## Alpha-Fetoprotein (AFP) in HCC **Key Point:** AFP is the gold standard tumor marker for HCC, with sensitivity of 60–70% and specificity >90% when levels >400 ng/mL in a cirrhotic patient. ### Why AFP is Most Common: - Produced by malignant hepatocytes and regenerating liver tissue - Elevated in >70% of HCC cases globally - In India, HCC is often associated with hepatitis B and C cirrhosis, where AFP is routinely monitored - Serial AFP elevation (doubling time <20 days) is diagnostic in cirrhotic patients ### Clinical Utility: | Marker | HCC Sensitivity | Specificity | Notes | |--------|-----------------|-------------|-------| | AFP | 60–70% | >90% | Gold standard; >400 ng/mL highly specific | | CEA | 10–20% | Variable | Used in colorectal cancer, not HCC | | CA 19-9 | 15–30% | Variable | Pancreatic/biliary marker | | PSA | Not applicable | Not applicable | Prostate-specific | **High-Yield:** AFP >400 ng/mL in a cirrhotic patient on ultrasound is diagnostic of HCC without need for biopsy (AASLD criteria).
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