Abstract
Objectives
This study aimed to analyze disease presentation, management, and oncological outcomes of patients diagnosed with peripartum colorectal cancer (CRC).
Methods
Retrospective cohort study of all consecutive women of childbearing age (18–45 years) between 2002 and 2014 diagnosed with CRC adenocarcinoma at a tertiary academic institution. Patients who experienced pregnancy within 12 months of their diagnosis (peripartum period, group 1) were compared to the remaining patients of the cohort (group 2). Overall survival (OS) was compared between the two groups through Kaplan-Meier estimates.
Results
Out of 555 consecutive women with a mean age of 37.8 + 6 years, 31 (5.6%) were diagnosed with CRC in the peripartum period. Of these, all patients were symptomatic during pregnancy due to bleeding, abdominal pain, or constipation; however, only 11 CRC (35.5%) were diagnosed during pregnancy, 1 (3.2%) during C section, and the remaining (61.3%) postpartum. TNM stage at presentation was I in 6 patients (19.4%), II in 4 patients (13.9%), III in 8 patients (25.8%), and IV in 13 patients (41.9%). Surgical resection was performed in 23 patients (74.2%): 2 while pregnant, 2 at the time of C section, and the remainder postpartum. Across all stages, OS was 95% at 1 year and 62% at 5 years and did not differ between the two comparative groups (p = 0.16).
Conclusions
A suspicious attitude towards cancer-related symptoms during pregnancy is crucial to prevent delayed evaluation for CRC.
Similar content being viewed by others
References
Pavlidis NA (2002) Coexistence of pregnancy and malignancy. Oncologist 7(4):279–287
Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, Young J (2012) Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study. BJOG 119(13):1572–1582. https://doi.org/10.1111/j.1471-0528.2012.03475.x
Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri MM, Van Gemert W, Halaska M, Vergote I, Ottevanger N, Amant F (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol 28(4):683–689. https://doi.org/10.1200/JCO.2009.23.2801
Albright CM, Wenstrom KD (2016) Malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 33:2–18. https://doi.org/10.1016/j.bpobgyn.2015.10.004
Saif MW (2005) Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer 5(4):247–256
Mechery J, Ikhena SE (2007) Cancer of the descending colon during pregnancy. J Obstet Gynaecol 27(3):311–312. https://doi.org/10.1080/01443610701241159
Smith LH, Danielsen B, Allen ME, Cress R (2003) Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 189(4):1128–1135
Rogers JE, Dasari A, Eng C (2016) The treatment of colorectal cancer during pregnancy: cytotoxic chemotherapy and targeted therapy challenges. Oncologist 21(5):563–570. https://doi.org/10.1634/theoncologist.2015-0362
Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V (2013) Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can 35(3):263–278. https://doi.org/10.1016/S1701-2163(15)30999-3
Benard F, Barkun AN, Martel M, von Renteln D (2018) Systematic review of colorectal cancer screening guidelines for average-risk adults: summarizing the current global recommendations. World J Gastroenterol 24(1):124–138. https://doi.org/10.3748/wjg.v24.i1.124
Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G (2008) Hemorrhoids in pregnancy. Can Fam Physician 54(2):189–190
Dahling MT, Xing G, Cress R, Danielsen B, Smith LH (2009) Pregnancy-associated colon and rectal cancer: perinatal and cancer outcomes. J Matern Fetal Neonatal Med 22(3):204–211. https://doi.org/10.1080/14767050802559111
Kocian P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, Halaska MJ, Amant F (2018) Writing Committee of the International Network on Cancer I, Pregnancy on this particular m (2018) Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chir Belg:1–10. https://doi.org/10.1080/00015458.2018.1493821
Chan YM, Ngai SW, Lao TT (1999) Colon cancer in pregnancy. A case report. J Reprod Med 44(8):733–736
Robson DE, Lewin J, Cheng AW, O'Rourke NA, Cavallucci DJ (2017) Synchronous colorectal liver metastases in pregnancy and post-partum. ANZ J Surg 87(10):800–804. https://doi.org/10.1111/ans.13196
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474. https://doi.org/10.1245/s10434-010-0985-4
Dozois EJ, Boardman LA, Suwanthanma W, Limburg PJ, Cima RR, Bakken JL, Vierkant RA, Aakre JA, Larson DW (2008) Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome? Medicine (Baltimore) 87(5):259–263. https://doi.org/10.1097/MD.0b013e3181881354
Ye W, Tang Y, Yao C, Shi J, Xu Y, Jiang J (2017) Advanced gastrointestinal carcinoma with massive ascites and hydrothorax during pregnancy: a case report and review of the literature. Medicine (Baltimore) 96(51):e9354. https://doi.org/10.1097/MD.0000000000009354
Hojgaard HM, Rahr H (2012) Rectal cancer in a pregnant woman, a case report. Ugeskr Laeger 174(26):1827–1828
de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, Halaska MJ, Fruscio R, Lok CAR, Boere IA, Zola P, Ottevanger PB, de Groot CJM, Peccatori FA, Dahl Steffensen K, Cardonick EH, Polushkina E, Rob L, Ceppi L, Sukhikh GT, Han SN, Amant F, International Network on C, Infertility P (2018) Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol 19(3):337–346. https://doi.org/10.1016/S1470-2045(18)30059-7
Pellino G, Simillis C, Kontovounisios C, Baird DL, Nikolaou S, Warren O, Tekkis PP, Rasheed S (2017) Colorectal cancer diagnosed during pregnancy: systematic review and treatment pathways. Eur J Gastroenterol Hepatol 29(7):743–753. https://doi.org/10.1097/MEG.0000000000000863
Acknowledgments
Fabian Grass was supported by the Société Académique Vaudoise, Lausanne, Switzerland, and by the SICPA Foundation, Lausanne, Switzerland.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Grass, F., Spindler, B.A., Naik, N.D. et al. Oncological outcome of peripartum colorectal carcinoma—a single-center experience. Int J Colorectal Dis 34, 899–904 (2019). https://doi.org/10.1007/s00384-019-03278-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-019-03278-2