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Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children

Last updated Feb. 27, 2019

Approved by: Krish Tangella MD, MBA, FCAP

The Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children measures the amount of alpha feto-protein in blood.

What are the other Names for this Test? (Equivalent Terms)

  • Alpha Feto-Globulin Tumor Marker Test in Infants and Children
  • Alpha Fetoprotein Level Tumor Marker Test in Infants and Children
  • Total AFP Tumor Marker Test in Infants and Children

What is Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children? (Background Information)

  • Alpha feto-protein (AFP) is a form of serum protein similar to albumin, the most abundant protein in blood. It is produced by a developing fetus in the liver, yolk sac, and the gastrointestinal tract
  • Alpha feto-protein can be detected at elevated levels after birth for a few months, which is generally normal. The level of AFP starts to decrease soon after birth and is very low in normal adults i.e., less than 10 ng/ml (nanogram per milliliter)
  • Increased blood levels of alpha feto-protein may be observed with the following conditions:
    • Acute liver disease that includes hepatitis and extrahepatic biliary atresia
    • Ataxia telangiectasia: It is an uncommon, inherited disorder affecting the brain, spinal cord, and immune system
    • Tyrosinemia: It is a genetic condition that is characterized by the body’s inability to breakdown tyrosine (an amino acid), leading to a variety of signs and symptoms
  • The level of AFP may increase in infants and children with the following tumors:
    • Hepatocellular carcinoma (a form of cancer affecting the liver)
    • Hepatoblastoma (a rare form of liver malignancy)
    • Embryonal carcinoma
    • Yolk sac tumor
  • The Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children measures the amount of alpha feto-protein in blood. Measuring the blood levels of AFP in suspicious cases, helps in:
    • Early detection of cancer
    • Monitoring cancer and its response to treatment
  • Some healthcare providers may compare total alpha feto-protein levels to specific AFP-L3 levels, a variant of AFP. This may help in evaluating the risk of a future development of hepatocellular carcinoma in individuals at risk for the condition

It is important to note that alpha fetoprotein levels can be increased with tumor and non-tumor conditions. Thus, elevated AFP levels alone do not indicate the presence of malignancies.

What are the Clinical Indications for performing the Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children?

The alpha feto-protein tumor marker test is performed to diagnose, stage, and help in the treatment of infants and children who have been detected with the following types of cancer:

  • Hepatocellular carcinoma (HCC, affecting the liver)
  • Germ cell tumors that include embryonal carcinomas and yolk sac tumors

Additionally, the test may help in the following manner:

  • Monitoring cancer recurrences (if any); alpha feto-protein levels may increase, if the cancer returns
  • Monitoring effectiveness of the treatment provided; AFP levels decrease with effective treatment
  • Additional tests for screening are required to confirm cancers in which the AFP levels are usually elevated


  • Given their low specificity and sensitivity, the AFP tumor marker test is generally not used as screening tool in detecting malignancies. The test is rather used as an indicator, in conjunction with other clinical findings and radiological results, to help diagnose various cancers
  • Also, it is also important to note that in healthy children with normal immune system, the test is not recommended for cancer detection as a screening tool

How is the Specimen Collected for Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children?

Following is the specimen collection process for Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children:

Sample required: Blood

Process of obtaining blood sample in older children:

  • A band is wrapped around the arm, 3-4 inches above the collection site (superficial vein that lies within the elbow pit)
  • The site is cleaned with 70% alcohol in an outward spiral, away from the zone of needle insertion
  • The needle cap is removed and is held in line with the vein, pulling the skin tight
  • With a small and quick thrust, the vein is penetrated using the needle
  • The required amount of blood sample is collected, by pulling the plunger of the syringe out slowly
  • The wrap band is removed, gauze is placed on the collection site, and the needle is removed
  • The blood is immediately transferred into the blood container, which has the appropriate preservative/clot activator/anti-coagulant
  • The syringe and the needle are disposed into the appropriate “sharp container” for safe and hygienic disposal
  • In newborns, infants, and younger children, the blood sample is drawn from the heel after making a small nick using a scalpel. This is called a heel stick

Preparation required: No special preparation is needed prior to the test.

What is the Significance of the Alpha Feto-Protein (AFP) Tumor Marker Test in Infants and Children Result?

The significance of Alpha Feto-Protein Tumor Marker Test in Infants and Children is explained.

Increased levels of alpha feto-protein (AFP) may indicate a presence of the following cancer types:

  • Hepatocellular carcinoma (involving the liver)
  • Hepatoblastoma
  • Embryonal carcinoma
  • Yolk sac tumor

Elevated AFP levels may also be noted in patients previously treated for cancer, thus signifying a recurrence of the condition.


  • Alpha feto-protein levels may not be significantly elevated in every case of cancer of the liver, ovary, or testis, since not all such cancers produce AFP
  • If AFP levels are elevated prior to cancer treatment, then serial levels are obtained to monitor treatment effectiveness. With appropriate and effective treatment, the AFP levels are known to drop

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

  • Increased levels of total AFP and AFP-L3 in patients having chronic liver disease may point to the development of hepatocellular carcinoma (in future). In such cases, the cancer that develops may have a poor prognosis
  • Individuals with high levels of both, total AFP and AFP-L3, in the absence of liver disease, may or may not develop cancer

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider, the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 27, 2019
Last updated: Feb. 27, 2019