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How to make sense of AFP numbers

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  • How to make sense of AFP numbers


    My husband had TC in 1988. He was treated then and we thought he was fine until recently. Now after 23 years we see some elevation in his AFP. The amount (11.2 ng/ml) seems marginal (normal range 0.0-8.0 ng/ml), but the urologist believed it could be a recurrence and urged us to investigate it with ultrasound and CT Scan. We've done the Ultrasound today and the CT Scan is scheduled for the day after tomorrow. I've read a lot about AFP on the internet, but I haven't found how high is too high. We repeated the test about a month after the first time and the result came out 11.4 ng/ml. The lab says that they tested AFP using ADVIA Centaur method and the normal range in this lab is 0.0-8.0 ng/ml. I really appreciate if somebody answers these questions:

    Given the method and the normal range,
    1) how high is 11.2 or 11.4? (I've seen people talk about 400 ng/ml and above for cancer cases)
    2) how severe is the elevation from 11.2 to 11.4 in a month?
    3) in other words, does anyone know if this amount of AFP could suggest Testicular cancer?

    I'm concerned about doing the CT Scan. I'm afraid if he doesn't have cancer and the AFP elevation is due to some other reason, we are exposing him to unnecessary radiation. I really appreciate if someone answers my questions so that we know what to do with proceeding with the CT Scan. Thanks a lot!

  • #2
    Hi, and welcome to you and hubby. Congrats on 23 years of survivorship! I hope you have been enjoying life.

    AFP slightly elevated and stable means that the cause is not likely cancer related. A 0.2 increase is insignificant. Mine fluctuates about that much between 4-6 monthly tests from the beginning. These days, the rule of thumb is that cancer is not presumed for any reading less than 25. And while radiation from a CT is a bummer, the risks of cancer from other causes are much greater. Especially with age.

    When you get a chance, could you post a bit more of hubby's history? Something may ring a bell with somebody who has experienced elevated AFP. Also, among the bad news of new diagnoses, it's always encouraging to newcomers that there is long life and normalcy after the battle.

    Best wishes. Let us know how it goes.
    "Statistics are human beings with the tears wiped off" - Paul Brodeur
    Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)


    • #3
      Thanks Paul for taking time to read and to answer my questions. We talked to some other doctors that are not specialist in this area but as you said they believed that CT Scan's benefits outweighs its harms in this case. So we are going to go for it tomorrow.

      You are right that a bit more information can increase our chance of getting more accurate answer, and other people can benefit from it as well.

      Here's the past history. We have lost the original documents so I can't give you more info. This information is what is recorded with our current family doctor:

      - in 1988 diagnosed with TC: teratoma with embryonal elements
      - treated with VP-16 and Cis-Platinum
      - left orchiectomy and aortic node dissection
      - age 21

      We are going to discuss the results with the doctor on Friday. I'll let you know the results.

      I hope that he is okay and it will be a relief and sense of gratefulness for us and a sign of hope for all the others.


      • #4
        We did the CT and Ultra-Sound. US is clear. There's a small nodule about 2mm in his lung. We don't know yet if it is cancerous. The doctor has asked for PET/CT to investigate this nodule and also to check the other parts of the body. We are skeptical about doing the PET/CT because of the amount of radiation. Also we learned that PET/CT doesn't work very well with tumors less than one centimeter. We decided to wait till the end of the month and run another AFP test. If it's still rising, then we'll go for PET/CT.


        • #5
          It is not unusual for people to have small benign nodules in their lungs. I work in radiology and do cat scans as well and we see them quite frequently. Normally they just watch them to make sure they stay stable. I think your plan to recheck labs is a good one. I hope his next test comes back normal
          Tina, wife to Gene
          Right I/O 2/21/11
          60% embryonal carcinoma- 40% seminoma with L/V invasion, Stage 1B, Cat Scan- clear
          HCG- 1.2, AFP-1.5, LDH-normal
          BEP X 2 started 3-7-11
          Bleo canceled for 2nd round, lung issues
          EP 3-28-11 X 5 days, finished chemo 4-1-11
          F/U cat scan 4/14/11 - Stable
          3rd round EP as precaution because Bleo was cancelled, start 4-25, finished chemo 4-29-11, pneumonia 5-6-11
          6-1-11, 8-3-11, 9-7-11, 10-19-11, 11-16-11, 12-18-11, 1-18-12, 5-8-12 Clear


          • #6
            Thanks MrsB! I'll post updates here when we get more information.


            • #7
              We tested his AFP after a month. It's dropped from 11.4 ng/ml to 9.8 ng/ml, still above normal (8.0). We were hoping that a decrease in AFP would be a proof that it's not cancer, but his doctor still recommends PET/CT. We're going to see the doctor tomorrow to ask why he still thinks it might be a relapse. Does anyone know if AFP can fluctuate in cancer cases? Thanks!


              • #8
                We saw the doctor. He suggested that since AFP is decreased we can skip PET/CT for the moment, and go for checking his AFP and another CT of chest in 6 weeks. He said that AFP fluctuation could exist in presence of cancer, although he didn't tell me why. Hopefully, this is going to be all resolved. I'll keep you posted.