Alpha fetoprotein (AFP) analysis uses risks and results

The Alpha-Fetoprotein (AFP) test is one of the most important medical tests used to detect liver problems and to monitor certain types of cancers. It is also commonly performed during pregnancy to help assess fetal health. This test measures the level of AFP protein in the blood, which is an important indicator of liver activity or the presence of abnormalities in the body.If you have chronic liver disease, a family history of liver cancer, or if you are pregnant and want to monitor your baby’s health, understanding AFP test results and the normal range plays a crucial role in determining the next diagnostic or treatment steps. In this Dalili Medical article, we will cover everything you need to know about the AFP test, including how it is performed, possible risks, reasons for testing, result interpretation, and normal AFP levels.

Uses and Testing of Alpha-Fetoprotein (AFP)

Alpha-fetoprotein (AFP) is a protein produced mainly by the liver and intestines of a fetus, and in very small amounts in adults. Doctors use the AFP test to help detect certain diseases and tumors, because elevated AFP levels in the blood may indicate underlying health problems or specific types of cancer.

What Is the Alpha-Fetoprotein (AFP) Test?

The AFP test is a blood test that measures the level of AFP in the body. This protein is normally produced during fetal development, while in adults it is present only in very low levels. An elevated AFP level may be associated with certain tumors or medical conditions.

Importance of the AFP Test

The AFP blood test is used to:

Monitor chronic liver diseases
Detect liver cancer at an early stage
Follow up on certain other tumors
Assess fetal health during pregnancy

Does the AFP Test Diagnose Cancer Accurately?

❌ No, AFP is only a supportive marker.

It does not confirm cancer on its own.
Results must be interpreted along with:
- Imaging tests (ultrasound or MRI)
- Liver function tests
- Clinical examination

Normal Range of AFP

Non-pregnant adults: 0–10 ng/mL
Normal values may vary slightly depending on the laboratory.

When Is a High AFP Level Concerning?

AFP level above 200 ng/mL
Or a steadily increasing AFP level over time

This is especially concerning in patients with:

Liver cirrhosis
Hepatitis B or C

⚠️ In these cases, urgent medical follow-up and imaging are required to identify the cause.

Can Liver Diseases Raise AFP Without Cancer?

✔️ Yes. AFP levels may increase due to:

Hepatitis
Liver cirrhosis
Regeneration or activation of liver cells

These elevations are usually mild to moderate and do not necessarily indicate cancer.

Can AFP Be Normal Even If Liver Cancer Is Present?

✔️ Yes. About 30–40% of liver cancer patients may have normal AFP levels.
❌ That is why diagnosis should never rely on AFP alone.

Does Pregnancy Increase AFP Levels?

✔️ Yes, this is completely normal, as AFP is produced by the fetal liver.

AFP levels increase according to gestational age
They may be higher in multiple pregnancies

???? AFP interpretation during pregnancy follows specific reference charts.

Does the AFP Test Require Fasting?

❌ No, fasting is usually not required unless your doctor advises otherwise.

Is the AFP Test Painful or Risky?

✔️ No, it only involves a simple blood sample.

You may feel a mild needle prick
A small bruise may appear at the injection site

Can Medications Affect AFP Results?

✔️ Sometimes, especially:

Certain liver medications
Chemotherapy drugs

???? Always inform your doctor about all medications before testing.

How Often Should AFP Be Tested in Chronic Liver Disease?

Usually every 3 to 6 months
Along with liver ultrasound
Frequency depends on your doctor’s evaluation

Difference Between AFP and Liver Function Tests

AFP: Tumor marker and disease monitoring tool
Liver function tests (ALT, AST, Bilirubin): Measure liver performance

???? Both tests complement each other for a full liver health assessment.

Common Questions About AFP Testing

1. What Is the Purpose of the AFP Test?

The AFP test measures AFP levels to help detect:

Birth defects during pregnancy
Liver cancer or germ cell tumors
Liver health status

It provides important information about fetal and maternal health or helps diagnose certain cancers in non-pregnant adults.

