Although alpha-fetoprotein (AFP) is a golden diagnostic marker for hepatocellular carcinoma (HCC), its value is debatable. Differentiation between primary and secondary hepatocarcinomas (HC) relying on AFP is confusing, does not exceed 20 % in the later. To find alternative markers other than AFP to differentiate between primary and secondary HC from colorectal carcinoma (CRC) and breast (BC) and lung cancers (LC), 60 individuals were recruited: group 1, healthy volunteers; group 2, with primary; and group 3, with secondary HC. Carcinoembryonic antigen (CEA), total glycosaminoglycans (TGAGs), total sialic acid (TSA), free glucosamine (FGA), leucine aminopeptidase (LAP), 5'-nucleotidase (5'-NU) activities, and AFP were estimated in sera, in addition to liver histology. CEA, TGAGs, TSA, and FGA were elevated in secondary HC among CRC primary cancers, while LAP, 5'-NU activities, and AFP were elevated in primary HCC. We concluded that a new panel can be used to differentiate primary from secondary HC better than AFP, speculating the primary cancer. AFP, LAP, and 5'-NU predominated in primary, while CEA, TGAGs, TSA, and FGA, in secondary HC. Elevation of 5'-NU, LAP, TGAGs, TSA, and FGA to CEA indicated that primary source of HC is CRC. Association of TGAGs, TSA, and FGA only to CEA indicated that the primary cancer is breast. Elevation of TGAGs, TSA, and FGA, with other normal parameters, indicated that the primary cancer is lung. A guiding table is recommended in the oncology laboratory, for management and follow-up, and having more expected level of sensitivity than AFP.
Keywords: Alpha-fetoprotein glycosaminoglycans; Hepatocellular carcinoma; Liver metastasis; Sialic acid.