Aa
AFP Decrease
When AFP goes down with no treatment what so ever, what does that say? Husband has hep c foR about 20 years. Old treatment never worked. Afp was 220, now 189. Cats can came back neg, ultrasound neg, endoscopy neg, colonoscopy neg? Doc is now making him go for a MRI?
Hi and welcome to Medhelp
Hector is the person you want to ask this question.
I would go to the Cirrhosis of the Liver community and post it there.
Hector is the moderator there and will definately help you with your question.
He is extremely knowledgable
My best
.....Kim
Hector is the person you want to ask this question.
I would go to the Cirrhosis of the Liver community and post it there.
Hector is the moderator there and will definately help you with your question.
He is extremely knowledgable
My best
.....Kim
I had a routine Ultrasound about 11 months ago and it was discovered that I had a mass of 2.2 CM on my liver which was said to be hamongioma. The Ultrasound was repeated in June this year and the size of the mass remained the same. Also I ran a blood test recently and my AFP is about 9.1 rising from 8.2 about 3 months ago. The laboratory where I ran the test indicated the normal range for the AFP to be between 0- 5.8. Please advice. I do not smoke and I do not drink. I am a little over weight
Hector's right. Should there be a problem the sooner you address it the better the outcome. If they find nothing, it's always better to be safe then sorry. Kim
If I were you I would request to see a hepatologist as soon as possible. No one doctor including a gastro can diagnosis or treatment of liver cancer. Transplant centers have multidisciplinary teams of specialists for liver patients. Advanced liver disease is a very complex illness that can effect many body systems.
Frankly I would want an appointment with the liver transplant center as soon as possible. Your gastro knows he or she is no expert on liver cancer and can't treat it. They should be humble enough to admit it and refer your husband to a specialist who work with cirrhotic patients on a daily basis what they do on a daily basis and are knowledgeable and experienced in diagnosing and treating liver cancer. The transplant center may have their own people redo the MRI anyway on their own equipment and review by they own pathologists that are experienced in diagnosing HCC.
Waiting when there is a risk of liver cancer (HCC) is NEVER a good idea. They have already done at least 2 AFP tests and have come to no conclusion? That is very scary. What are they waiting for? Don't they know that early diagnoses and treatment is vital for the best outcome? Don't they know that many centers now use AFP levels as selection criteria for appropriate transplant candidates. Previous research has shown that AFP levels greater than 1,000 ng/mL are a risk factor for HCC recurrence and death after a patient undergoes liver transplant, regardless of hepatitis C virus (HCV) status?
After getting rid of the first two HCC tumors completely with 2 TACE treatments. Then tumor number 3 showed up first by seeing a rising AFP.
12/1/12 AFP=291
3/7/13 AFP=670 – INELIGIBLE FOR TRANSPLANT – TOO HIGH
4/9/13 AFP=1,069 - keeps going higher through TACE treatments
4/22/13 AFP=1,348
5/3/13 AFP=1,473
5/29/13 AFP=1,892
7/16/13 AFP=564 (after ethanol injection PEI)
7/23/13 AFP=589
7/29/13 AFP=578.4
8/26/13 AFP=810.1 – Rising again!
9/18/13 AFP=1240.4 (before 3rd PEI 9/30) High
AFP tested weekly
10/14/13 AFP=562.8
10/18/13 First CyberKnife treatment
10/21/13 AFP=641.4 (rising again when CyberKnife treatment started!)
10/28/13 AFP=565.9 (after 4 of 5 Cyber treatments starting to come down!)
11/5/13 AFP=377 !!!
Under < 500 put back on the transplant waiting-list!!!
These were some pretty dark days last year, especially after being removed from the transplant waiting-list and told I only had a few months to live.
Obviously I don't know the details of the situation. All I can say is if it were my family member or girlfriend I would be in their office tomorrow and getting a referral to the nearest transplant center as soon as possible.
