Alpha-Fetoprotein (AFP): Liver Cancer & Pregnancy Marker
Content last reviewed 2026-09-12 · Educational information — not medical advice
Quick answer
AFP serves two roles: prenatal screening for neural-tube defects (elevated) and Down syndrome (low), plus adult liver-cancer surveillance in cirrhosis patients. Adult elevations demand imaging investigation — they rarely appear from benign causes.
Dual clinical contexts
Pregnancy: AFP produced by fetal liver/yolk sac — rises then falls through gestation. MSAFP (maternal serum) screening integrates with estriol/hCG/Inhibin A for quad-screen risk calculations. Elevated → neural-tube-defect workup; low → trisomy-21 association.
Adults: elevated AFP signals hepatocellular regeneration or malignancy. Cirrhosis patients get AFP+ultrasound every 6 months for early HCC detection (surveillance imperfect but standard).
Adult interpretation
<10 ng/mL: normal · 10–200: chronic hepatitis, cirrhosis, HCC possible, germ-cell tumors · 200–400+: strongly HCC-suggestive · >10,000: advanced HCC or nonseminomatous germ-cell tumors. LECTIN-reactive AFP fractionation distinguishes HCC from benign regeneration when totals ambiguous.
What AFP DOESN'T screen
AFP is NOT a general cancer screening test — ordering it as 'cancer blood work' in asymptomatic adults generates false-positive cascades. It serves established-disease monitoring (treatment response, recurrence) and high-risk-population surveillance only.
Non-malignant AFP elevations
Acute hepatitis flares (transient surge), cirrhosis (modest sustained elevations), tyrosinemia, ataxia-telangiectasia, and pregnancy (expected). Levels >500 essentially always pathologic — investigation mandatory.
Order this test online
Direct-access laboratory testing — no appointment or doctor visit required. Results delivered as secure PDFs.
We may earn a commission when you order through partner links. Educational content only — never a substitute for professional medical advice.
Frequently asked questions
My AFP is 15 — do I have liver cancer?
Normal-range with cirrhosis — surveillance continues; single mild elevation without ultrasound lesion is reassuring.
Can I test AFP during pregnancy without prenatal care?
Maternal AFP is standard prenatal screening — discuss with obstetric provider; interpreting without gestational-age context is unreliable.