AFP test

[Steve76]

My doctor said I should get this AFP test every 6 months. I asked what the protocol was and he said Ultrasound with/or without AFP.

I was diagnosed by Fibroscan(14 or 16 don't remember exactly)back in 2015. Cured with 24 weeks of Harvoni EOT April of 2016.

I looked at my old labs and my AFP was never out of range. Checked in 2012 and it was 4.0.

Had one done in late 2017 and it was 2.5. Had a repeat just the other day and it was 2.5 again.  "AFP TUMOR MARK (ROCHE)   2.5 ng/mL   0.0 - 8.3 ng/mL"

Doctor said sometimes this test can pick up small tumors not seen on the Ultrasound.

My question is does this test fluctuate? Mine has been the exact same last 2 tests.

All of my bloodwork is in the normal range including the platelets(low normal 180's).

I get frigging stressed by all of the tests. I wonder how useful the AFP really is.

I know the European Counterpart of the AASLD does not recommend it in the screening for HCC, just ultrasound.

THanks 

 

[Lynn K]

AFP can be a liver tumor marker but not super indicative which is why it is accompanied by liver ultrasound testing. Mostly looking for trend information like if your AFP were to suddenly jump to 100 or 500.

I’ve been slightly above normal since I became aware of the test. My last was 8.2 this month. An old result from 2014 before I was cured of hep c was 15.6. My most recent Fibroscan was 29. I was diagnosed with cirrhosis via liver biopsy in Jan 2008. My most recent platelet test was 125 up from pretreatment levels of around 85.

As we have liver cirrhosis the AASLD follow on monitoring protocol currently is abdominal ultrasound with/without AFP testing every six months as even though we are cured of hep c we remain at increased risk of HCC. Although with cure, our risk of HCC is greatly decreased as well as our odds of developing decompensated cirrhosis. This is assuming we have no other liver health risks like fatty liver or drinking any alcohol.

Congrats on your hep c free life

[Steve76]

Thanks for the reply. I get stressed every 6 months now just knowing they are looking for the big C.

I am just seeing a regular Gastro guy not a liver specialist. He does go to the AASLD meeting every year though and seems to be up on the latest research.  I  guess I need to ask more questions. I meet him once a year only per my request.

So SVR improves chances of not getting HCC and your liver not going south even further.

He did tell me my Liver should remain stable. I did read one study that said compensated F-4 status was very unlikely to progress to decompensated; exact words were "rare".

I get the Fatty Liver and the no alcohol as well.

He wants me to take another fibroscan, but I have been putting it off. Even if it is lower I don't think the protocol for monitoring for HCC changes. My point is why do it then. Quite frankly I don't totally trust the accuracy of the test anyway. 

HCC risk being lowered after SVR I did not know about. Hopefully that is really true.

I hope they develop an accurate sensitive blood test for HCC that would enable us to get just that done without the scan.

[Lynn K]

I’m personally not really confident about them developing any blood testing for HCC. The reason we do this testing is to catch HCC in its earliest stages so we have a better chance of survival maybe even just have a tumor removed and not needing a liver transplant to survive so getting this testing every six months is a good thing.


There is evidence that curing hep c reduced risk of HCC not to the same level as if we never had cirrhosis and hep c but lower than if we had never been cured. Kind of like quitting smoking g reduces lung cancer risk and with time may approach the risk level of a non smoker.

There is even some evidence our livers may heal with time and our “F” scores could back away from F4 cirrhosis of course that depends on the level of existing damage before cure. I was diagnosed with cirrhosis 7 years before I was cured and have had a Fibroscan done a couple of time with no real change in the 4 years since I was cured but others here have had Fibroscan indicating reductions to F2 or even F1. But even so if the person was F4 before treatment they should still have ongoing monitoring for HCC as no one really knows what a reduction in Fibroscan scores really means for someone who previously was F4. For me it would be heartening to see a reduction in Fibroscan score even though the test is an imperfect tool.

The test I stress about is the ultrasound if the tech takes longer or does a lot of images makes me wonder if they are seeing something. But in-between testing I just live my life and try not to dwell on my damaged liver