| Theme |
Controversies Over Diagnosis and Treatment of Hepatocellular Carcinoma |
| Title |
Tumor Markers (AFP, AFP-L3 and PIVKA-II) in Early Diagnosis of Hepatocellular Carcinoma |
| Author |
Hiroshi Ashihara |
Third Department of Internal Medicine, Kumamoto University School of Medicine |
| Author |
Sigetoshi Fujiyama |
Third Department of Internal Medicine, Kumamoto University School of Medicine |
| [ Summary ] |
The mainstays for the early diagnosis for hepatocellular carcinoma (HCC) include serological tumor markers, such as alpha-fetoprotein (AFP), the L3 fraction there of (AFP-L3) and protein induced by vitamin K absence or antagonist-II (PIVKA-II), in addition to imaging modalities. These modalities do not correlate, but complement each other. Hence, a combination diagnoses to take advantage of the characteristics of each modality needs to be formulated. First, it is necessary to identify those patients at high risk for developing HCC, such as those with chronic hepatitis or liver cirrhosis. It is also necessary to identify them in follow-ups for serological tumor markers. Those testing positive for any marker are at the highest risk for developing this condition when positive results are obtained in concert with imaging. This is so even when imaging fails to disclose any space-occupying lesions. Because these serum markers can miss small tumors, they should be applied hand in hand with sensitive imaging modalities in the detection of early HCCs.
Equally important in the management of patients with small HCC are biological indicators for malignancy, the selection of therapeutic intervention and prediction of outcome. |