At a Glance
Why Get Tested?
To evaluate your risk of developing hepatocellular carcinoma (HCC); to evaluate HCC treatment; to monitor for recurrence
When to Get Tested?
Periodically when you have chronic liver disease or have been treated for hepatocellular carcinoma
Sample Required?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
None
The Test Sample
What is being tested?
This test measures the amount of des-gamma-carboxy prothrombin (DCP) in the blood. DCP is an abnormal form of prothrombin, a clotting factor produced by the liver. DCP can be produced by liver tumors, and levels are frequently elevated when a person has hepatocellular carcinoma (HCC). This makes the test potentially useful as a tumor marker.
According to the American Cancer Society (ACS), hepatocellular carcinoma is the most common type of liver cancer, accounting for 3 of 4 cancers that originate in the liver. ACS estimates that about 22,620 new liver cancers will be diagnosed in the U.S in 2009 and about 18,160 people will die of the disease. Liver cancer is much more common in other parts of the world, with more than 500,000 people diagnosed each year.
Most cases of HCC develop in those who have chronic liver diseases such as hepatitis and cirrhosis. In the U.S., the most common risk factor for HCC is a chronic hepatitis C infection; worldwide it is chronic hepatitis B. When it occurs, HCC may emerge several decades after the initial infection. HCC affects more males than females, with the average age of diagnosis at 64 years. Symptoms of HCC, such as a liver mass, abdominal pain, weight loss, nausea, ascites, jaundice, and a worsening of symptoms in those with chronic hepatitis and cirrhosis, are often not present until the later stages of the disease. For this reason, HCC is rarely detected early unless screening is done in high risk persons.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
The Test
How is it used?
Des-gamma-carboxy prothrombin (DCP) is a relatively new test that may be ordered along with an imaging study, plus alpha-fetoprotein (AFP) and/or an AFP-L3% to evaluate whether a person with chronic liver disease has developed hepatocellular carcinoma (HCC). The DCP test is not considered a replacement for the AFP or AFP-L3% tests but gives the doctor additional information. These tests allow HCC to be detected as soon as possible and generally reflect tumor burden – the amount of cancer present.
Not every HCC will produce DCP. If DCP is initially elevated in a patient with HCC, then it can be used as a monitoring tool. It may be ordered along with an AFP to evaluate the effectiveness of treatment for HCC and used as a monitoring tool to detect cancer recurrence.
DCP is not sensitive or specific enough to be used to screen the general population for their risk of developing HCC cancer.
When is it ordered?
The DCP test is not routinely ordered. It shows promise and gives the doctor additional information, but it has not yet gained widespread acceptance. The AFP test has been the tumor marker traditionally used to detect and monitor HCC, and it is the test most likely to be ordered.
DCP may be ordered periodically, along with imaging studies and AFP and/or AFP-L3% test, to detect HCC when it may still be treatable. When initially elevated, it may be ordered during and after treatment of HCC to evaluate the effectiveness of treatment, and ordered periodically along with an AFP and/or AFP-L3% to monitor a person for cancer recurrence.
What does the test result mean?
When DCP and AFP and/or AFP-L3% levels are increased in a person with chronic liver disease, they indicate an increased likelihood that a person has HCC. Since these tests are typically ordered periodically, changes over time can be evaluated. Increasing levels suggest the presence or recurrence of HCC. Decreasing concentrations in someone who is being treated for HCC suggest response to treatment. Levels that stay the same or increase after treatment indicate that the treatment has not been effective.
A person can have HCC without having elevated DCP. The tumor may not produce DCP or it may be small enough that it is not producing significant amounts.
Is there anything else I should know?
Increases in DCP and/or AFP are not diagnostic of HCC. For a diagnosis, the tumor must be located - typically through the use of imaging scans - and cells from it must be examined under a microscope (also known as a biopsy).
DCP can also be elevated because of acute hepatitis. In persons with chronic hepatitis, mild increases in DCP are common, although not as commonly as with AFP, and generally not to as high levels.
If you are taking warfarin to lower your risk of blood clots, DCP will be markedly increased, since this drug works by blocking the action of vitamin K and leads to production of the same abnormal form of prothrombin as occurs in HCC. If you have vitamin K deficiency, DCP can also be increased.
A person with a persistent vitamin K deficiency or jaundice due to a liver obstruction may have elevated DCP levels that are not due to HCC. The anticoagulant warfarin and some broad-spectrum antibiotics can affect test results.
Common Questions
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Article Sources
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
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Singal, A. and Marrero, J. (2008 March). Screening for Hepatocellular Carcinoma. Gastroenterology & Hepatology Volume 4, Issue 3 [On-line information]. PDF available for download at http://www.clinicaladvances.com/article_pdfs/gh-article-200803-marrero.pdf through http://www.clinicaladvances.com. Accessed September 2009.
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Mayo Clinic Staff (2009 July 2). Liver Cancer. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/liver-cancer/DS00399 through http://www.mayoclinic.com. Accessed September 2009.
(Modified 2009 June 30). Liver (Hepatocellular) Cancer Screening (PDQ®). National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/screening/hepatocellular/healthprofessional through http://www.cancer.gov. Accessed September 2009.
Lopez, J. (2005 August). Recent Developments in the First Detection of Hepatocellular Carcinoma. Clin Biochem Rev. 2005 August; 26(3): 65–79 [On-line information]. Available online at http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16450014 through http://www.pubmedcentral.nih.gov. Accessed September 2009.
Stitham, S. et. al. (Updated 2008 September 4). Hepatocellular Carcinoma. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000280.htm. Accessed September 2009.
Yamamoto, K. et. al. (2009 August 11). Significance of Alpha-Fetoprotein and Des-gamma-Carboxy Prothrombin in Patients with Hepatocellular Carcinoma Undergoing Hepatectomy. Ann Surg Oncol Abstract [On-line information]. Available online at http://www.ncbi.nlm.nih.gov/pubmed/19669841?dopt=Abstract through http://www.ncbi.nlm.nih.gov. Accessed September 2009.
Sherman, M. (2005 June 23). Hepatocellular Carcinoma: Epidemiology, Risk Factors, and Screening. Medscape Today from Seminars in Liver Disease [On-line information]. Available online at http://www.medscape.com/viewarticle/506830 through http://www.medscape.com. Accessed September 2009.
