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Liver Cancer Diagnosis

Primary liver cancer is the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide in 2020. [1] .Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Serological markers for hepatocellular carcinoma (HCC) are important for early diagnosis, as well as monitoring of tumour aggressiveness, treatment responsiveness, recurrence and survival. [1]

HCC is commonly performed using serum marker alfa-fetoprotein (AFP) often in combination with ultrasonography. [2] Ferritin is another commonly used clinical cancer biomarker, as cancer may alter the whole body iron metabolism, occasionally reflected in the change of the serum ferritin levels.[3,4]


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Clinical Significance


AFP is a serum glycoprotein that was first recognized as a marker for HCC more than 40 years ago and has since been described to detect preclinical HCC.[3] As a significant markers for HCC, AFP is helpful in assessing problems in management of HCC and monitoring treatment regiments. In addition, AFP is also an indicator of HCC risks mostly in patients with cirrhosis and HCV/HBV infections.[6]


Recent studies have found that tumor tissue can synthesize and secrete ferritin. It is reported that Ferritin has a sensitivity of 50.8% to 88.0% for the diagnosis of liver cancer. Also, NACB suggest that Ferritin can be used to monitor HCC in patients whose tumors do not produce AFP [7].


[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.

[2] Man-Fung Yuen, Ching-Lung Lai. Serological markers of liver cancer. Best Pract Res Clin Gastroenterol. 2005 Feb;19(1):91-9. doi: 10.1016/j.bpg.2004.10.003.

[3] Eldad S. Bialecki, Adrian M. Di Bisceglie. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34. doi: 10.1080/13651820410024049.

[4] Torti SV and Torti FM: Iron and ferritin in inflammation and cancer. Adv Inorg Biochem. 10:119–137. 1994.

[5] Richardson DR: Iron and neoplasia: serum transferrin receptor and ferritin in prostate cancer. J Lab Clin Med. 144:173–175. 2004.

[6] Jawed Altaf Baig, Junaid Mahmood Alam, Syed Riaz Mahmood, Mohammad Baig, Rabia Shaheen, Ishrat Sultana, Abdul Waheed. Hepatocellular carcinoma (HCC) and diagnostic significance of A-fetoprotein (AFP). J Ayub Med Coll Abbottabad. Jan-Mar 2009;21(1):72-5.

[7] Sturgeon CM, Duffy MJ, Hofmann BR, Lamerz R, Fritsche HA, Gaarenstroom K, Bonfrer J, Ecke TH, Grossman HB, Hayes P, Hoffmann RT, Lerner SP, Löhe F, Louhimo J, Sawczuk I, Taketa K, Diamandis EP; National Academy of Clinical Biochemistry. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in liver, bladder, cervical, and gastric cancers. Clin Chem. 2010 Jun;56(6):e1-48. doi: 10.1373/clinchem.2009.133124. Epub 2010 Mar 5. PMID: 20207771.

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