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Kolorektale Neoplasien in der Schwangerschaft

Colorectal cancer during pregnancy

Zusammenfassung

Kolorektale Neoplasien während der Schwangerschaft sind selten, dennoch ist es auch aufgrund des zunehmenden Lebensalters der Schwangeren zu einem leichten Anstieg der Inzidenz gekommen. Da die Hauptsymptome dieser Neoplasien und typische schwangerschaftsassoziierte Symptome identisch sind, ist die Diagnose häufig verspätet. Damit ist die Koinzidenz von Schwangerschaft und kolorektaler Neoplasie mit einer schlechten Prognose assoziiert. Kolorektale Neoplasien während der Schwangerschaft sind zu 80% im Rektum lokalisiert und können daher durch geringen klinischen Aufwand mittels rektal-digitaler Untersuchung und Sigmoidoskopie leicht diagnostiziert werden. Lokalisation, Stadium und Komplikationen des Tumors, Alter des Fetus, ethische/moralische Einstellungen und die weitere Familienplanung der Patientin sind bei der Entwicklung interdisziplinärer individualisierter Therapiekonzepte von herausragender Bedeutung. Prinzipiell ist eine chirurgische Sanierung des Tumorbefundes nach der 12. Schwangerschaftswoche ohne erhöhtes Risiko für den Fetus möglich. Adjuvante Verfahren der Chemo- und Strahlentherapie sind von untergeordneter Bedeutung. Die Entbindung sollte durch Sectio erfolgen, wenn die Integrität des Tumors durch die vaginale Geburt zerstört werden könnte.

Abstract

Colorectal cancer during pregnancy is uncommon although there was a slightly increase maybe due to delay of pregnancy later in life. Diagnosis was frequently delayed because major symptoms of colorectal cancer were similar to clinical findings during pregnancy. More than 80% of these cancers were located in the rectum and could therefore easily detect by anorectal examination and sigmoidoscopy. Interdisciplinary treatment is individualized and guided by the location, stage, complication of the tumor, fetal age, ethical/moral issues and the desire of future pregnancies. Curative surgery after 12 weeks of gestation did not affect fetus outcome. Moreover, adjuvant chemotherapy and radiation have limited roles in the treatment of pregnant patients. Nevertheless, colorectal cancer during pregnancy was accompanied with a poor prognosis. Earlier diagnosis is necessary to achieve better results in this special subgroup of patients.

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Correspondence to Dr. H. Janßen.

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Janßen, H. Kolorektale Neoplasien in der Schwangerschaft. Gynäkologe 38, 112–118 (2005). https://doi.org/10.1007/s00129-004-1642-4

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Schlüsselwörter

  • Kolorektale Neoplasie
  • Rektumkarzinom
  • Schwangerschaft
  • Chemotherapie

Keywords

  • Colorectal cancer
  • Rectal cancer
  • Pregnancy
  • Chemotherapy