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Alpha fetoprotein (AFP) is a marker used to detect and diagnose certain cancers and liver diseases. AFP blood testing may also be performed during pregnancy to determine a baby’s risk for a congenital disability or genetic disorder.

AFP is an albumin-like glycoprotein which performs similar functions to albumin in foetal circulation. It is initially produced by the yolk sac, but by 13 weeks of gestation the foetal liver is the main source. After birth, levels in the infant decline rapidly during the first year and reach a low basal range by the end of the second year. These low levels of between 0 and 10 IU/mL are maintained throughout normal adult life.

Elevation of serum AFP may also occur in many patients suffering from primary hepatocellular carcinoma, non-seminomatous testicular cancer and endodermal tumours of the ovary. Elevated levels have also been found in non-malignant diseases such as liver cirrhosis and viral hepatitis.

The most important application of AFP testing in cancer management is for testicular cancer. Although not present in pure seminoma, elevated serum AFP is closely associated with non-seminomatous testicular cancer. The measurement of AFP in serum, in conjunction with serum hCG is an established regimen for monitoring patients with non-seminomatous testicular cancer. The growth rate of progressive cancer can be monitored by serially measuring serum AFP concentration over time.