Pregnancy and Gastrointestinal Cancers

  • Irfan Cicin
  • Gulay Durmus Altun
  • Nermin Tuncbilek
  • Yavuz Atakan Sezer
  • Ezgi Cisil Erdogan


The second most common cause of death for women in reproductive age is cancer. The mean age of mothers is on the rise today. As the incidence of cancer rises with age, the incidence of cancer during pregnancy is expected to also rise. Colorectal cancer is the 7th most common type of cancer diagnosed during pregnancy. There are oncologic, obstetrical, ethical, religious, legal, and socioeconomic issues regarding the diagnosis and treatment of gastrointestinal cancer. The well-being of the fetus and the mother must always be considered. There are contradictions as the treatment of the pregnant woman may harm the fetus. Working with a multidisciplinary team involving an obstetrician/perinatologist, a surgeon, a radiation oncologist, a medical oncologist, a radiologist, a social worker, a genetic counselor, and an ethicist is necessary for the diagnosis and treatment of gastrointestinal cancers during pregnancies. The two most important factors that need to be considered are the stage of cancer and pregnancy. Stages of pregnancy and fetal development should be well-known to find the appropriate treatment plan for both the patient and fetus. The location, type, and stage of the cancer and what the mother prefers are very important considerations.


Gastrointestinal Cancer Pregnancy Placenta Neoplasms Pregnancy outcome Laparoscopy Fetus radiation effects Fetus drug effects Treatment 


