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Also known as: PIVKA II (protein induced by vitamin K absence or antagonists II)
Formal name: Des-gamma-carboxy prothrombin

At a Glance

Why Get Tested?

To evaluate effectiveness of hepatocellular carcinoma (HCC) treatment if elevated prior to treatment; to monitor for recurrence of HCC

When to Get Tested?

Periodically when you have been treated for HCC

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?


The Test Sample

What is being tested?

Des-gamma-carboxy prothrombin (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. This test measures the amount of DCP in the blood.

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 30,640 new liver cancers will be diagnosed in the U.S in 2013 and about 21,670 people will die of the disease. Liver cancer is much more common in other parts of the world, with more than 700,000 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 62 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 those who are at high risk.

It was hoped that DCP testing would prove useful as a screening and surveillance tool to help with early HCC detection in those with chronic liver disease, but studies have shown mixed results and a recent guideline by the American Association for the Study of Liver Diseases (AASLD) recommends that it not be used for this purpose.

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

Common Questions

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Article Sources

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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.

Sources Used in Current Review

Stuart, K. and Stadler, Z. (Updated 2012 November 26). Primary Hepatic Carcinoma. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/282814-overview through http://emedicine.medscape.com. Accessed July 2013.

Bruix, J. and Morris Sherman, M. (2011). Management of Hepatocellular Carcinoma: An Update. Hepatology v 53 (3) 3, 2011 [On-line information]. Available online through https://www.aasld.org. Accessed July 2013.

Grenache, D. (Updated 2013 March). Hepatocellular Carcinoma. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HepatocellularCarcinoma.html?client_ID=LTD#tabs=0 through http://www.arupconsult.com. Accessed July 2013.

(© 1995–2013) Des-Gamma-Carboxy Prothrombin (DCP), Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/61844 through http://www.mayomedicallaboratories.com. Accessed July 2013.

Herrine, S. (Revised 2012 November). Primary Liver Cancer. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed July 2013.

Lok, A. et. al. (2010 February). Des-gamma-carboxy Prothrombin and Alpha fetoprotein as Biomarkers for the Early Detection of Hepatocellular Carcinoma. Gastroenterology v138 (2): 493 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819612/ through http://www.ncbi.nlm.nih.gov. Accessed July 2013.

Nguyen-Khoa, D-T. (Updated 2012 February 23) Vitamin K Deficiency. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/126354-overview through http://emedicine.medscape.com. Accessed July 2013.

Sources Used in Previous Reviews

(Revised 2009 May 05). Liver Cancer. American Cancer Society [On-line information]. Available online at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=25 through http://www.cancer.org. Accessed September 2009.

Grenache, D. et. al. (Updated 2009 May). Hepatocellular Carcinoma. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HepatocellularCarcinoma.html?client_ID=LTD through http://www.arupconsult.com. Accessed September 2009.

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.

Axelrod, D. and Leeuwen, D. (2008 September 18). Hepatocellular Carcinoma. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/197319-overview through http://www.medscape.com. Accessed September 2009.

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.