Tumor markers in internal medicine hepatology

: Primary liver tumour, i.e. hepatocellular carcinoma (HCC) is one of the world's most common malignancies. The age-standardized incidence rate varies widely from 6/100,000 (Austria) to 100 and more per 100,000 in Mozambique and Taiwan. In these high-risk areas, infection with hepatitis B virus is considered the main risk factor. In low-incidence areas as in Western Europe, main risk factors are older age, male sex and liver cirrhosis. The prognosis depends mainly on the size of the tumour. Alpha-fetoprotein is an ideal tumour marker for prospective screening in high-incidence areas. There is not much information, however, on the value of this marker for screening in low-incidence areas. There is some information that HCC-associated alkaline phosphatase could be a good tumour marker in non-viral liver tumours. Furthermore, des-gamma-carboxyprothrombin and vitamin B 12-binding protein could be specific markers for tumours in non-cirrhotic livers. But large clinical studies have not yet confirmed the value of these markers. Hormonal and haematological markers and some isoenzymes are tumour markers characterized by high sensitivity but low specificity. There are no specific tumour markers for metastatic liver disease.