Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review

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.

Surgical intervention for adnexal masses during pregnancy

“…Thus, it is still controversial to use Ca125 as a tumour marker during pregnancy even in the second trimester of gestation 13. In the present study, the level of Ca125 was higher than 35 IU/mL in only two women; one with a mucinous borderline tumour and the other with serous cystadenoma and the preoperative Ca125 level was not helpful in estimating the final pathology.…”

“…Although the level of Ca125 was found below the cut-off value during the second trimester of gestation, there is data showing elevated levels of Ca125 up to 73 U/mL during this period 13 14. Thus, it is still controversial to use Ca125 as a tumour marker during pregnancy even in the second trimester of gestation 13.…”

Mortalidade materna tardia: comparação de dois comitês de mortalidade materna no Brasil

“…O diagnóstico de câncer na gravidez é mais difícil em face de fatores como: (1) sobreposição dos sintomas de malignidade com os sintomas da gravidez como náuseas, vômitos, alterações da mama e dor abdominal; (2) exame físico comprometido devido a alterações da mama e útero gravídico; (3) hesitação para realizar determinados exames e as preocupações com imagem corporal; (4) diminuição da utilidade dos marcadores tumorais e valores laboratoriais neste período 20 .…”

Ovarian Cancer and Pregnancy

“…Additionally, for patients with diagnosed ovarian cancer during pregnancy and focusing on the current guidelines platinum-based chemotherapy, combination of carboplatin with weekly paclitaxel is strongly recommended after the first trimester, representing a safe chemotherapeutic procedure [17].…”

“…Due to daily physiologic and hormonal changes during pregnancy, all tumor markers are increased. Ca-125, a tumor marker capable of distinguishing a benign from a malignant adnexal mass, is often increased during pregnancy [7].…”