Alpha-Fetoprotein (AFP), Serum, Tumor Marker
Alpha-Fetoprotein (AFP), Serum, Tumor Marker
    
Number
002253
CPT
82105
Related Information
  • Alpha-Fetoprotein (AFP) With AFP-L3%, Serum
    • Synonyms
    AFP, Serum ; Alpha1-Fetoprotein
    Special Instructions
    If patient is pregnant, include approximate gestational age on the request form and order test 010801. Values obtained with different assay methods should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor each patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please use the serial monitoring number 480012 (see test below) to order.
    Specimen
    Serum
    Volume
    1 mL
    Minimum Volume
    0.3 mL (Note: This volume does not allow for repeat testing.)
    Container
    Red-top tube or gel-barrier tube
    Collection
    If a red-top tube is used, transfer separated serum to a plastic transport tube.
    Storage Instructions
    Refrigerate
    Causes for Rejection
    Plasma specimen; gross hemolysis
    Reference Interval
    Tumor marker normals: 0-6 ng/mL. Normal values apply only to males and to nonpregnant females. These results are not interpretable for pregnant females.
    Use
    The most important application of AFP testing in cancer management is for testicular cancer. Although not present in pure seminoma,1 elevated serum AFP is closely associated with nonseminomatous testicular cancer.2,3,4 The measurement of AFP in serum, in conjunction with serum hCG, is an established regimen for monitoring patients with nonseminomatous testicular cancer.5,6,7,8 In addition, monitoring the rate of AFP clearance from serum after treatment is an indicator of the effectiveness of therapy.9,10 Conversely, the growth rate of progressive cancer can be monitored by serially measuring serum AFP concentration over time.11 Serial serum AFP testing is a useful adjunctive test for managing nonseminomatous testicular cancer.
    Limitations
    Investigators have demonstrated elevated serum AFP levels in hepatocellular cancer,12,13,14 malignant germ cell tumors of the ovary and testis,15,16 and teratocarcinoma of the testis.17 Although at a very low rate of incidence, increased circulating AFP concentrations may also occur in serum specimens from patients with gastrointestinal, pancreatic, and pulmonary cancers.18 AFP is not a screening test for cancer.
    Methodology
    Immunochemiluminometric assay (ICMA)
    Additional Information
    AFP is a single chain glycoprotein with a molecular weight of approximately 70 kilodaltons.19 AFP was first described as a fetal protein by Bergstrand and Czar in 1965.20 AFP and albumin share considerable sequence homology and some physiological functions.21,22 In adults, serum AFP concentrations remain low except during pregnancy, benign liver diseases, (hepatitis, cirrhosis), primary hepatocellular carcinoma, and certain germ cell tumors.
    Footnotes
    1. Javadpour N, McIntire KR, and Waldmann TA, “Human Chorionic Gonadotropin (HCG) and Alpha-Fetoprotein (AFP) in Sera and Tumor Cells of Patients With Testicular Seminoma: A Prospective Study,” Cancer, 1978, 42(6):2768-72.
    2. Lange PH, McIntire KR, Waldmann TA, et al, “Serum Alpha-Fetoprotein and Human Chorionic Gonadotropin in the Diagnosis and Management of Nonseminomatous Germ-Cell Testicular Cancer,” N Engl J Med, 1976, 295(22):1237-40.
    3. Javadpour N, McIntire KR, Waldmann TA, et al, “The Role of the Radioimmunoassay of Serum Alpha-Fetoprotein and Human Chorionic Gonadotropin in the Intensive Chemotherapy and Surgery of Metastatic Testicular Tumors,” J Urol, 1978, 119(6):759-62.
    4. Kohn J, Orr AH, McElwain TJ, et al, “Serum Alpha1-Fetoprotein in Patients With Testicular Tumors,” Lancet, 1976, 1(7982):433-6.
