“The Role Of Tumor Markers In Diagnostic Evaluation During Pregnancy”

Abstract

The diagnosis of cancer during pregnancy presents a significant clinical challenge, as physiological gestational changes often mask the signs and symptoms of malignancy. Standard tumor markers, while pivotal in general oncology, demonstrate limited utility in pregnant women due to a lack of specificity and profound physiological alterations. This review aims to summarize current evidence regarding the reliability, limitations, and diagnostic utility of common tumor markers in the obstetric population.

Methods: A comprehensive literature review was conducted using electronic databases, including PubMed/MEDLINE, Scopus, and Google Scholar, for articles published up to 2025. The search strategy focused on studies reporting serum concentrations of markers such as CA-125, CEA, AFP, hCG, CA 19-9, and CA 15-3 in healthy pregnant women as well as those with benign or malignant conditions.

Results: Pregnancy induces systemic hemodynamic and renal adaptations, including hemodilution and increased glomerular filtration, which significantly alter serum protein concentrations. Oncofetal antigens like AFP and hCG are physiologically produced by the feto-placental unit, limiting their specificity. CA-125 is frequently elevated, particularly in the first trimester, leading to high false-positive rates when standard non-pregnant cut-offs are applied. Conversely, CEA remains relatively stable and independent of gestational age. Other markers, such as CA 19-9 and CA 15-3, may exhibit subtle physiological rises, specifically in the third trimester.

Conclusion: The interpretation of tumor markers during pregnancy requires extreme caution and the use of trimester-specific reference ranges rather than standard thresholds. These biomarkers should not be used as standalone screening tools. In the event of elevated levels, clinicians must prioritize ruling out obstetric causes, such as fetal anomalies or placental dysfunction, before suspecting maternal malignancy.