## Alpha-Fetoprotein (AFP) in HCC **Key Point:** AFP is the most sensitive and specific tumor marker for hepatocellular carcinoma (HCC), produced by malignant hepatocytes and regenerating liver tissue. ### Clinical Significance - **Sensitivity:** 60–70% in HCC; higher in advanced disease - **Specificity:** 95–98% for HCC when levels > 400 ng/mL - **Diagnostic criterion:** AFP > 20 ng/mL in a cirrhotic patient with a nodule 1–2 cm on imaging is diagnostic of HCC (AASLD criteria) - **Prognostic value:** High AFP (> 400 ng/mL) indicates poor prognosis and advanced disease ### Other Markers in HCC | Marker | Tissue Origin | Sensitivity in HCC | Specificity | |--------|---------------|-------------------|-------------| | AFP | Hepatocytes | 60–70% | 95–98% (>400 ng/mL) | | CEA | Colon, GI | Low | Low | | CA 19-9 | Biliary, pancreas | Moderate | Low | | PIVKA-II | Hepatocytes | 40–60% | High | **High-Yield:** AFP is the gold standard marker for HCC screening in cirrhotic patients and is part of all major HCC diagnostic algorithms (AASLD, EASL, BCLC). **Clinical Pearl:** A rising AFP trend (even within normal range) in a cirrhotic patient warrants imaging surveillance; absolute value matters less than serial change. [cite:Robbins 10e Ch 18] 
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