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SURVEILLANCE FOR LIVER CANCER

As liver cancer cells grow they produce abnormal proteins and secrete them into the blood. These proteins are known as liver cancer biomarkers because they are produced primarily by liver cancer cells. Currently available liver cancer biomarkers are Alpha Fetoprotein (AFP), Lectin reactive Alpha Fetoprotein (AFP-L3), and Des-gamma-carboxy prothrombin (DCP). In recently published studies, researchers found that the three liver cancer biomarkers complement each other [3,4].

Liver cancer biomarkers that can help assess risk for development of liver cancer.

Liver cancer surveillance applies screening tests such as blood tests and ultrasonography every six months. Blood tests may include measurement of liver cancer biomarkers to supplement ultrasonography results. Routine monitoring of currently available liver cancer biomarkers AFP-L3 and DCP allow patients to be assessed for risk of developing liver cancer. That is, periodic measurement of these biomarkers can give an early warning signal for developing liver cancer.

How do I access these biomarker tests?

Liver cancer biomarkers AFP-L3 and DCP are FDA cleared, Medicare reimbursed and covered by some insurance companies. Ask your doctor about these tests. Each test has a unique code (called a CPT code) that your doctor will need to know in order to prescribe these tests. The CPT codes for each test are listed below.

CPT Code
AFP Biomarker Test          82105
AFP-L3% Biomarker Test   82107
DCP Biomarker Test          83951

More information can be found at www.labtestsonline.org

Effectiveness of Liver Cancer Biomarkers - AFP-L3 and DCP

AFP-L3 (lectin reactive alpha-fetoprotein) is one of the two most effective liver cancer biomarkers available. Serum AFP-L3 level has been shown to increase as early as 21 months before liver cancer detection with conventional tools [5]. Patients who were positive for AFP-L3 were also 8 times more likely to develop liver cancer over this period.

DCP (des-gamma-carboxy prothrombin) is another liver cancer biomarker that has been demonstrated to be effective. Many clinical studies show that DCP is accurate in discriminating chronic liver diseases (e.g., hepatitis, cirrhosis) from liver cancer. This reduces the rate of false-positive diagnosis and allows detection of liver cancer in its early stages. In addition, DCP is also associated with tumor characteristics and patient outcome [3, 5-9].

Measuring AFP-L3 and DCP in tandem enhances clinical accuracy for liver cancer detection. In recently published studies, researchers found that the two biomarkers complement each other. This complementarity allows detection of more liver cancer patients while maintaining clinical accuracy. Periodic measurement of these biomarkers in tandem gives early warning while reducing your exposure to harmful radiation from CT or MRI scans.

Ask your specialist about including AFP-L3 and DCP tests in your liver cancer surveillance program. The test only requires small volume of your blood. Your doctor in turn will be able to determine the most up to date treatment plan and provide the care that you deserve. Be informed and take charge of your health.

Both AFP-L3 and DCP tests have the FDA clearance as risk assessment tests for liver cancer development. Both tests are currently available at major US reference labs.


References

Survival in Asian Americans After Treatments for Hepatocellular Carcinoma A Seven-year Experience at UCLA. Tong, M., et al., J Clin Gastroenterol 2010 Mar;44(3):e63-70.
Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Stravitz, R., et al.,The American Journal of Medicine 2008;121:119-126.
Clinical Evaluation of Lens culinaris Agglutinin-Reactive a-Fetoprotein and Des-gamma-Carboxy Prothrombin in Histologically Proven Hepatocellular Carcinoma in the United States. Carr B, et al., Dig Dis Sci. 2007; 52:776-782
Early recognition of rapidly growing hepatocellular carcinoma with use of AFP-L3%: a multicenter, prospective, longitudinal and double-blinded study in North America. Poster presented at: Digestive Disease Week. Sherman, M. et al., May 14-19. 2005; Chicago, Ill
Prediction of recurrence of hepatocellular carcinoma after curative ablation suing three tumor markers. Tateishi, R., et al., Hepatology 2006 Dec; 44(6):1518-1527
Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: A comparison of AFP, DCP, and AFP-L3. Volk, M. et al., Cancer Biomarkers 2007; 3:79-87.
Des-gamma-carboxy prothrombin as a useful predisposing factor for the development of portal venous invasion in patients with hepatocellular carcinoma.Koike, Y. et al., Cancer 2001; 91:561-9.
Sensitivity and specificity of des-gamma-carboxy prothrombin for diagnosis of patients with hepato-cellular carcinoma varies according to tumor size. Nakamura, S. et al., American Journal of Gastroenterology, 2006, 101:2038-2043.
Prognostic significance of simultaneous measurement of three tumor markers in patients with hepatocellular carcinoma. Toyoda, H. et al., Clinical Gastroenterology and Hepatology. 2006; 4:111-117.

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