Challenges Associated with Colorectal Cancer in Pregnancy

Abstract

Colorectal cancer is epidemiologically a disease of the middle-aged and elderly. However, it may occur in the young where it presents with virulent biological behavior and poor prognosis. The symptoms of colorectal cancer may be masked by symptoms of pregnancy and the patient may attribute it to the pregnancy, especially in multiparous patients whose anxiety and apprehension levels may be lower and hence present late to health care providers. Antenatal women who present with such symptoms must be investigated further under the available repertoire of investigations possible in pregnancy without causing any maternal or fetal hazard. Treatment with chemotherapy and radiation for cancer in this setting is further hampered by justifiable concerns over fetal well-being. We present a case of colorectal cancer in a young multiparous female and the associated difficulties in diagnosis and management. The challenges with colorectal cancers and pregnancies are expected to rise in the future with a decreasing trend in age of colorectal cancer occurrence and an increasing age of pregnancy due to lifestyle changes.

Reproductive Health Experiences of Females Diagnosed with Young-Onset Colorectal Cancer: A Multi-Method Cross-Sectional Survey

“…Indeed, with an estimated incidence of CRC during 2 of every 100,000 pregnancies [ 12 ], yCRC is among the cancers with negative implications on pregnancy. Even so, prior research on yCRC and pregnancy is limited and has largely focused on clinical aspects during pregnancy such as treatment options, maternal and fetal outcomes, and effects of treatment on reproduction [ 12 , 28 ] as well as difficulties of diagnosing CRC during pregnancy given the similarity to symptoms experienced in normal pregnancy (e.g., nausea, vomiting, constipation, and anemia) [ 4 , 13 , 14 ]. A study on specific and non-specific symptoms of CRC by Rasmussen et al found that women of 20–39 years of age experienced the following symptoms in association with CRC: abdominal pain (38.0%), blood in stool (7.7%), diarrhea (19.9%), constipation (23.5%), and tiredness (73.4%) [ 29 ].…”

“…Prior research on yCRC and reproductive health is limited and has largely focused on clinical aspects during pregnancy and difficulties of diagnosing yCRC given that symptoms tend to be similar to those experienced in normal pregnancies (e.g., nausea, vomiting, constipation, and anemia) [ 4 , 13 , 14 ]. Understanding of reproductive health impacts, particularly on family planning decisions, of yCRC among women who experienced pregnancy around the time of their yCRC diagnosis (e.g., before or after) as well as those who have never been pregnant are lacking.…”

A Challenging Case: Colorectal Cancer During Pregnancy

“…There is an average 2% increase in the incidence of colorectal cancer in individuals aged 20-34 years. By 2030, the incidence of colorectal cancer in this age group is predicted to increase by 90%-124% [1,6]. The increased incidence is not only seen in the general population but also due to the delay in pregnancy until the third or fourth decade of life [7,8].…”

Lower gastrointestinal bleeding in pregnancy: Differential diagnosis, assessment and management

“…48 Weight loss, tenesmus, nausea and a change in bowel movement have also been reported, however, the latter symptoms are common in pregnancy and diagnosis may be delayed as a result. 51 A family history of colorectal malignancies should also be sought.…”