Best
Hector
Frankly I would want an appointment with the liver transplant center as soon as possible. Your gastro knows he or she is no expert on liver cancer and can't treat it. They should be humble enough to admit it and refer your husband to a specialist who work with cirrhotic patients on a daily basis what they do on a daily basis and are knowledgeable and experienced in diagnosing and treating liver cancer. The transplant center may have their own people redo the MRI anyway on their own equipment and review by they own pathologists that are experienced in diagnosing HCC.
Waiting when there is a risk of liver cancer (HCC) is NEVER a good idea. They have already done at least 2 AFP tests and have come to no conclusion? That is very scary. What are they waiting for? Don't they know that early diagnoses and treatment is vital for the best outcome? Don't they know that many centers now use AFP levels as selection criteria for appropriate transplant candidates. Previous research has shown that AFP levels greater than 1,000 ng/mL are a risk factor for HCC recurrence and death after a patient undergoes liver transplant, regardless of hepatitis C virus (HCV) status?
After getting rid of the first two HCC tumors completely with 2 TACE treatments. Then tumor number 3 showed up first by seeing a rising AFP.
12/1/12 AFP=291
3/7/13 AFP=670 – INELIGIBLE FOR TRANSPLANT – TOO HIGH
4/9/13 AFP=1,069 - keeps going higher through TACE treatments
4/22/13 AFP=1,348
5/3/13 AFP=1,473
5/29/13 AFP=1,892
7/16/13 AFP=564 (after ethanol injection PEI)
7/23/13 AFP=589
7/29/13 AFP=578.4
8/26/13 AFP=810.1 – Rising again!
9/18/13 AFP=1240.4 (before 3rd PEI 9/30) High
AFP tested weekly
10/14/13 AFP=562.8
10/18/13 First CyberKnife treatment
10/21/13 AFP=641.4 (rising again when CyberKnife treatment started!)
10/28/13 AFP=565.9 (after 4 of 5 Cyber treatments starting to come down!)
11/5/13 AFP=377 !!!
Under < 500 put back on the transplant waiting-list!!!
These were some pretty dark days last year, especially after being removed from the transplant waiting-list and told I only had a few months to live.
Obviously I don't know the details of the situation. All I can say is if it were my family member or girlfriend I would be in their office tomorrow and getting a referral to the nearest transplant center as soon as possible.
Best
Hector
Hi it is his Gastro doc. I think after MRI we will be involved with liver Dr. Have not been to liver doc yet.
I just wanted to say that until we have a proper diagnosis a high AFP is worrisome and not to be taken lightly.
Until we feel 100% sure it is not being caused by HCC it is smart to be concerned.
I almost died from HCC last year and you can read my posts about my battle with it if you want. I don't want anyone to have a diagnosis of HCC, but if they do, I want them to get the proper treatment ASAP so they will have the best outcome possible. With early detection and treatment it can be overcome. Have no doubt about that.
You and your husband need to get to the bottom of this rise in AFP then you will be able to move forward and deal with his hep C and liver disease.
Hector
Until we feel 100% sure it is not being caused by HCC it is smart to be concerned.
I almost died from HCC last year and you can read my posts about my battle with it if you want. I don't want anyone to have a diagnosis of HCC, but if they do, I want them to get the proper treatment ASAP so they will have the best outcome possible. With early detection and treatment it can be overcome. Have no doubt about that.
You and your husband need to get to the bottom of this rise in AFP then you will be able to move forward and deal with his hep C and liver disease.
Hector
Is this a hepatologist at the liver transplant center?
"endoscopy, cat scan and ultra sound?"
Endoscopy is used to detect/see varices. A common complication of cirrhosis. And cirrhosis of the liver, stage 4 liver disease increases the risk of developing liver cancer.
