Also Known As
Total AFP
Formal Name
Alpha-fetoprotein, Total; Alpha-fetoprotein-L3 Percent
This article was last reviewed on
This article waslast modified on
March 22, 2018.
At a Glance
Why Get Tested?

To help diagnose and monitor therapy for certain cancers of the liver, testicles, or ovaries

When To Get Tested?

When your healthcare practitioner suspects that you have certain cancers of the liver, testicles, or ovaries; at intervals during and after treatment for one of these cancers; sometimes when you have cancer-predisposing diseases such as chronic hepatitis or cirrhosis

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?


You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Alpha-fetoprotein (AFP) is a protein produced primarily by the liver in a developing baby (fetus) and the portion of a developing embryo that is similar to the yolk cavity in bird eggs (yolk sac tissues). AFP levels are typically elevated when a baby is born and then decline rapidly. Liver damage and certain cancers can increase AFP concentrations significantly. This test measures the level of AFP in the blood.

AFP is produced whenever liver cells are regenerating. With chronic liver diseases, such as hepatitis and cirrhosis, AFP may be chronically elevated. Very high concentrations of AFP may be produced by certain tumors. This characteristic makes the AFP test useful as a tumor marker. Increased amounts of AFP are found in many people with a type of liver cancer called hepatocellular carcinoma and in a liver cancer occurring in infants called hepatoblastoma. They are also found in some people with cancers of the testicles or ovaries.

AFP exists in several different variants. The standard AFP test is for a total AFP, one that measures all of the AFP variants together. This is the primary AFP test used in the United States.

One of the AFP variants is called L3 because of its ability, in the laboratory, to bind to a particular protein called Lens culinaris agglutinin. The AFP-L3% test is a relatively new test that compares the amount of AFP-L3 to the total amount of AFP. An increase in the percentage of L3 is associated with increased risk of developing hepatocellular carcinoma in the near future and of having a poorer prognosis, as the L3-related cancers tend to be more aggressive.

Among patients with low total AFP, AFP-L3 can be higher in those with hepatocellular carcinoma than patients with benign liver diseases. Tumor markers including total AFP and AFP-L3 are used in addition to ultrasound for surveillance of hepatocellular carcinoma in Japan. This practice is different from that in the U.S. and Europe, but the two tests are occasionally ordered by healthcare practitioners in the U.S.

How is the sample collected for testing?

A blood sample is taken by needle from a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Accordion Title
Common Questions
  • How is it used?

    Alpha-fetoprotein (AFP) is used as a tumor marker to help detect and diagnose cancers of the liver, testicles, and ovaries. Though the test is often ordered to monitor people with chronic liver diseases such as cirrhosis, chronic hepatitis B or hepatitis C because they have an increased lifetime risk of developing liver cancer, most current guidelines do not recommend this use. A healthcare practitioner may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest and most treatable stages.

    If a person has been diagnosed with hepatocellular carcinoma or another form of AFP-producing cancer, an AFP test may be ordered periodically to help monitor the person's response to therapy and to monitor for cancer recurrence.

    An AFP-L3% is sometimes also ordered to compare the amount of the AFP variant called AFP-L3 to the total amount of AFP. The AFP-L3% test is not yet widely used in the U.S. but has gained wider acceptance in other countries such as Japan. The test is used to help evaluate the risk of developing hepatocellular carcinoma, especially in those with chronic liver disease, and also to evaluate response of hepatocellular carcinoma to treatment.

  • When is it ordered?

    A healthcare practitioner may order an AFP blood test:

    • When it is suspected that someone has liver cancer or certain cancers of the testicles or ovaries; cancer may be suspected when, for example, lumps are felt in the abdominal area during a physical exam or when imaging tests detect possible tumors.
    • When someone who has been diagnosed with and treated for a cancer of the liver, testicles, or ovaries is being monitored for the effectiveness of treatment
    • When someone is being monitored for cancer recurrence
    • To follow up patients with chronic hepatitis or liver cirrhosis

    An AFP-L3% is sometimes ordered to help evaluate the risk of hepatocellular carcinoma when a person has chronic liver disease or to test the effectiveness of treatment of hepatocellular carcinoma or monitor for its recurrence.

  • What does the test result mean?

    Increased AFP levels may indicate the presence of cancer, most commonly liver cancer, cancer of the ovary, or germ cell tumor of the testicles. However, not every liver, ovarian, or testicular cancer will produce significant quantities of AFP.

