14 - Serum markers for gynaecological cancer in the reproductive years

Summary

Introduction

The current trend of increasing life expectancy and advancing age at which women opt to have children suggests that the number of cancers presenting in pregnancy is likely to increase. The recent triennial Confidential Enquiry into Maternal Deaths in the UK reported the deaths of 81 women from cancer in pregnancy during 2003—05, compared with 28 in 2000—02. However, this increase in number was thought to be entirely due to a more intensive follow-up of the ‘late coincidental deaths’ identified through the Office for National Statistics (ONS) linkage system. Nine of these were attributable to gynaecological malignancies: four choriocarcinomas, two ovarian and three vulval or uterine cancers.

Conservative management of gynaecological cancer with fertility preservation is becoming increasingly important in the reproductive age group. This requires early detection and effective monitoring and follow-up. In addition, diagnosis of cancer in pregnancy is complicated by physiological changes, which tend to mask signs and symptoms, together with the limitations of imaging and other investigative modalities. In such a situation, serum tumour markers, despite difficulties in interpretation, play an important role. This chapter focuses on the various tumour markers relevant to gynaecological malignancies in premenopausal women and their role in management.

Tumour markers

Tumour markers are molecules or substances produced by or in response to neoplastic proliferation and which enter the circulation in detectable amounts. They indicate the likely presence of cancer or provide information about its behaviour.