"Patients with chronic hepatitis C and cirrhosis have a 2 to 5% annual risk and a 7% to 14% risk over 5 years of developing HCC. The risk of developing HCC among persons infected with HCV increases with substantial alcohol intake—the risk increases in a linear fashion with daily alcohol intake greater than 60 g (approximately 6 cans of beer, shots of liquor, or glasses of wine). The overall incidence rate of HCC is approximately three times higher in males than females. "
Varices are enlarged veins that can appear in patients with cirrhosis and portal hypertension. Portal hypertension occurs because when a person has cirrhosis most of their liver is made up of scarring. Scarring block blood flow causing the blood pressure to rise as the natural flow of blood from the digestive system up through the liver back into the heart is meets resistance due to the scarring. When the blood can't flow naturally through the liver it finds other arteries to flow back to the heart. These arteries follow along the digestive system. Commonly varices in the esophagus develop. These arteries are not "designed" to carry this increased blood flow and so when they expand if they expand too much they can burst causing either vomiting or defecating of blood. HIgh dangerous occurrences requiring immediate ER attention to stop the loss of blood. So doctors monitor varices in patients with cirrhosis that is way endoscopy is performed. To treat portal hypertension first the patient will usually be given a med to reduce their heart rate and lower the blood pressure.Nadolol is commonly used. If it appears that the arteries are in danger of bursting "banding" of the risky artery locations will be performed to prevent bleeding.
A CAT scan can detect many tumors if especially those greater than 1.0 cm in size if the proper protocol is followed. But no CAT scan, ultrasound or MRI is 100%. All liver specialists know this. That is why they will sometimes use AFP-L3 to determine if a high AFP level is being caused by liver cancer or something else.
Surveillance of HCC when done in a cirrhotic patient is normally done every 6 or 12 months using both ultrasound and AFP. The combo makes it more likely that one or the other or both will detect any cancer that is present.
"Hepatic Ultrasound:
Hepatic ultrasound is reported to have a sensitivity of 65 to 80% and specificity 87 to 94% for detecting HCC. The clinician’s order for the hepatic ultrasound should designate the purpose of screening for HCC and the test should focus on examination of the right upper quadrant region, including evaluation of the liver for any evidence of a hepatic mass. The interpretation of ultrasound is operator-dependent and can be difficult in persons who are obese or have underlying cirrhosis, particularly those with nodular cirrhosis.
"Computed Tomographic Abdominal Scan: For patients who have a liver nodule greater than 1 cm detected on ultrasound, many experts recommend using a 4-phase (unenhanced, arterial, venous, and delayed) dynamic contrast CT scan of the liver as a secondary test for diagnosis. During the arterial phase, HCC lesions enhance more intensely than the surrounding liver, but the opposite is observed during the venous and washout phases (where HCC lesions have little enhancement). The characteristic finding with HCC is presence of arterial hypervascularity (uptake) in the lesion followed by venous or delayed phase washout. The role of 4-phase CT scan in the diagnosis of HCC is particularly important since many experts rely on CT or magnetic resonance imaging (MRI) findings to establish the diagnosis, without the need for liver biopsy, if characteristic radiographic findings for HCC are present.
Liver Magnetic Resonance imaging (MRI): For patients who have a nodule greater than 1 cm detected on ultrasound, a dynamic contrast-enhanced MRI is often recommended as a secondary test. This should be distinguished from the use of MRI as a screening test since current guidelines do not recommend MRI as a screening test."
I hope this helps. It is complicated, lever disease is complicated as there are many factors at work at the same time, so I hope I made it somewhat understandable.
Hector
"endoscopy, cat scan and ultra sound?"
Endoscopy is used to detect/see varices. A common complication of cirrhosis. And cirrhosis of the liver, stage 4 liver disease increases the risk of developing liver cancer.
"Patients with chronic hepatitis C and cirrhosis have a 2 to 5% annual risk and a 7% to 14% risk over 5 years of developing HCC. The risk of developing HCC among persons infected with HCV increases with substantial alcohol intake—the risk increases in a linear fashion with daily alcohol intake greater than 60 g (approximately 6 cans of beer, shots of liquor, or glasses of wine). The overall incidence rate of HCC is approximately three times higher in males than females. "
Varices are enlarged veins that can appear in patients with cirrhosis and portal hypertension. Portal hypertension occurs because when a person has cirrhosis most of their liver is made up of scarring. Scarring block blood flow causing the blood pressure to rise as the natural flow of blood from the digestive system up through the liver back into the heart is meets resistance due to the scarring. When the blood can't flow naturally through the liver it finds other arteries to flow back to the heart. These arteries follow along the digestive system. Commonly varices in the esophagus develop. These arteries are not "designed" to carry this increased blood flow and so when they expand if they expand too much they can burst causing either vomiting or defecating of blood. HIgh dangerous occurrences requiring immediate ER attention to stop the loss of blood. So doctors monitor varices in patients with cirrhosis that is way endoscopy is performed. To treat portal hypertension first the patient will usually be given a med to reduce their heart rate and lower the blood pressure.Nadolol is commonly used. If it appears that the arteries are in danger of bursting "banding" of the risky artery locations will be performed to prevent bleeding.