    Elevated levels may sometimes be seen with other cancers such as stomach, colon, lung, breast, and lymphoma, although it is rarely ordered to evaluate these conditions. Other diseases such as cirrhosis and hepatitis can also cause increased levels.

    When AFP is used as a monitoring tool, decreasing levels indicate a response to treatment. If concentrations after cancer treatment do not significantly decrease, usually to normal or near normal levels, then some of the tumor tissue may still be present.

    If AFP concentrations begin to increase, then it is likely that the cancer is recurring.  However, since AFP can be increased in hepatitis or cirrhosis, AFP levels can sometimes be misleading. If AFP levels are not elevated prior to treatment, then the test will not generally be useful to monitor the effectiveness of treatment or to monitor for recurrence.

    When the AFP concentrations of people with chronic liver disease go from normal or moderately elevated to greatly elevated, their risk of developing liver cancer increases. When total AFP and AFP-L3% are significantly elevated, then the affected person has an increased risk of having or developing hepatocellular carcinoma in the next year or two. However, both AFP and AFP-L3% concentrations can be elevated, and fluctuate, in people with chronic hepatitis and cirrhosis. In these cases, a sharp increase in AFP is more important than the actual numerical value of the test result.

  • Is there anything else I should know?

    Not every person with increased AFP and AFP-L3% test results has cancer or will develop liver cancer. The AFP and AFP-L3% tests are not diagnostic per se; they are indicators. They must be used in conjunction with information from a medical history and physical examination as well as histopathological examination and imaging studies to look for the development of tumors.

    Although these tests can provide useful information, they are not as specific or sensitive as healthcare practitioners would wish. AFP can temporarily increase whenever the liver is injured and regenerating, and moderate elevations can be seen with a variety of conditions. Because of this, AFP testing cannot be used solely to diagnose cancer. In addition, not every cancer will produce AFP, so a person could still have cancer even when the AFP is normal. For these reasons, the AFP test should not be used to screen the general population for cancer.

    AFP is not only a tumor marker. Because AFP is produced by the fetus, levels are normally higher in pregnant women and in their newborns. For more information on AFP testing during pregnancy, see the Second Trimester Maternal Serum Screen.

  • What are the risk factors for hepatocellular carcinoma?

    This cancer usually occurs in people who have chronic scarring of the liver, called cirrhosis. Most commonly, this is caused by chronic infection from one of two viruses: hepatitis B or hepatitis C. Alcohol abuse also increases the risk of developing cirrhosis. Some inherited diseases, especially a disorder called hemochromatosis (in which the body absorbs too much iron, which gets deposited in liver among other organs), can cause cirrhosis and, in time, hepatocellular carcinoma, as can non-alcoholic steatohepatitis (NASH), which is fat deposition in the liver, along with inflammation and damage.

  • If my AFP is abnormal, do I need other tests?

    If you have chronic liver infection or damage and your AFP suddenly rises, or if it is very elevated, your healthcare practitioner will usually ask for a study to look at your liver, such as an ultrasound exam, a CT scan, an MRI scan, or a biopsy for histopathological evaluation of tumor tissues. The scans can usually spot liver cancers if they are present. Your healthcare practitioner may also order a blood test for des-gamma carboxy prothrombin (DCP), which is also known as prothrombin induced by vitamin K absence-II (PIVKA-II), to help detect liver cancer and monitor patients with hepatocellular carcinoma.

  • Can an AFP test be performed at home or in my healthcare practitioner's office?

    AFP is not available as a home test and it is not typically performed in a healthcare practitioner's office. Testing is done by either a hospital laboratory or a reference laboratory.

View Sources

Sources Used in Current Review

Abdel B Halim, PharmD, PhD, DABCC, FACB, VP Translational Medicine, Biomarkers and Diagnostics.

(May 2014) Nonalcoholic steatohepatitis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Available online at Accessed on 02/06/2016.

Serum Des-Gamma-Carboxy Prothrombin (DCP). Mayo Clinic. Available online at Accessed on 02/06/2016.

Choi JY et al. Diagnostic value of AFP-L3 and PIVKA-II in hepatocellular carcinoma according to total-AFP. World J Gastroenterol. 2013 Jan 21; 19(3): 339–346. Available online at Accessed 02/06/2016.

