**5.4 Tumor-specific growth factor (TSGF)**

Malignant tumors have the ability to synthesize tumor-specific growth factors, releasing them into the capillaries surrounding the tumor and peripheral blood vessels during their development. Therefore, serum TSGF levels may be a marker of tumor survival. In one study, serum TSGF concentrations were used as a diagnostic marker for HCC with 82% sensitivity at 62 UI/ml [84]. Combined with other cancer markers, TSGF may yield higher diagnostic values with increased sensitivity. Theoretically, preeclampsia is highly expressed in many malignant tumors and HCC, but there are currently too few studies evaluating the role of TSGF in other malignancies to consider it as a potential factor. There are other markers, such as serum insulin-like growth factor-II (IGF-II), which can be used as diagnostic or prognostic markers for HCC. A cut-off of 4.1 mg/l of IGF-II obtained results of 63% sensitivity, 90% specificity and 70% accuracy in early HCC diagnosis with small tumor size. Moreover, the combination of IGF-II and AFP (cut-off value of 50 ng/ ml) increases sensitivity up to 80% and accuracy up to 88% [85].