    5. Perlin E, Engeler JE, Edson M, et al, “The Value of Serial Measurement of Both Human Chorionic Gonadotropin and Alpha-Fetoprotein for Monitoring Germinal Cell Tumors,” Cancer, 1976, 37(1):215-9.
    6. Scardino PT, Cox HD, Waldmann TA, et al, “The Value of Serum Tumor Markers in the Staging and Prognosis of Germ Cell Tumors of the Testis,” J Urol, 1977, 118(6):994-9.
    7. Javadpour N, “The Role of Biologic Tumor Markers in Testicular Cancer,” Cancer, 1980, 45(7 Suppl):1755-61.
    8. Mason MD, “Tumour Markers,” Testicular Cancer Investigation and Management, Horwich A, ed, Baltimore, MD: Williams and Wilkins, 1991. 35-50.
    9. Toner GC, Geller NL, Tan C, et al, “Serum Tumor Marker Half-Life During Chemotherapy Allows Early Prediction of Complete Response and Survival in Nonseminomatous Germ Cell Tumors,” Cancer Res, 1990, 50(18):5904-10.
    10. Kirkpatrick AM and Kirkpatrick KA, “Clearance-Corrected Differencing and Other Analytic Techniques Useful in the Interpretation of Serum AFP Values,” Alpha-Fetoprotein: Laboratory Procedures and Clinical Applications, Kirkpatrick AM, et al, eds, NY, NY: Masson, 1981, 135-48.
    11. Price P, Hogan SJ, and Horwich A, “The Growth Rate of Metastatic Nonseminomatous Germ Cell Testicular Tumors Measured by Marker Production Doubling Time-I. Theoretical Basis and Practical Application,” Eur J Cancer, 1990, 26(4):450-3.
    12. Abelev GI, “Alpha-Fetoprotein in Ontogenesis and its Association With Malignant Tumors,” Adv Cancer Res, 1971, 14:295-358 (review).
    13. Chen DS and Sung JL, “Serum Alpha-Fetoprotein in Hepatocellular Carcinoma,” Cancer, 1977, 40(2):779-83.
    14. McIntire KR, Vogel CL, Princler GL, et al, “Serum α-Fetoprotein as a Biochemical Marker for Hepatocellular Carcinoma,” Cancer Res, 1972, 32(9):1941-6.
    15. Kawai M, Furuhashi Y, Kano T, et al, “α-fetoprotein in Malignant Germ Cell Tumors of the Ovary,” Gynecol Oncol, 1990, 39(2):160-6.
    16. Javadpour N, “Serum and Cellular Biologic Tumor Markers in Patients With Urologic Cancer,” Hum Pathol, 1979, 10(5):557-68.
    17. Masopust J, Kithier K, Radl J, et al, “Occurrence of Fetoprotein in Patients With Neoplasms and Non-neoplastic Diseases,” Int J Cancer, 1968, 3(3):364-73.
    18. Waldmann TA and McIntire KR, “The Use of a Radioimmunoassay for Alpha-Fetoprotein in the Diagnosis of Malignancy,” Cancer, 1974, 34(4 Suppl):S1510-5.
    19. Ruoslahti E and Seppala M, “Studies of Carcinofetal Proteins: Physical and Chemical Properties of Human α-Fetoprotein,” Int J Cancer, 1971, 7(2):218-25.
    20. Bergstrand CG and Czar B, “Demonstration of a New Protein Fraction in Serum From the Human Fetus,” Scand J Clin Lab Invest, 1956, 8(2):174.
    21. Ruoslahti E, Engvall E, and Kessler MJ, “Chemical Properties of Alpha-Fetoprotein,” Immunodiagnosis of Cancer, Herberman RB and McIntire KR, eds, NY: Marcel Dekker, 1979, 101-17.
    22. Morinaga T, Sakai M, Wegmann T, et al, “Primary Structures of Human α-Fetoprotein and its mRNA,” Proc Natl Acad Sci USA, 1983, 80(15):4604-8

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