abnormalities.

2. Further Blood Tests: If the CT scan does not reveal any abnormalities, consider discussing additional blood tests with your physician. Tests for viral hepatitis (such as Hepatitis B and C), autoimmune liver diseases, and other tumor markers (like CA-125 for ovarian cancer) may provide further insights.

3. Follow-Up AFP Testing: Regular monitoring of AFP levels over time can help determine if the elevation is persistent or if it fluctuates. A rising trend in AFP levels over time is more concerning than a single elevated reading.

4. Consideration of a Liver Biopsy: If imaging and blood tests do not provide a clear diagnosis, a liver biopsy may be warranted to rule out any underlying liver pathology.

5. Consultation with a Specialist: If you have not already, consider consulting a hepatologist or an oncologist who specializes in liver diseases. They can provide a more comprehensive evaluation and guide you through the diagnostic process.

Addressing Anxiety and Concerns
It is completely normal to feel anxious about elevated AFP levels and the potential implications. However, it is crucial to remember that elevated AFP does not automatically indicate cancer. Many benign conditions can cause elevated levels, and thorough investigation is key to understanding the underlying cause.

In summary, while elevated AFP levels can be concerning, they are not definitive for liver cancer, especially in the absence of other abnormal findings. Continuing with the recommended imaging and blood tests, along with regular follow-up, will be essential in determining the cause of your elevated AFP levels. Always communicate openly with your healthcare provider about your concerns and the next steps in your diagnostic journey.

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