A rising level of which substance in patients with cirrhosis or hepatitis B should raise concern for hepatocellular carcinoma?

Alpha-fetoprotein (AFP) is a protein that is typically produced by the fetal liver and is used as a tumor marker in adults, particularly in the context of liver disease. In patients with conditions like cirrhosis or hepatitis B, the levels of AFP can become elevated, and this is clinically significant. Rising AFP levels are particularly associated with hepatocellular carcinoma (HCC), a common type of liver cancer that can develop in patients with chronic liver diseases.

In the context of cirrhosis and hepatitis B, monitoring AFP levels is an important part of cancer surveillance. Physicians often use AFP levels, along with imaging studies, to help make early diagnoses of HCC, as early detection can significantly improve treatment outcomes and survival rates. Thus, an increasing trend in AFP levels in these patients is a strong clinical indicator that warrants further investigation for malignancy.

The other substances listed, while they may have their own clinical significance, are not typically associated with the diagnosis of hepatocellular carcinoma in the same manner as AFP. Carcinoembryonic antigen (CEA) is more commonly linked to colorectal and other gastrointestinal cancers, lactate dehydrogenase (LDH) can be elevated in various conditions but is less specific for