In conjunction with abdominal ultrasonography, it is recommended that alphafetoprotein (AFP) be measured at six-monthly intervals in patients at high risk for hepatocellular carcinoma (especially those with liver cirrhosis related to hepatitis B or hepatitis C). A raised AFP is found in 80% of patients with hepatocellular carcinoma and in 40% of these patients, the AFP exceeds 1000 ng/mL.
However, AFP can be raised in other cancers, namely:
AFP can be raised in non-malignant conditions like:
Carcinoembryonic antigen (CEA) is a glycoprotein, which is present in normal mucosal cells but increased amounts are associated with adenocarcinoma, especially colorectal cancer. Levels exceeding 10 ug/L are rarely due to benign disease. Sensitivity increases with advancing colorectal cancer state. However, poorly differentiated tumours are less likely to produce CEA.
CEA levels are useful in assessing prognosis (with other factors), detecting recurrence and monitoring treatment in patients with colorectal cancer.
Conditions which may have elevated CEA include:
Elevated levels of CA19-9, an intracellular adhesion molecule, occur primarily in patients with pancreatic and biliary tract cancers, but may be raised in colorectal, gastric, hepatocellular, oesophageal and ovarian cancers.
Benign conditions such as cirrhosis, cholestasis, cholangitis and pancreatitis also result in elevations, although values are usually less than 1000 u/mL. CA19-9 may be raised in diabetes mellitus.
Another abnormal blood test result that requires further evaluation and treatment is anaemia. For men, anaemia is typically defined as a haemoglobin level of less than 13.5g/dL and in women as haemoglobin of less than 12g/ dL. Some patients with anaemia have no symptoms but can be symptomatic if the haemoglobin is significantly low.
Anaemia can be categorized as microcytic (MCV less than 80FL), normocytic (MCV 80-100FL) or macrocytic (MCV more than 100FL). The most common cause of microcytic anaemia is iron deficiency anaemia, although hereditary disorders like alpha thalassaemia or beta thalassaemia needs to be excluded.
The most common causes of iron deficiency anaemia are:
Vitamin B12 deficiency may be due to:
Patients with no or minimal symptoms and abnormal liver function test results are common. These abnormal liver function tests fall in three main groups:
i. Isolated hyperbilirubinemia
ii. Predominantly raised serum alkaline phosphatase (SAP) and gamma-GT
iii. Predominantly raised alanine transaminase (ALT) and Aspartate transaminase (AST)