Abstract
BackgroundRecent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk. Our aim was to critically review studies on the physiologic variations during pregnancy, the most common tumor markers used in diagnosis and follow-up of gynecological cancers.MethodsWe conducted a systematic review of six tumor markers during normal pregnancy: carbohydrate antigen (CA) 15-3 (breast cancer); squamous cell carcinoma antigen (cervical cancer); and CA 125, anti-Müllerian hormone, inhibin B and lactate dehydrogenase (ovarian cancer).ResultsFor CA 15-3, 3.3% to 20.0% of all measurements were above the cut-off (maximum 56 U/mL in the third trimester). Squamous cell carcinoma antigen values were above cut-off in 3.1% and 10.5% of the measurements (maximum 4.3 µg/L in the third trimester). Up to 35% of CA 125 levels were above cut-off: levels were highest in the first trimester, with a maximum value up to 550 U/mL. Inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels were not elevated in maternal serum during normal pregnancy.ConclusionDuring normal pregnancy, tumor markers including CA 15.3, squamous cell carcinoma antigen and CA 125 can be elevated; inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels remain below normal cut-off values. Knowledge of physiological variations during pregnancy can be clinically important when managing gynecological cancers in pregnant patients.
Highlights
Recent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk
We focused on six tumor markers that are well-established in gynecological cancers and are used for breast cancer (carbohydrate antigen (CA) 15-3), cervical squamous cell cancer (squamous cell carcinoma antigen (SCC)), and ovarian cancer (CA 125 for epithelial ovarian tumors, inhibin B and anti-Müllerian hormone (AMH) for sex cord-stromal tumors, and lactate dehydrogenase (LDH) for germ cell tumors)
The first trimester was defined as the period between the beginning of pregnancy up to 12 to 14 weeks’ gestation; the second trimester was defined as the period from the end of the first trimester up to 24 to 28 weeks’ gestation, after which began the third trimester until delivery
Summary
Recent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk. Our aim was to critically review studies on the physiologic variations during pregnancy, the most common tumor markers used in diagnosis and follow-up of gynecological cancers. Tumor markers can be found in a variety of bodily fluids and tissues and include hormones and several subgroups of (glyco)proteins, such as oncofetal antigens (which are normally expressed during fetal life), enzymes and receptors. They are used for diagnosis, assessment of therapeutic efficacy, and detecting recurrence during follow-up. Unawareness of pregnancy-related physiologic elevations of tumor markers may lead to the search for metastatic disease, using extensive and unnecessary diagnostic examinations that are costly and uncomfortable, and expose the fetus to avoidable radiation
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