Detecting cancer during pregnancy is an incredibly delicate and emotional process. Pregnant women already experience so many changes in their bodies, and when cancer is suspected, it can add layers of uncertainty and fear. 

Maternal cancer refers to cancer that develops during pregnancy or within the postpartum period (typically the first year after childbirth). Although it is rare, the diagnosis of cancer during pregnancy presents unique challenges both for the mother and her healthcare team. 

It can affect any type of cancer, but certain cancers are more commonly diagnosed during pregnancy, including breast cancer, cervical cancer, melanoma, and hematologic cancers such as leukaemia and lymphoma.

Blood tests can play a crucial role in detecting potential signs of cancer, but they aren't always straightforward—many of the markers used to diagnose cancer can also be affected by the normal changes of pregnancy. It’s a challenging balancing act for doctors to distinguish between the two.

In this article, we’ll take a closer look at how blood tests are used to detect cancer in expectant mothers, the hurdles doctors face, and how these tests are helping to provide earlier diagnoses, offering hope for both the mother and her baby.

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Blood Tests For Detecting Cancer in Pregnant Individuals 

1. Circulating Tumor DNA (ctDNA) Tests:

• These tests detect small fragments of DNA that are released into the bloodstream by tumours. The presence of ctDNA can sometimes indicate cancer, though it's not specifically used for pregnancy-related cancers.
• ctDNA testing is most commonly used in oncology for detecting certain cancers such as breast cancer or colon cancer.

2. Cancer Antigen (CA) Markers:

• CA-125: Often used to detect ovarian cancer, but elevated levels can also be seen in pregnancy, especially in the first trimester, as well as other benign conditions.
• CA 15-3 and CA 27-29: These markers are mainly used in breast cancer detection, but can be influenced by pregnancy hormones, especially during the first and second trimesters.
• Alpha-fetoprotein (AFP): Elevated AFP levels are typically associated with certain cancers like liver or testicular cancer, but AFP is also naturally elevated in the blood of pregnant women, as it is produced by the fetus.

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3. Placental Protein Tests:

• Some placental proteins, such as PAPP-A (pregnancy-associated plasma protein A), are measured during pregnancy. Low or high levels could be a sign of various conditions, including potential cancerous changes in the mother, though they are primarily used for screening for chromosomal abnormalities.

4. Liquid Biopsy for Cancer Detection:

• Liquid biopsy involves blood tests that detect genetic mutations or tumor-specific markers in the blood. This is an emerging field, and while not widely available, liquid biopsies are showing promise in detecting a range of cancers, including lung, breast, and colorectal cancers, by analysing cfDNA (circulating free DNA) and ctDNA.

5. Human Chorionic Gonadotropin (hCG) Levels:

• hCG is a hormone produced by the placenta during pregnancy. Though not used to detect cancer directly, abnormal hCG levels can be indicative of trophoblastic disease, a rare cancer that can occur during pregnancy.

Related story: 5 Habits That May Increase Cancer Risk

Types of Maternal Cancer

 

 

 

 

1. Breast Cancer

The most common cancer is diagnosed in pregnant women. Changes in the breast during pregnancy (like swelling or tenderness) can sometimes mask the symptoms, which makes early detection more difficult. However, breast cancer can also grow rapidly during pregnancy due to hormone fluctuations.

2. Cervical Cancer

Pregnancy hormones can lead to changes in the cervix that might be mistaken for signs of cancer, such as unusual bleeding or discharge. Cervical cancer is often detected through abnormal pap smears, and the diagnosis during pregnancy might require special consideration for treatment options.

Related story: Everything You Need to Know About Skin Cancer

3. Melanoma

Skin cancer, particularly melanoma, can be more aggressive during pregnancy, as hormonal changes may influence the growth of the tumour. It’s important to examine any new or changing moles or spots on the skin, as they could signal melanoma. But the good part is melanoma is not commonly found in India.

4. Leukaemia and Lymphoma

Hematologic cancers, such as leukaemia or lymphoma, are rare but can develop during pregnancy. These cancers can be hard to distinguish from pregnancy-related fatigue or other symptoms, so they require careful medical evaluation.

Related story: Preventing Breast Cancer

5. Ovarian Cancer

Though less common, ovarian cancer can be detected in pregnant women, particularly if a mass is found during a routine ultrasound. Symptoms such as bloating, pelvic pain, or unusual changes in bowel movements may be indicative of ovarian cancer.

6. Choriocarcinoma

A rare type of cancer that can develop in the uterus after pregnancy, particularly following a miscarriage, abortion, or molar pregnancy. It involves the abnormal growth of tissue in the uterus and can be life-threatening if not treated.

Related story: Is Early Onset Cancer on Rise?

Challenges in Pregnancy

1. Interference from Pregnancy-Related Markers

Many cancer biomarkers, such as AFP, CA-125, and hCG, can also be elevated during pregnancy. For example, elevated AFP is typically associated with liver cancer but can also rise in pregnant women, making it challenging to distinguish between cancer and normal pregnancy changes.

2. Hormonal Changes and Symptom Overlap

More often than not pregnancy causes significant hormonal fluctuations, which can lead to symptoms like fatigue, weight changes, and abdominal discomfort. The catch is these symptoms that can also be present in cancer. This creates difficulty in accurately diagnosing the underlying cause.

Related story: How to Lower The Chances of Developing Prostate Cancer

3. Imaging Limitations

While imaging tests like CT scans and X-rays are effective for detecting cancer, they are generally avoided during pregnancy due to the risks of radiation exposure to the fetus. While ultrasound and MRI are safer options, they may not always provide the level of detail required for an accurate diagnosis, especially for certain types of cancer.

4. Risk of Procedural Complications

Performing biopsies or other invasive diagnostic procedures in pregnant women can carry risks such as miscarriage, preterm labour, or infection, which complicates the decision-making process.

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5. Difficulty in Interpreting Test Results

The elevated levels of pregnancy-related hormones and proteins may mask or mimic cancer-related changes, leading to false positives or ambiguous results. This makes it harder to rely solely on blood tests for an accurate diagnosis.

6. Need for a Multidisciplinary Approach

Accurate cancer diagnosis during pregnancy requires the collaboration of various specialists, including oncologists, obstetricians, and radiologists. A comprehensive approach that combines blood tests, clinical evaluation, imaging, and biopsies ensures the best care for both mother and baby while minimising risks.

7. Timing and Pregnancy Stage Considerations

The stage of pregnancy can also impact diagnostic choices and the interpretation of results. Certain tests might be more reliable in the second or third trimester compared to the first, requiring careful timing for optimal accuracy. For example, imaging tests like Magnetic Resonance Imaging (MRI) are often preferred over X-rays in the later stages of pregnancy, due to their avoidance of radiation exposure to the fetus. Similarly, blood tests like serum tumour marker levels might need to be timed carefully to account for hormonal changes associated with pregnancy. 

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