Understanding tumour marker AFP

Overview

Alpha-fetoprotein (AFP) is a protein made by the liver and the yolk sac of a developing baby. A blood test measures the level of AFP in your blood. High levels can sometimes be a sign of liver disease, certain cancers (like liver cancer or germ cell tumours), or other conditions. It is often used as a tumour marker — a substance that may be higher when cancer is present. But AFP can also be raised in non-cancerous conditions, so it is not a definite diagnosis by itself.

An AFP test is a common blood test, especially in people with liver disease or symptoms of certain cancers. High AFP levels are less common and always require further testing.

It affects people with liver conditions (hepatitis, cirrhosis), those at risk for liver cancer (e.g., chronic hepatitis B or C), men with testicular germ cell tumours, women with ovarian germ cell tumours, and pregnant women (used in prenatal screening for neural tube defects).

Symptoms

Common symptoms

• High AFP itself does not cause symptoms. Symptoms come from the underlying condition. For liver cancer: yellowing of skin or eyes (jaundice), abdominal pain or swelling, unexplained weight loss, loss of appetite, feeling very tired.

Symptoms in children

• In children, high AFP may be linked to certain childhood liver tumours or germ cell tumours. Symptoms may include a lump in the belly, pain, fever, or jaundice.

Symptoms in older adults

• In older adults, high AFP may be linked to liver cancer or chronic liver disease. Symptoms can include abdominal discomfort, jaundice, weakness, and swelling in the legs.

Causes

Main causes

• Liver cancer (hepatocellular carcinoma)
• Germ cell tumours of the testicles or ovaries
• Chronic liver diseases such as hepatitis B, hepatitis C, and cirrhosis
• Pregnancy (especially with certain fetal abnormalities)
• Some benign liver conditions like acute hepatitis

Risk factors

• Chronic infection with hepatitis B or C virus
• Long-term heavy alcohol use leading to cirrhosis
• Non-alcoholic fatty liver disease
• Exposure to aflatoxins (fungal toxins found in contaminated food)
• Personal or family history of liver cancer or germ cell tumours
• Certain genetic conditions like hereditary tyrosinemia

When to see a doctor

See a doctor urgently if:

• If you have jaundice, sudden abdominal pain, or a lump in your belly
• If you are vomiting blood or have black stools

Book a routine appointment if:

• If you have chronic liver disease and your doctor wants to monitor AFP levels
• If you have symptoms like unexplained weight loss, fatigue, or appetite loss
• If you are at high risk for liver cancer (e.g., hepatitis B/C, cirrhosis) and screening is recommended

Diagnosis

A simple blood test measures the amount of AFP. The test is often done along with other blood tests and imaging studies. Because AFP can be raised in many conditions, the result is always interpreted alongside your symptoms, medical history, and other tests.

Tests that may be done

• Blood test for AFP level
• Liver function tests and other blood markers
• Imaging tests: ultrasound, CT scan, or MRI of the liver
• Biopsy (taking a small tissue sample from the liver or tumour) if cancer is suspected
• For germ cell tumours: ultrasound of the testicles or pelvis, and sometimes CT scan

What to expect at your appointment

Your doctor will take a blood sample from your arm, which takes a few minutes. You can usually eat and drink normally before the test. Results come back in a few days. If the level is elevated, your doctor will talk with you about next steps, which might include repeating the test, having imaging scans, or seeing a specialist.

Treatment

Treatment depends entirely on what is causing the high AFP. If it is due to liver cancer, treatment may include surgery, procedures to destroy the tumour, medications, or a liver transplant. For germ cell tumours, treatment may include surgery, chemotherapy, and sometimes radiation. For non-cancerous causes like hepatitis, treatment focuses on managing the liver disease.

Self-care at home

• Follow your doctor's advice about managing any underlying liver condition
• Avoid alcohol completely if you have liver disease
• Eat a balanced diet and maintain a healthy weight
• Get vaccinated against hepatitis B if you are at risk

Medical treatments

Medical treatments for causes of high AFP vary. For liver cancer, options may include surgical removal of the tumour, ablation (using heat or cold to destroy cancer cells), embolisation (blocking blood supply to the tumour), targeted therapy, immunotherapy, or a liver transplant for eligible patients. For germ cell tumours, chemotherapy is often effective, sometimes combined with surgery. For chronic hepatitis, antiviral medications may be used. Your doctor will discuss the best plan for your specific situation, including the benefits and risks of each approach.

When is surgery considered?

Surgery may be recommended if the cancer is confined to one area of the liver and the patient is healthy enough. For some germ cell tumours, surgery to remove the affected testicle or ovary is standard. A liver transplant may be an option for some people with early-stage liver cancer and underlying cirrhosis.

Living with this condition

Living with a condition that causes high AFP means working closely with your healthcare team. You will have regular blood tests and scans to monitor AFP levels and the underlying disease. It's important to attend all appointments and report any new symptoms.

Lifestyle tips

• Limit or avoid alcohol
• Maintain a healthy weight with diet and exercise
• Follow a liver-friendly diet: low salt, low fat, and plenty of fruits and vegetables
• Practice safe sex and avoid sharing needles to prevent hepatitis
• Take all medications as prescribed, and never stop without talking to your doctor

Diet and exercise

A balanced diet rich in whole grains, lean protein, fruits, and vegetables supports liver health. Avoid processed foods and high-sugar drinks. Gentle exercise like walking can help maintain energy and mood, but check with your doctor before starting a new exercise routine, especially if you have advanced liver disease or are undergoing cancer treatment.

Mental health and emotional wellbeing

A high AFP result can cause anxiety and worry, especially while waiting for more tests. It is normal to feel stressed or scared. Talk to your doctor or a counsellor about your feelings. Many hospitals have support services for people with chronic illness or cancer.

Prevention

You cannot always prevent the conditions that cause high AFP, but you can reduce your risk. For liver cancer: get vaccinated against hepatitis B, avoid heavy alcohol use, and manage chronic liver disease. For germ cell tumours, there is no known prevention, but early detection improves outcomes.

Vaccines

Hepatitis B vaccination is recommended for all newborns and for adults at risk. It is highly effective in preventing hepatitis B infection, which is a major cause of liver cancer. There is no vaccine for hepatitis C, but treatment can cure it.

Screening programmes

Screening with AFP and ultrasound is recommended for people at high risk of liver cancer, such as those with cirrhosis or chronic hepatitis B. This helps detect cancer early when treatment is most effective. For germ cell tumours, regular self-exams of the testicles can help find lumps early.

Complications

If left untreated

• If high AFP is caused by liver cancer, without treatment the cancer can grow and spread to other parts of the body.
• Untreated germ cell tumours can also spread and become harder to treat.
• Chronic liver disease can worsen, leading to liver failure or more advanced cancer.

Long-term outlook

The outlook depends on what is causing the high AFP and how early it is treated. Many causes of high AFP, especially when found early, can be managed successfully. For liver cancer, survival rates are improving with newer treatments. For germ cell tumours, the cure rate is very high with modern therapy. If the elevated AFP is due to a benign liver condition, managing the underlying disease often brings levels back to normal. Regular monitoring and following your doctor's advice gives you the best chance at a good outcome.

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