Kudo M. Clinical Practice Guidelines for Hepatocellular Carcinoma Differ between Japan, United States, and Europe. Liver Cancer. 2015 Mar; 4(2): 85–95. Available online at Accessed Feb 2016.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Sherman, M. (2005 June 23). Hepatocellular Carcinoma: Epidemiology, Risk Factors, and Screening. Medscape, from Semin Liver Dis. 2005;25(2):143-154 [On-line information]. Available online at

(2005 January 05). LBA AFP-L3. Wako [On-line package insert]. PDF available for download at

Hepatocellular Carcinoma: Alpha Fetoprotein. Specialty Laboratories [On-line information]. Available online at

Grund, S. (2004 August 10, Updated). Hepatocellular Carcinoma. MedlinePlus, Medical Encyclopedia [On-line information]. Available online at

(2005 April 14, Modified). Hepatocellular Cancer (PDQ®): Screening Health Professional Version. National Cancer Institute [On-line information]. Available online at

(© 2003). Alpha-Fetoprotein (AFP) with AFP L3%, Serum. Laboratory Corporation of America [On-line test information]. Available online at

Wako Diagnostics Receives the FDA Approval for a New Biomarker for Liver Cancer. Press Release, Richmond VA USA -- Medical Industry E-mail News Service(TM) -- June 21, 2005.

Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 47-49.

Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 271-272.

(2008 March). Germ Cell Tumors – Childhood. Cancer.Net [On-line information] Available online at Accessed May 2009.

Vorvick, L. (2008 October 28). Alpha fetoprotein. MedlinePlus Medical Encyclopedia [On-line information] Available online at Accessed May 2009.

(Revised 2009 May 06). Overview: Liver Cancer, How Is Liver Cancer Found? American Cancer Society [On-line information]. Available online at Accessed May 2009.

(Modified 2009 May 22). Adult Primary Liver Cancer Treatment (PDQ®) National Cancer Institute [On-line information]. Available online at Accessed May 2009.

(Revised 2009 May 14). Detailed Guide: Testicular Cancer, How Is Testicular Cancer Diagnosed? American Cancer Society [On-line information]. Available online at Accessed May 2009.

(Revised 2008 December 08). Tumor Markers, What are tumor markers? American Cancer Society [On-line information]. Available online at Accessed May 2009.

Walzer, N. and Kulik, L. (2008 June 10). Hepatocellular Carcinoma: Latest Developments. Medscape from Current Opinion in Gastroenterology [On-line information]. Available online at Accessed May 2009.

(2007 November). AFP-L3% in Serum (Includes Total Alpha Fetoprotein). ARUP Technical Bulletin [On-line information]. Available online through Accessed May 2009.

(Revised 2012 October 5). Ovarian Cancer. American Cancer Society [On-line information]. Available online at Accessed October 2012.

(Updated 2012 May 14). Stuart, K. and Stadler, Z. Primary Hepatic Carcinoma. Medscape Reference [On-line information]. Available online at Accessed October 2012.

(© 1995-2012). Alpha-Fetoprotein (AFP) Tumor Marker, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at Accessed October 2012.

Grenache, D. and Jarboe, E. (Updated 2011 May). Hepatocellular Carcinoma. ARUP Consult [On-line information]. Available online at Accessed October 2012.

(Updated 2012 August 1). Fazal Hussain, F. and Homoud, H. Gynecologic Tumor Markers Tumor Marker Overview. Medscape Reference [On-line information]. Available online at Accessed October 2012.

Grenache, D. et. al. (Updated 2012 May). Ovarian Cancer. ARUP Consult [On-line information]. Available online at Accessed October 2012.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 42-44.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 486, 496, 499.

(January 2011) Bruix J, Sherman M. Management of Hepatocellular Carcinoma. American Association for the Study of Liver Diseases Practice Guideline. Hepatology Vol. 53, No. 3, 2011. PDF available for download at Accessed November 2012.

(December 2011) Llovet J, et al. Clinical Practice Guidelines: Management of hepatocellular carcinoma. European Association for the Study of the Liver and European Organisation for Research and Treatment of Cancer. Journal of Hepatology 2012 vol. 56 j 908–943. PDF available for download at Accessed November 2012.

Ask a Laboratory Scientist

lab scientist

Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you.

Contact a Scientist