Question:
Which one of the following is a frequent cause of a serum alpha-fetoprotein level greater than 10 times the normal upper limit?
Which one of the following is a frequent cause of a serum alpha-fetoprotein level greater than 10 times the normal upper limit?
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Think about which of these conditions involves a large enough burden of altered liver tissue to push AFP many-fold above normal.
Updated On: Jul 16, 2026
- Seminoma
- Metastatic carcinoma of liver
- Cirrhosis of liver
- Oat cell tumour of lung
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The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
The question asks which of the listed conditions is a frequent cause of a markedly raised serum alpha-fetoprotein (AFP), specifically more than ten times the upper limit of normal.
Step 2: Key Concept or Approach:
AFP is a fetal glycoprotein normally produced by the yolk sac and fetal liver; in adults it becomes a tumour marker when hepatocytes or certain germ-cell tissues turn its production back on. The size of the rise matters: mild-to-moderate elevations are common in benign or reactive liver conditions, while a very large, many-fold rise points toward a tumour actively producing large amounts of the protein.
Step 3: Working Through the Options:
Cirrhosis of the liver can raise AFP as hepatocytes regenerate, but the rise is usually mild and rarely crosses ten times the upper limit unless malignant transformation to hepatocellular carcinoma has occurred. Oat cell (small cell) tumour of the lung is not a recognised source of AFP; it produces other markers such as ACTH or ADH in paraneoplastic syndromes, not AFP. Pure seminoma is characteristically AFP-negative - if AFP is raised in a testicular germ cell tumour, the tumour is reclassified as a non-seminomatous or mixed germ cell tumour, so seminoma itself is not the answer. Metastatic deposits of tumour within the liver replace and damage functioning liver tissue and, when the burden is large, can be associated with a markedly raised AFP as regenerating and stressed hepatocytes around the deposits re-express the fetal protein, which is the mechanism this question is testing.
Step 4: Conclusion:
Metastatic carcinoma of the liver is marked as the frequent cause of AFP greater than ten times the upper limit of normal in this question.
The question asks which of the listed conditions is a frequent cause of a markedly raised serum alpha-fetoprotein (AFP), specifically more than ten times the upper limit of normal.
Step 2: Key Concept or Approach:
AFP is a fetal glycoprotein normally produced by the yolk sac and fetal liver; in adults it becomes a tumour marker when hepatocytes or certain germ-cell tissues turn its production back on. The size of the rise matters: mild-to-moderate elevations are common in benign or reactive liver conditions, while a very large, many-fold rise points toward a tumour actively producing large amounts of the protein.
Step 3: Working Through the Options:
Cirrhosis of the liver can raise AFP as hepatocytes regenerate, but the rise is usually mild and rarely crosses ten times the upper limit unless malignant transformation to hepatocellular carcinoma has occurred. Oat cell (small cell) tumour of the lung is not a recognised source of AFP; it produces other markers such as ACTH or ADH in paraneoplastic syndromes, not AFP. Pure seminoma is characteristically AFP-negative - if AFP is raised in a testicular germ cell tumour, the tumour is reclassified as a non-seminomatous or mixed germ cell tumour, so seminoma itself is not the answer. Metastatic deposits of tumour within the liver replace and damage functioning liver tissue and, when the burden is large, can be associated with a markedly raised AFP as regenerating and stressed hepatocytes around the deposits re-express the fetal protein, which is the mechanism this question is testing.
Step 4: Conclusion:
Metastatic carcinoma of the liver is marked as the frequent cause of AFP greater than ten times the upper limit of normal in this question.
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