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To evaluate effectiveness of treatment for hepatocellular carcinoma (HCC), a type of liver cancer, if the level of des-gamma-carboxy prothrombin is elevated prior to treatment; to monitor for recurrence of HCC
Periodically when you have been treated for HCC
A blood sample drawn from a vein in your arm
Des-gamma-carboxy prothrombin (DCP) is an abnormal form of prothrombin, a clotting factor produced by the liver. This test measures the amount of DCP in the blood to help evaluate whether treatment for one type of liver cancer, hepatocellular carcinoma (HCC), is effective.
DCP can be produced by liver tumors, and levels are frequently elevated in conjunction with related tumor markers such as alpha-fetoprotein (AFP) and AFP-L3% when a person has HCC or has an increased risk of HCC recurrence. This makes the test potentially useful as a tumor marker.
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 over 40,000 new liver cancers are diagnosed in the U.S. each year and about 29,000 people will die of the disease. The incidence in the U.S. has more than tripled since 1980. 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 people 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 men than women, 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.
A blood sample is obtained by inserting a needle into a vein in the arm.
No test preparation is needed.
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 healthcare 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. Guidelines in the U.S. and Europe, however, have not endorsed the use of AFP or DCP as screening tools. However, some healthcare practitioners may this test to aid in the risk assessment of patients with chronic liver disease for progression to HCC in conjunction with other laboratory findings and imaging studies.
DCP is not sensitive or specific enough to be used to screen the general population for risk of developing HCC cancer.
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.
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.
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.
This depends on the laboratory performing the test. The test requires specialized equipment and is not offered by every laboratory. The blood sample will usually be sent to a reference laboratory and it make take a few days before results are available.
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 healthcare practitioner wants the additional information it may offer.
You should talk to your healthcare practitioner. 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.
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