Patient Test Information


Also known as:

PIVKA II (protein induced by vitamin K absence or antagonists II)

Formal name:

Des-gamma-carboxy prothrombin

Related tests:

AFP Tumor Markers, Tumor Markers

Why Get Tested?

To evaluate effectiveness of hepatocellular carcinoma (HCC) treatment if elevated prior to treatment; to monitor for recurrence of HCC

When to Get Tested?

Periodically when you have been treated for HCC

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?


How is it used?

A des-gamma-carboxy prothrombin (DCP) test may be used along with other tumor markers such as an alpha-fetoprotein (AFP) and/or an AFP-L3% to monitor the effectiveness of treatment for hepatocellular carcinoma (HCC), a type of liver cancer. It may also be used to monitor for recurrence of HCC after successful treatment.

Not every HCC will produce DCP. If DCP is initially elevated in person who has been diagnosed with HCC, then it can be used as a monitoring tool. The DCP test is not considered a replacement for the AFP or AFP-L3% tests, but gives the health practitioner additional information. These tests generally reflect tumor burden - the amount of cancer present.

In Japan, DCP is being used, along with AFP and/or AFP-L3% to periodically screen those considered to be at high risk of progressing from chronic hepatitis or cirrhosis to HCC. Recent guidelines in the U.S. and Europe, however, have not endorsed the use of AFP or DCP as screening tools. Some doctors may occasionally order DCP for this purpose.

DCP is not sensitive or specific enough to be used to screen the general population for risk of developing HCC cancer.

When is it ordered?

The DCP test is not routinely ordered. However, it may initially be ordered when an individual is diagnosed with HCC. If the initial level is elevated, it may then be ordered periodically during and after treatment of HCC to evaluate the effectiveness of treatment and ordered periodically along with an AFP and/or AFP-L3% to monitor for cancer recurrence.

What does the test result mean?

When the DCP level is increased in a person diagnosed with HCC, it means that the cancer is producing this substance and the test can be used as a tumor marker. Since the test is typically ordered periodically, changes over time can be evaluated. Decreasing concentrations in someone who is being treated for HCC suggest response to treatment. Levels that stay the same or increase after treatment indicate that the treatment has not been effective. Increasing levels after treatment has been completed suggest recurrence of HCC.

A person can have HCC without having elevated DCP. The tumor may not produce DCP or it may be small enough that it is not producing significant amounts.

Is there anything else I should know?

Increases in DCP and/or AFP are not diagnostic of HCC. For a diagnosis, the tumor may be located through the use of imaging scans. Sometimes a biopsy may be performed and cells from it examined under a microscope to aid in establishing a diagnosis.

DCP can also be elevated because of acute hepatitis. In persons with chronic hepatitis, mild increases in DCP are common, although not as commonly as with AFP, and generally not to as high levels.

If someone is taking the anticoagulant warfarin to lower the risk of blood clots, DCP will be markedly increased, since this drug works by blocking the action of vitamin K and leads to production of the same abnormal form of prothrombin as occurs in HCC. DCP can also be increased with vitamin K deficiency.

A person with a persistent vitamin K deficiency or jaundice due to a liver obstruction may have elevated DCP levels that are not due to HCC. Some broad-spectrum antibiotics can affect DCP test results.

What is being tested?

Des-gamma-carboxy prothrombin (DCP) is an abnormal form of prothrombin, a clotting factor produced by the liver. DCP can be produced by liver tumors, and levels are frequently elevated when a person has hepatocellular carcinoma (HCC). This makes the test potentially useful as a tumor marker. This test measures the amount of DCP in the blood.

According to the American Cancer Society (ACS), hepatocellular carcinoma is the most common type of liver cancer, accounting for 3 of 4 cancers that originate in the liver. ACS estimates that about 30,640 new liver cancers will be diagnosed in the U.S in 2013 and about 21,670 people will die of the disease. Liver cancer is much more common in other parts of the world, with more than 700,000 people diagnosed each year.

Most cases of HCC develop in those who have chronic liver diseases such as hepatitis and cirrhosis. In the U.S., the most common risk factor for HCC is a chronic hepatitis C infection; worldwide it is chronic hepatitis B. When it occurs, HCC may emerge several decades after the initial infection. HCC affects more males than females, with the average age of diagnosis at 62 years. Symptoms of HCC, such as a liver mass, abdominal pain, weight loss, nausea, ascites, jaundice, and a worsening of symptoms in those with chronic hepatitis and cirrhosis, are often not present until the later stages of the disease. For this reason, HCC is rarely detected early unless screening is done in those who are at high risk.

It was hoped that DCP testing would prove useful as a screening and surveillance tool to help with early HCC detection in those with chronic liver disease, but studies have shown mixed results and a recent guideline by the American Association for the Study of Liver Diseases (AASLD) recommends that it not be used for this purpose.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

  1. Can the DCP test be done in my doctor's office?

    No. The test requires specialized equipment and is not offered by every laboratory. The blood sample will usually be sent to a reference laboratory.

  2. If I have liver cancer in my family, should I be tested for DCP?

    DCP is not intended to be used to screen the general population or those who are healthy. A DCP test may be occasionally performed if you have chronic liver disease and your doctor wants the additional information it may offer.

  3. If I have hepatitis, should I have a DCP test performed?

    You should talk to your doctor. Recent guidelines by the American Association for the Study of Liver Diseases (AASLD) do not recommend using DCP as a screening test for the development of HCC, but it is used for this purpose in some other parts of the world.