Dobrokhotova Y1, Danelian S2 and Borovkova E1*
1Department of Obstetrics and Gynecology, Russian National Research Medical University, Russia 2Department of Obstetrics and Gynecology, City Clinical Hospital No. 40, RussiaFulltext PDF
Background: Colorectal Cancer (CRC) is exceedingly rare in pregnancy, estimated to occur in 1 in 13000 pregnancies. CRC symptoms such as abdominal pain, constipation, nausea, and vomiting are usually attributed to the physiological changes of pregnancy. Case Presentation: A 30-year-old woman at 23-24 weeks of gestation presented with abdominal discomfort, constipation, and bloody rectal discharge. A 34-year-old woman at 27-28 weeks of gestation delivered to the emergency room with the episode of unconsciousness and involuntary urination. Both patients underwent the MRI examination without contrast. MRI scanning showed a formation of the sigmoid colon without obstruction and a cystic-solid formation of the right ovary (in the first patient) and formations of the frontal-parietal lobe, multiple hepatic metastases, and the tumour of the ampullary rectum with stenosis (in the second patient). The diagnosis of the sigmoid and rectal adenocarcinoma was estimated in both women via performing the colonoscopy with biopsy. After the neoadjuvant chemotherapy with FOLFOX was done, doctors performed surgical operations as follows: the laparotomy, caesarean section, panhysterectomy, hemicolectomy with descendo-rectal anastomosis, and pelvic lymphody section for the first patient (performed on 33 gestation week due to increase of the size of metastasis in ovary); caesarean section for the second patient (performed on the 33 gestation week of pregnancy due to the fetal stress). The second patient deceased 5 months after delivery. The first patient four weeks postoperatively, we continue the course of adjuvant chemotherapy with XELOX. Five months later PET/CT revealed a single metastasis in the liver and multiple metastases in the lungs. Two line chemotherapy (FOLFIRI+) was administered. Six months revealed a reactivation of tumour progression and a STIVARGA therapy was started. Conclusion: The most common colorectal cancer symptoms can usually be masked by those developing due to the physiological changes during the pregnancy. That hardens the diagnosis of CRC in pregnant patients. The management tactics are similar in pregnant and non-pregnant patients, but there are some special considerations for securing fetal safety.
Colorectal cancer; Pregnancy; Chemotherapy
Dobrokhotova Y, Danelian S, Borovkova E. Colon Cancer during Pregnancy: A Report of Two Cases. Ann Clin Case Rep. 2020; 5: 1788..