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AFP marker driving me crazy

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  • AFP marker driving me crazy

    Hi all,
    I am not new at the forum but this is my first post.
    My tests diagnosed a TC on Dec/04 and I rapidly did a left I/O. At that time AFP was < 6.0 and B-HCG < 0.1 indicating a seminoma that was confirmed with the anatomo analysis.
    All tests were clear until Jan/07 when a big 9 cm retroperitoneal mass was found. Blood tests indicated that AFP was 8.22 and B-HCG 6.2, being a sign of non-seminomal components.
    After the first BEP cycle, my CT images showed that the mass has completly disappeared! My B-HCG has dropped below 0.1 but my AFP raised to 11.13. My doctor, a reference specialist in TC here in Sao Paulo, Brazil, was concerned about that but he decided to follow up the results and keep the threatment. After more 3 BEPs the results was no image, AFP = 9.62 and B-HCG = 0.2. The decision was surveillance but with a closer follow up.
    For the last 2 years, doing monthly blood tests and more than 5 CTs, all images have been clear but the AFP is still kidding with us. Sometimes its near 8 and other times close to 13. It raises and drops monthly.
    With so many TC cases, my doctor says that this is not the first time he faces such AFP behavior. Sometimes, results are out of the 95% normal curve. His studies also point out to changes during chemoterapy that lead to different normal AFP levels. He says that this is a critical situation that demands a special attention, but no despair.
    Does anyone know other case where the marker by itself was not definitive?
    I once read that AFP levels below 25 are not conclusive. Is that true? My highest AFP was 13.06 so far.
    Is there any relation between AFP level and alcohol consumption? I know that liver problems could change AFP but I once did liver tests and they were normal.
    Tomorrow I will have a new CT and I am really scared about it.
    Last edited by nfranco; 05-06-09, 12:15 AM.
    right inguinal orchiectomy Dec/04 > seminoma, stage I > surveillance > Jan/06 9 cm retroperitoneal mass, suspected carcinoma > 4x BEP > surveillance since but AFP between 8 and 13.

  • #2
    Gustavo, "welcome" doesn't seem quite right, since you've been registered for so long. It's good to see you post.

    Mark Kantrowitz maintains a page that lists possible causes of false positive AFP readings at this link. I expect that unless your AFP were to continue to rise rather than fluctuate in its current range, it's best to keep watch.
    right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since

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    • #3
      Hey Gustavo

      Just to let you know that my AFP has never been within the 'NORMAL' range and they can move a few points. I am nearing 8 years and quite some time ago the med team decided that this is "my normal". The best description that I have had is that some people are short and some tall and there is an average height and I just happen to be Taller than the norm.

      Also become a TC x2 last year and at that time was actually nearest to 'normal' I had been for a number of years. After TCx2 I am still within my normal variations. Hey have paid a lot of money to be told I am not normal, darrr I knew that.

      I would not threat too much.


      TC1: May 2001 / Right orchiectomy / seminoma stage 1 / Radiation
      TC2: July 2008 / Left orchiectomy / seminoma stage 1 / X2 Prostheses / Reandron (long term Testosterone injections)


      • #4
        Kiwi: already knowing that you are not normal is great. Much money was spent with CTs but you have saved a lot with psychoanalysts ... lol =)

        Scott: thanks a lot for Kantrowitz' link. It really made things clear.

        I have just arrived from my CT exam and there is no image. Tomorrow I'll talk to my doctor and I return to post his opinion.

        right inguinal orchiectomy Dec/04 > seminoma, stage I > surveillance > Jan/06 9 cm retroperitoneal mass, suspected carcinoma > 4x BEP > surveillance since but AFP between 8 and 13.


        • #5
          Hello Gustavo,

          When my son was first diagnosed in 2006 his AFP and HCG were both elevated. He had non-seminoma/ embryonal carcinoma 95%/ yolk sac 5%
          and a mass in the retroperitoneal area too.

          After chemo both AFP and HCG returned to normal, but the mass was still there

          Three weeks after ending chemo his AFP started going back up, and he had RPLND. There was yolk sac in the pathology which was causing the AFP. After the RPLND his AFP returned to normal (3.2 area)

          A month later his AFP started fluctuating.. went up to 9.2 and we started testing it weekly to see if it continued an upward trend.
          Next one was 11, then down to the 7s range. It stayed in the 7s range for three tests and then went back down to the 2.9 to 3.8 range.

          When this started going on I was frantic, but thankfully it was nothing and my son is ok to date. July will be his 2 year all clear mark.

          I know the AFP can fluctuate and I also know it can take its toll on you emotionally, but hopefully the fact that it is fluctuating rather than steadily rising will give you some comfort. Just make sure you keep a watch on it to be sure.

          Praying that all is well


          Son Anthony DX 12/11/06
          L/O 12/20/06 Stage IIIA, 95% EC, 5% Yolk Sac
          4XEP 1/29-4/6/ 07
          AFP started increasing3 wks later
          Residual abdominal mass found on CT
          RPLND 6/8/07
          Cancer in pathology-
          80% mature teratoma, 20% Yolk Sac. --
          No adjuvent chemo and
          AFP normalised

          July 22, 2010 ---- 3 years all clear!


          • #6
            Hi Gustavo,
            It's just under a year since my i/o for non-seminoma. I had problems with my AFP tests and it took 5 months for the markers to drop to normal rather than the expected 4-5 weeks. Then I had a blip where they rose to 14, but have now dropped down and seem to be staying around the 5 level. My oncologist said that everyone is different and not to worry unless they start going above the 20-25 range. All of my bloods have been done on a monthly basis and I got the impression that they would only be done more regularly if they got to the 25 level as that would imply more treatment would be required. When my AFP level rose, they ran other blood tests for liver etc, but all of these turned out to be normal.
            Hope you get good news from your doctor.
            Left orchiectomy May 2008, AFP 1600, βHCG 200and normal after 5 months (AFP4, βHCG<1)
            Non-Seminoma stage 1 - Under surveillance
            3 years on and still all clear


            • #7

              I too had an "issue" with AFP and HCG. Mine elevated right at the end of my second and final cycle of BEP. After being retested the following week they had both returned to normal. I did though have 6-7 beers watching soccer the day before. I was told this could have been a factor given your liver is so comprised after 6 weeks of chemo. My levels have all been normal now for nearly 9 months.


              approx. 28 April 08 - Noticed lump
              23 June 08 - Diagnosed (Yep! Left it 2 months!)
              30 June 08 - R I/O (NSGCT 90% EC Stage 1)
              28 July 08 - Start 2XBEP
              3 Sept 08 - Finished chemo


              • #8
                I'd like to thank you all for your comments.
                It's been 2 years since the end of my BEP and my CT is all clear. AFP is 13 but my doctor is quite confident that my normal is over 7. Too much beer all over the Carnaval is a reasonable explanation.
                Next blood test will be in 3 months and CT in 6 months. Attention is necessary but with no stress.
                Last edited by nfranco; 05-06-09, 12:16 AM.
                right inguinal orchiectomy Dec/04 > seminoma, stage I > surveillance > Jan/06 9 cm retroperitoneal mass, suspected carcinoma > 4x BEP > surveillance since but AFP between 8 and 13.