2. When Is AFP Tested During Pregnancy?

Usually between weeks 15 and 20 of pregnancy as part of maternal serum screening. This timing allows accurate fetal assessment.

3. What Does High AFP Mean During Pregnancy?

High AFP levels may indicate:

Neural tube defects (such as spina bifida)
Abdominal wall defects
Multiple pregnancy

???? Further tests like detailed ultrasound or amniocentesis are often needed.

4. Can AFP Be Low During Pregnancy?

✔️ Yes. Low AFP levels may suggest chromosomal abnormalities such as:

Down syndrome
Edwards syndrome

Additional tests are usually recommended to confirm results.

5. Is AFP Accurate for Detecting Fetal Abnormalities?

No. AFP is a screening test, not a definitive diagnosis.
Abnormal results require further evaluation, including:

Detailed ultrasound
Genetic testing

6. Conditions AFP Can Detect in Non-Pregnant Adults:

Liver cancer
Germ cell tumors
Chronic liver diseases such as hepatitis or cirrhosis

Elevated AFP often leads to further imaging or biopsy.

7. Do I Need to Fast Before the AFP Test?

❌ No fasting is required unless advised by your doctor.

8. Can AFP Levels Change Over Time?

✔️ Yes, depending on:

Health condition
Pregnancy stage
Response to treatment

Regular monitoring may be necessary.

9. Are There Any Risks Associated With AFP Testing?

AFP testing is very safe. Possible effects include:

Mild discomfort
Minor bruising at the blood draw site

Serious complications are extremely rare.

10. What Happens If AFP Results Are Abnormal?

During pregnancy: Your doctor may recommend ultrasound or amniocentesis
In adults: Imaging studies or biopsy may be needed to determine the cause

???? Always discuss results with your healthcare provider for accurate interpretation and next steps.

Indications for Performing the Alpha-Fetoprotein (AFP) Test

1. Diagnosis of Malignant Tumors

Liver cancer (Hepatocellular carcinoma): The most common cancer associated with elevated AFP.
Ovarian or testicular cancer: AFP is a marker for some types of these tumors.
Other cancers: AFP may occasionally be elevated in gastric or colorectal cancer.

2. Diagnosis of Benign Tumors

The AFP test helps physicians differentiate between benign and malignant tumors of the liver or other organs.

3. Chronic Liver Diseases

Liver cirrhosis or chronic hepatitis (B or C): AFP is used to monitor patients who are at higher risk of developing liver cancer.

4. Diagnosis of Fetal Conditions

During pregnancy: AFP is used to detect fetal abnormalities such as:
- Open neural tube defects (e.g., spina bifida)
- Down syndrome
  AFP is usually measured in the mother’s blood between weeks 16–18 of pregnancy.

5. Monitoring Disease Progression and Treatment

Follow-up of patients after treatment of liver cancer or other tumors.
A decrease in AFP after treatment indicates a good response.
It can be used to monitor recurrence or relapse of tumors.

How the Alpha-Fetoprotein (AFP) Test Is Performed

Blood sample: Taken from a vein in the arm.
No special preparation: Fasting is not required.
Laboratory analysis: Measures the level of AFP in the blood.

Interpretation of AFP Test Results

1. Normal Levels

Adults: Less than 10 ng/mL.
During pregnancy: AFP normally increases according to the stage of pregnancy.

2. Elevated Levels

Liver cancer: Especially in patients with chronic liver disease or hepatitis.
Ovarian or testicular cancer: Some tumors secrete AFP.
Other liver diseases: Such as cirrhosis or chronic hepatitis.
Pregnancy: Markedly high or low levels may indicate fetal abnormalities.

3. Low Levels

May be seen in some non-pathological situations or in healthy individuals.