A CAT scan can detect many tumors if especially those greater than 1.0 cm in size if the proper protocol is followed. But no CAT scan, ultrasound or MRI is 100%. All liver specialists know this. That is why they will sometimes use AFP-L3 to determine if a high AFP level is being caused by liver cancer or something else.
Surveillance of HCC when done in a cirrhotic patient is normally done every 6 or 12 months using both ultrasound and AFP. The combo makes it more likely that one or the other or both will detect any cancer that is present.
"Hepatic Ultrasound:
Hepatic ultrasound is reported to have a sensitivity of 65 to 80% and specificity 87 to 94% for detecting HCC. The clinician’s order for the hepatic ultrasound should designate the purpose of screening for HCC and the test should focus on examination of the right upper quadrant region, including evaluation of the liver for any evidence of a hepatic mass. The interpretation of ultrasound is operator-dependent and can be difficult in persons who are obese or have underlying cirrhosis, particularly those with nodular cirrhosis.
"Computed Tomographic Abdominal Scan: For patients who have a liver nodule greater than 1 cm detected on ultrasound, many experts recommend using a 4-phase (unenhanced, arterial, venous, and delayed) dynamic contrast CT scan of the liver as a secondary test for diagnosis. During the arterial phase, HCC lesions enhance more intensely than the surrounding liver, but the opposite is observed during the venous and washout phases (where HCC lesions have little enhancement). The characteristic finding with HCC is presence of arterial hypervascularity (uptake) in the lesion followed by venous or delayed phase washout. The role of 4-phase CT scan in the diagnosis of HCC is particularly important since many experts rely on CT or magnetic resonance imaging (MRI) findings to establish the diagnosis, without the need for liver biopsy, if characteristic radiographic findings for HCC are present.
Liver Magnetic Resonance imaging (MRI): For patients who have a nodule greater than 1 cm detected on ultrasound, a dynamic contrast-enhanced MRI is often recommended as a secondary test. This should be distinguished from the use of MRI as a screening test since current guidelines do not recommend MRI as a screening test."
I hope this helps. It is complicated, lever disease is complicated as there are many factors at work at the same time, so I hope I made it somewhat understandable.
Hector
Thank you for your comment I am very scared. If my husbands afp was 189 or 200 why wouldn't DR do an MRI first instead of endoscopy, cat scan and ultra sound?
The AFP is not going down. There is really little difference between the two. AFP numbers that is that high can be very serious and need immediate, specialized attention an proper diagnoses. A normal AFP is under 10 ng/ml.
Sometimes higher levels of AFP are found in people with hep C due to inflammation of the liver. But AFP over 100 from inflammation is rare and must be monitored closely and it cause diagnosed as soon as possible as liver cancer can be life-threatening.
There are a number of serious conditions that can also cause AFP to rise that high, but if your husband has chronic hepatitis C the most likely cause would be HCC sometimes just called "liver cancer". The risk of liver cancer rises when a person has cirrhosis of the liver especially when their cirrhosis is caused by the hepatitis C virus. This is why people with cirrhosis are tested for liver cancer every 6 months. Liver cancer has no symptoms like most cancers so testing is essential as when symptoms do appear it is often too advanced for treatment.
"In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
* Liver cancer. Hepatocellular Carcinoma (HCC)
* Germ cell tumors (cancer of the testes and ovaries)
* Metastatic cancer in the liver (originating in other organs)"
A MRI with and without contrast at a transplant center that is experienced in diagnosing liver cancer is the best and most reliable way to determine if a person has liver cancer and should have been done as soon as his rising AFP was seen.