  1. 1.
    Mathews TJ, Hamilton BE. First births to older women continue to rise. NCHS data brief, no 152. Hyattsville, MD: National Center for Health Statistics; 2014.Google Scholar
  2. 2.
    Woods JB, Martin JN Jr, Ingram FH, Odom CD, Scott-Conner CE, Rhodes RS. Pregnancy complicated by carcinoma of the colon above the rectum. Am J Perinatol. 1992;9(2):102–10.CrossRefPubMedGoogle Scholar
  3. 3.
    Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Backes CH, Moorehead PA, Nelin LD. Cancer in pregnancy: fetal and neonatal outcomes. Clin Obstet Gynecol. 2011;54(4):574–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Bural GG, Laymon CM, Mountz JM. Nuclear imaging of a pregnant patient: should we perform nuclear medicine procedures during pregnancy? Mol Imaging Radionucl Ther. 2012;21(1):1–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bithell JF, Stone RA. On statistical methods for analysing the geographical distribution of cancer cases near nuclear installations. J Epidemiol Community Health. 1989;43(1):79–85.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics. 2007;27:909–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Wang PI, Chong ST, Kielar AZ, Kelly AM, Knoepp UD, Mazza MB, et al. Imaging of pregnant and lactating patients: part I, evidence-based review and recommendations. AJR Am J Roentgenol. 2012;198(4):778–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Ueo H, Matsuaka H, Tamura S. Prognosis in gastric cancer associated with pregnancy. World J Surg. 1991;15:293–7.CrossRefGoogle Scholar
  10. 10.
    Kraljevic M, Hoffmann H, Knipprath A, von Holzen U. Obstructing adenocarcinoma of the descending colon in a 31-year-old pregnant woman. Int J Surg Case Rep. 2014;5(12):958–60.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Khodaverdi S, Kord Valeshabad A, Khodaverdi M. A case of colorectal cancer during pregnancy: a brief review of the literature. Case Rep Obstet Gynecol. 2013;2013:626393.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Minter A, Malik R, Ledbetter L, Winokur TS, Hawn MT, Saif MW. Colon cancer in pregnancy. Cancer Control. 2005;12(3):196–202.CrossRefPubMedGoogle Scholar
  13. 13.
    Yaghoobi M, Koren G, Nulman I. Challenges to diagnosing colorectal cancer during pregnancy. Can Fam Physician. 2009;55(9):881–5.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Cappell MS, Colon VJ, Sidhom OA. A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison to control groups. Dig Dis Sci. 1996;41:2353–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Kocian PA, Hoch J, Halaska M. Sigmoid colon cancer in pregnancy –a case report. Rozhl Chir. 2015;94(4):170–3.PubMedGoogle Scholar
  16. 16.
    Lazarus E, Debenedectis C, North D, Spencer PK, Mayo-Smith WW. Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients—1997–2006. Radiology. 2009;251(2):517–24.CrossRefPubMedGoogle Scholar
  17. 17.
    Long SS, Long C, Lai H, Macura KJ. Imaging strategies for right lower quadrant pain in pregnancy. AJR Am J Roentgenol. 2011;196:4–12.CrossRefPubMedGoogle Scholar
  18. 18.
    Huda W. Review of radiologic physics. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.Google Scholar
  19. 19.
    Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness. Radiographics. 2010;30:1215–29; discussion 1230–33CrossRefPubMedGoogle Scholar
  20. 20.
    Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012;32(3):897–911.CrossRefPubMedGoogle Scholar
  21. 21.
    Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008;112(2 pt 1):333–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Voulgaris E, Pentheroudakis G, Pavlidis N. Cancer and pregnancy: a comphrehensive review. Surg Oncol. 2011;20:175–85.CrossRefGoogle Scholar
  23. 23.
    Kanal E. Pregnancy and the safety of magnetic resonance imaging. Magn Reson Imaging Clin N Am. 1994;2(2):309–17.PubMedGoogle Scholar
  24. 24.
    Strasilova P, Prochazka M, Pilka R. Maligni tumory v tehotenství. Postgraduaní medicina. 2014;5:52–61.Google Scholar
  25. 25.
    De Wilde JP, Rivers AW, Price DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol. 2005;87(2–3):335–53.PubMedGoogle Scholar
  26. 26.
    Qureshi WA, Rajan E, Adler DG, Davila RE, Hirota WK, Jacobson BC, et al. ASGE Guideline: guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2005;61:357–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Xie T, Zaidi H. Development of computational pregnant female and fetus models and assessment of radiation dose from positron-emitting tracers. Eur J Nucl Med Mol Imaging. 2016;43(13):2290–300.CrossRefPubMedGoogle Scholar
  28. 28.
    Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989;161(5):1178–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Nesbitt JC, Moise KJ, Sawyers JL. Colorectal carcinoma in pregnancy. Arch Surg. 1985;120:636.CrossRefPubMedGoogle Scholar
  30. 30.
    Barbosa OA, Souza AD, Moura MR, Junior EJ, Fontenele JP. Diffuse gastric cancer during pregnancy: report of a rare association. World J Oncol. 2015;6(5):456–8.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Davis J, Bashir S, Wubneh H, Borum ML. Metastatic pancreatic adenocarcinoma during pregnancy. ACG Case Rep J. 2016;3(4):e190.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Choi KK, Hong YJ, Choi SB, Park YN, Choi JS, Lee WJ, Kim KS. Hepatocellular carcinoma during pregnancy: is hepatocellular carcinoma more aggressive in pregnant patients? J Hepatobiliary Pancreat Sci. 2011;18(3):422–31.CrossRefPubMedGoogle Scholar
  33. 33.
    Amant F, Vandenbroucke T, Verheecke M, Fumagalli M, Halaska MJ, Boere I, International Network on Cancer, Infertility, and Pregnancy (INCIP), et al. Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med. 2015;373(19):1824–34.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Karnaofsky DA. Drugs as teratogens in animals and man. Annu Rev Pharmacol. 1965;5:447.CrossRefGoogle Scholar
  35. 35.
    Koren G, Carey N, Gagnon R, Maxwell C, Nulman I. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013;35(3):263–78.CrossRefPubMedGoogle Scholar
  36. 36.
    Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol. 2005;6(5):328–33.CrossRefPubMedGoogle Scholar
  37. 37.
    Geisler JP, Rose SL, Mernitz CS, Warner JL, Hiett AK. Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications. JSLS. 1998;2(3):235–8.PubMedPubMedCentralGoogle Scholar
  38. 38.
    ESMO E-Learning: Cancer Management During Pregnancy. Last accessed 19 Jan 2018.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Irfan Cicin
    • 1
  • Gulay Durmus Altun
    • 2
  • Nermin Tuncbilek
    • 3
  • Yavuz Atakan Sezer
    • 4
  • Ezgi Cisil Erdogan
    • 5
  1. 1.Department of Medical OncologyTrakya UniversityEdirneTurkey
  2. 2.Department of Nuclear Medicine, PhysiologyTrakya University Medical FacultyEdirneTurkey
  3. 3.Department of RadiologyTrakya UniversityEdirneTurkey
  4. 4.Department of General SurgeryTrakya University Medical FacultyEdirneTurkey
  5. 5.Department of Medical OncologyTrakya University Medical FacultyEdirneTurkey

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