Risks of the AFP Tumor Marker Test

The AFP test is a simple and very safe blood test, but like any blood draw, it may cause mild temporary effects:

1. Mild Pain or Bruising at the Injection Site

A slight sting when the needle is inserted.
Small bruises or swelling may occur and usually resolve within days.
Cold compresses can reduce discomfort.

2. Dizziness or Fainting

More common in people who are afraid of needles.
It is advised to sit or lie down briefly after the test.

3. Rare Local Infection

Mild redness or pain may appear.
If pain persists or pus develops, medical attention is required.

4. Psychological Anxiety Due to Results

Elevated AFP does not always mean cancer.
AFP may rise in hepatitis, liver cirrhosis, or pregnancy.
Results must always be interpreted by a physician.

5. False Results

False positive: High AFP without a tumor.
False negative: Tumor present with normal AFP.
Therefore, AFP is usually combined with imaging and other tests.

AFP Tumor Marker Results

What Is AFP?

A protein normally produced by the liver and intestines of the fetus, which may increase in certain diseases or tumors.

1. Normal Results

Non-pregnant adults: 0–10 ng/mL
During pregnancy: Levels may normally reach 100–200 ng/mL, depending on gestational age.

2. Abnormal Results

High AFP: May indicate liver tumors, ovarian/testicular tumors, or liver disease such as cirrhosis or hepatitis.
Low AFP: Rare; may be associated with certain fetal conditions during pregnancy.

⚠️ Important: Results must always be interpreted by a physician, considering medical history and symptoms.

What Do AFP Test Results Mean?

1. Normal AFP Level

Non-pregnant adults: Less than 10 ng/mL
Usually indicates no serious conditions such as liver cancer or reproductive organ tumors.

2. Elevated AFP Levels

Elevated AFP requires further investigation and may indicate:

A. Liver Cancer (Hepatocellular Carcinoma)

The most common cause of high AFP.
Especially in patients with chronic hepatitis or cirrhosis.
Levels above 200 ng/mL strongly suggest malignancy.

B. Ovarian or Testicular Cancer

Some reproductive tumors produce AFP.

C. Chronic Liver Diseases

Such as cirrhosis or hepatitis B and C.
Elevated AFP does not always indicate cancer but requires monitoring.

D. Other Tumors

Occasionally elevated in colorectal, gastric, or intestinal tumors.

E. Fetal Disorders During Pregnancy

High AFP may indicate open neural tube defects or other congenital abnormalities.
Additional tests such as ultrasound or amniocentesis are usually recommended.

3. Low AFP Levels

In rare cases, very low AFP may be associated with:

A. Down Syndrome

Especially when combined with other abnormal screening markers.

B. Normal Pregnancy

Some healthy pregnancies may naturally have low AFP levels.

AFP and Cancer Monitoring

Role of AFP in Cancer

AFP is used as a supportive tool for:

Diagnosing certain cancers
Assessing disease severity and progression
Monitoring response to treatment
Detecting tumor recurrence after therapy

Cancers Associated with Elevated AFP

A. Primary Liver Cancer (Hepatocellular Carcinoma)

Most strongly associated with AFP elevation, especially in patients with cirrhosis or chronic hepatitis.

AFP Level	Interpretation
< 20 ng/mL	Usually normal
20–200 ng/mL	Possible inflammation or cirrhosis
200–400 ng/mL	Strong suspicion of liver cancer
> 1000 ng/mL	Often advanced tumor

⚠️ Some liver cancer cases may have normal AFP.

B. Testicular Germ Cell Tumors

AFP is used for diagnosis, monitoring chemotherapy, and detecting recurrence.

C. Ovarian Germ Cell Tumors

AFP elevation is rare and used only as a supportive marker.

D. Other Cancers (Stomach, Colon, Pancreas)

AFP elevation is uncommon and nonspecific.

AFP Levels During Cancer Treatment

Decreasing AFP: Good response to treatment.
Stable or rising AFP: Possible treatment failure or tumor recurrence.