Endoscopy and colonoscopy have nothing to do with liver cancer.
Although a CT scan was done it has to be done properly with and without contrast, reviewed by a pathologist experienced in diagnosing liver cancer. But in some cases there are tumors that will first show themselves by a rise in AFP before they can be seen by any imaging test. The patient must be monitored closely as these tumors tend to be aggressive tumors and they have to be seen before they can be treated. Sometimes different contrast can see the tumors that other types of contrast can't. I had one myself that took months to be visible on a MRI. Only a transplant center and their team of doctors can determine if this is the case.
There are other blood test that can determine if the AFP level is a result of cancer or not that can performed if the tumor(s) can not be seen on imaging. Only a hepatologist experienced in the treatment of liver cancer knows how to use these other test for proper diagnoses.
If I were you I would contact the nearest liver transplant center TODAY and tell them the facts as you have stated them. They will need to see your husband ASAP. I don't want to scare you but liver cancer is as about as serious as it gets. It must be diagnosed and treated in its earliest stages for the best outcomes.
I had liver cancer with high AFP for 2 1/2 years and luckily got a liver transplant 5 months ago in time to save my life. Liver cancer is survivable if diagnosed early and treated by doctors that specialized in liver cancer (HCC). Only transplant center hepatologists, interventional radiologists and oncologist that work at liver transplant centers are qualified to diagnose and treat your husband properly.
Hopefully the doctors will determine what is going on very soon and if needed take any steps needed.
I wish you both the best.
Hector
Sometimes higher levels of AFP are found in people with hep C due to inflammation of the liver. But AFP over 100 from inflammation is rare and must be monitored closely and it cause diagnosed as soon as possible as liver cancer can be life-threatening.
There are a number of serious conditions that can also cause AFP to rise that high, but if your husband has chronic hepatitis C the most likely cause would be HCC sometimes just called "liver cancer". The risk of liver cancer rises when a person has cirrhosis of the liver especially when their cirrhosis is caused by the hepatitis C virus. This is why people with cirrhosis are tested for liver cancer every 6 months. Liver cancer has no symptoms like most cancers so testing is essential as when symptoms do appear it is often too advanced for treatment.
"In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
* Liver cancer. Hepatocellular Carcinoma (HCC)
* Germ cell tumors (cancer of the testes and ovaries)
* Metastatic cancer in the liver (originating in other organs)"
A MRI with and without contrast at a transplant center that is experienced in diagnosing liver cancer is the best and most reliable way to determine if a person has liver cancer and should have been done as soon as his rising AFP was seen.
Endoscopy and colonoscopy have nothing to do with liver cancer.
Although a CT scan was done it has to be done properly with and without contrast, reviewed by a pathologist experienced in diagnosing liver cancer. But in some cases there are tumors that will first show themselves by a rise in AFP before they can be seen by any imaging test. The patient must be monitored closely as these tumors tend to be aggressive tumors and they have to be seen before they can be treated. Sometimes different contrast can see the tumors that other types of contrast can't. I had one myself that took months to be visible on a MRI. Only a transplant center and their team of doctors can determine if this is the case.
There are other blood test that can determine if the AFP level is a result of cancer or not that can performed if the tumor(s) can not be seen on imaging. Only a hepatologist experienced in the treatment of liver cancer knows how to use these other test for proper diagnoses.
If I were you I would contact the nearest liver transplant center TODAY and tell them the facts as you have stated them. They will need to see your husband ASAP. I don't want to scare you but liver cancer is as about as serious as it gets. It must be diagnosed and treated in its earliest stages for the best outcomes.
I had liver cancer with high AFP for 2 1/2 years and luckily got a liver transplant 5 months ago in time to save my life. Liver cancer is survivable if diagnosed early and treated by doctors that specialized in liver cancer (HCC). Only transplant center hepatologists, interventional radiologists and oncologist that work at liver transplant centers are qualified to diagnose and treat your husband properly.
Hopefully the doctors will determine what is going on very soon and if needed take any steps needed.
I wish you both the best.
Hector
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