Management of colorectal neoplasia during pregnancy and in the postpartum period

Abstract

AIM:To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum period. METHODS:Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum period (< 6 mo), between 8/1997 and 4/2013, in our department were reviewed. Patient characteristics, operations, fetal health and follow-up during pregnancy, type of delivery and oncologic outcomes were analyzed. RESULTS:Eight patients met our study criteria. Median age at the time of diagnosis of colorectal cancer was 31 years. Median follow-up after surgery was 36 mo. Median duration of symptoms before diagnosis was 16 wk. Three patients were diagnosed with colorectal cancer during pregnancy and underwent surgery prior to delivery. None of the patients received adjuvant treatment during pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1 mo after delivery and underwent surgery. No adverse neonatal outcomes were noted. All deliveries were at term (2 cesarean sections) except for one preterm delivery following low anterior resection on the 34 th week of pregnancy. CONCLUSION:There has been a significant delay in the diagnosis of colorectal cancer which is probably due to overlap of symptoms and signs between these tumors and a normal pregnancy. Surgery for colorectal cancer during pregnancy can be performed safely without compromising

Colorectal cancer during pregnancy or postpartum: Case series and literature review

“…There have been similar recent reports by Kocian et al 10 (41 cases), Aytec et al 11 (eight cases), and Pellino et al 8 (119 cases). We have summarized these similarities in Table 2.…”

“…In the metastatic setting, there are 19 CRC antineoplastic agents approved for use. Some of these agents have been used in pregnancy and are described in case reports or series, however the majority have no information regarding pregnancy 8,10–11,14–33. Long-term outcomes of infants exposed to these cytotoxic agents are unknown.…”

“…Patients often present with rectal bleeding, abdominal cramping, iron deficiency anemia, and constipation. 8,10,11 Given these overlapping symptoms, it is essential for clinicians to be aware of the early symptoms of CRC in order to distinguish between the timing and characteristics of normal pregnancy and those patients showing signs of CRC that will require further assessment.…”

Colorectal cancer in pregnancy: a case report and literature review

“…Possible complications include fetal growth restriction and premature delivery. When the condition permits, most researchers recommend postpartum chemotherapy (9,10). For advanced and metastatic CRC, FOLFOX [oxaliplatin, leucovorin, and 5-fluorouracil (5-FU)] regimen chemotherapy is recommended..…”

Colorectal Cancer in Pregnant Woman

“…An opion would be the weekly therapy, especially the treatment with doxorubicin, paclitaxel, epirubicin, with minimal hematological effects in the mother and a much faster recovery for childbirth [225,226]. Chemotherapy should not be given after 33 weeks or 3 weeks before birth [227].…”