AFP in Chronic Liver Disease

AFP is used for monitoring and early detection of liver cancer in patients with:

Chronic hepatitis B or C
Liver cirrhosis

⚠️ Elevated AFP does not always mean cancer.

AFP Monitoring in Chronic Liver Disease

AFP Level	Interpretation
< 10–15 ng/mL	Stable liver, no evidence of cancer
15–50 ng/mL	Mild elevation, often due to active inflammation
50–200 ng/mL	Moderate elevation, possible severe inflammation or early cancer
> 200–400 ng/mL	Strong suspicion of liver cancer

Regular monitoring every 3–6 months with liver ultrasound is recommended.

AFP Results in Chronic Liver Diseases

AFP Level	Interpretation
< 10–15 ng/mL	Stable liver condition, no evidence of cancer; imaging follow-up is still necessary
15–50 ng/mL	Mild elevation, usually due to active inflammation or liver cell regeneration
50–200 ng/mL	Moderate elevation; may indicate severe inflammation, progression of cirrhosis, or early suspicion of liver cancer
> 200–400 ng/mL	Marked elevation; strong suspicion of primary liver cancer, often associated with a liver mass on imaging and sudden deterioration of liver function

1. Do All Liver Cancer Patients Have Elevated AFP?

❌ No

Approximately 30–40% of patients with liver cancer may have normal AFP levels.
Therefore, diagnosis should not rely on AFP alone and always requires:

Imaging studies (ultrasound, CT scan, or MRI)
Additional laboratory tests
Clinical examination

2. Normal AFP Levels

A. Non-Pregnant Adults

Normal range: 0–10 ng/mL
Some laboratories accept values up to 15 ng/mL

➡️ Results within this range usually indicate no serious pathological condition.

B. Pregnant Women

AFP naturally increases during pregnancy because it is produced by the fetal liver.

Trimester	Approximate AFP Level
First	Up to 30 ng/mL
Second	30–150 ng/mL
Third	Up to 200 ng/mL or higher

➡️ Interpretation depends on:

Accurate gestational age
Comparison with pregnancy-specific reference charts

C. Newborns

AFP levels are very high at birth
They gradually decrease over the first 6–12 months of life

3. When Are AFP Results Considered Abnormal?

Elevated AFP May Indicate:

Liver diseases (hepatitis, cirrhosis)
Liver cancer or ovarian/testicular tumors
Pregnancy or fetal abnormalities

Low AFP During Pregnancy May Indicate:

Down syndrome
Incorrect calculation of gestational age

4. Factors Affecting AFP Levels

A. Pathological Factors

Liver diseases:

Hepatitis B or C
Liver cirrhosis
Liver failure
Liver cell regeneration during inflammation or recovery
➡️ Elevation is usually mild to moderate.

Malignant tumors:

Primary liver cancer
Germ cell tumors of the testis or ovary
Rare tumors (stomach, colon)
➡️ Elevation is often significant and persistent.

B. Physiological (Normal) Factors

Pregnancy:

AFP is produced by the fetal liver
Higher levels in multiple pregnancies or congenital anomalies
False elevation may occur due to miscalculated gestational age

Newborns:

Naturally high AFP levels that decline over time

C. Medications and Medical Treatments

Certain medications:

Liver treatments
Chemotherapy
Immunosuppressive drugs
➡️ May cause temporary changes in AFP levels.

After surgeries or procedures:

Liver surgery
Tumor ablation
Liver transplantation
➡️ Temporary elevation followed by a decrease with recovery

D. Lifestyle Factors

Alcohol consumption and smoking affect liver function
Poor nutrition, including protein, vitamin, or mineral deficiencies

E. Laboratory-Related Factors

Timing and frequency of testing
- Testing during acute inflammation may cause temporary elevation
Differences in laboratory measurement techniques
Laboratory errors:
- Improper sample storage
- Delayed analysis