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Niu C, Zhang J, Sun M, Saeed H, Han Y, Okolo PI. Maternal and perinatal outcomes of pregnant patients with colorectal cancer: a population-based study. J Cancer Res Clin Oncol 2023; 149:14159-14167. [PMID: 37553419 DOI: 10.1007/s00432-023-05248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE This study aimed to investigate the maternal and perinatal outcomes of pregnant patients with CRC using a large population-based database. METHODS A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS) from 2009 to 2019. Pregnant patients with and without CRC were compared for demographic characteristics, comorbidities, maternal and perinatal outcomes, and hospital burden. RESULTS The study included 306 pregnancies with CRC and 40,887,353 pregnancies without CRC. Pregnant patients with CRC were older and more likely to be White. A significant association was observed between CRC and a history of inflammatory bowel disease or a family history of gastrointestinal cancer. Pregnant patients with CRC had higher odds of maternal death (AOR 260.99, 95% CI 33.36-2041.64), cardiac arrhythmia (AOR 13.73, 95% CI 4.21-44.76), acute kidney injury (AOR 32.6, 95% CI 5.29-200.77), severe sepsis (AOR 163.98, 95% CI 22.05-1219.65), and respiratory failure (AOR 31.67, 95% CI 4.11-243.98). Furthermore, the CRC group experienced higher odds of cesarean section (AOR 1.78, 95% CI 1.05-3.03), preterm birth (AOR 4.16, 95% CI 2.05-8.47), and intrauterine death (AOR 13.18, 95% CI 3.33-52.16). Distinct differences in maternal and perinatal outcomes were observed based on the location of CRC. Pregnant patients with CRC faced higher hospital charges and had longer hospital stays during delivery hospitalization compared to those without CRC. CONCLUSION Pregnant patients with CRC are at increased risk for adverse maternal and perinatal outcomes, emphasizing the importance of early detection, timely intervention, and comprehensive management during pregnancy.
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Affiliation(s)
- Chengu Niu
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA.
| | - Jing Zhang
- Harbin Medical University, Harbin, 150081, China
| | - Melody Sun
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA
| | - Hassan Saeed
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA
| | - Yujing Han
- Harbin Medical University, Harbin, 150081, China
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, NY, 14621, USA
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Ibargüengoitia Ochoa F, Miranda Dévora G, Silva Lino L, Sepulveda Rivera C, González Vázquez D, Pérez Quintanilla M. Colorectal Signet Ring Cell Carcinoma in a Young Pregnant Woman. Case Rep Oncol 2020; 13:182-187. [PMID: 32231542 PMCID: PMC7098342 DOI: 10.1159/000504472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer during pregnancy is one of the less common neoplasms with an incidence of 0.8 in 100,000 pregnancies. Primary colonic signet ring cell carcinoma is a weird variety, characterized by a poor histologic differentiation, with a high morbidity-mortality rate. The case of a 24-year-old patient with a 22-week-old pregnancy and colorectal cancer stage IV in palliative state is presented, with a devastating result. Early diagnosis represents a challenge because of the presentation form and the histologic aggressiveness of this disease. We suggest that colorectal cancer during pregnancy must be treated by a multidisciplinary team.
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Affiliation(s)
| | | | | | - Cintia Sepulveda Rivera
- Gynecology and Obstetrics Department, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Diego González Vázquez
- Gynecology and Obstetrics Department, Instituto Nacional de Perinatología, Mexico City, Mexico
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Kocián P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, Halaska MJ, Amant F. Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chir Belg 2019; 119:166-175. [PMID: 30010511 DOI: 10.1080/00015458.2018.1493821] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer in pregnancy is rare, with an incidence of 0.8 per 100,000 pregnancies. Advanced disease (stage III or IV) is diagnosed more frequently in pregnant patients. We aimed to review all cases of colorectal cancer in pregnancy from the International Network on Cancer, Infertility and Pregnancy database in order to learn more about this rare disease and improve its management. METHODS Data on the demographic features, symptoms, histopathology, diagnostic and therapeutic interventions and outcomes (obstetric, neonatal and maternal) were analysed. RESULTS Twenty-seven colon and 14 rectal cancer cases were identified. Advanced disease was present in 30 patients (73.2%). During pregnancy, 21 patients (51.2%) received surgery and 12 patients (29.3%) received chemotherapy. Thirty-three patients (80.5%) delivered live babies: 21 by caesarean section and 12 vaginally. Prematurity rate was high (78.8%). Eight babies were small for gestational age (27.6%). Three patients (10.7%) developed recurrence of disease. Overall 2-year survival was 64.4%. CONCLUSION Despite a more frequent presentation with advanced disease, colorectal cancer has a similar prognosis in pregnancy when compared with the general population. Diagnostic interventions and treatment should not be delayed due to the pregnancy but a balance between maternal and foetal wellbeing must always be kept in mind.
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Affiliation(s)
- P. Kocián
- Department of Surgery, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J. de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - E. H. Cardonick
- Department of Obstetrics and Gynaecology, Division Maternal Fetal Medicine, Cooper Medical School at Rowan University, Camden, United States of America
| | - C. Uzan
- Department of Gynaecological Surgery, Institute Gustave Roussy, Villejuif, France
- Department of Gynaecology and Breast Surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, Paris, France
| | - C. A. R. Lok
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - R. Fruscio
- Division of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - M. J. Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
- Division of Gynaecologic Oncology, University Hospitals Leuven, Leuven, Belgium
- Centre for Gynaecologic Oncology Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
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Vega CEP, Soares VMN, Lourenço Francisco Nasr AM. [Late maternal mortality: comparison of maternal mortality committees in Brazil]. CAD SAUDE PUBLICA 2017; 33:e00197315. [PMID: 28444028 DOI: 10.1590/0102-311x00197315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/30/2016] [Indexed: 11/21/2022] Open
Abstract
This population-based study included all the late maternal deaths from the case series of the Maternal Mortality Committees in the city of São Paulo and the state of Paraná, Brazil. The study compared 134 deaths identified by the São Paulo committee and 124 from the Paraná committee in 2004-2013, aimed at demonstrating the magnitude and causes of late maternal mortality. Late maternal deaths accounted for 13.4% of all maternal deaths in the case series of the São Paulo committee and 12.1% in the cases series of the Paraná committee. Direct obstetric causes accounted for 32.1% of the late maternal deaths in São Paulo and 42.1% in Paraná, with postpartum cardiomyopathy as the principal cause in both case series. Death occurred between 43 and 69 days postpartum in 44% of the cases in São Paulo and 39.5% in Paraná. The correction factor for late maternal death was 3.3 in São Paulo and 4.3 in Paraná. Late maternal death had a relevant impact on overall maternal mortality, and postpartum cardiomyopathy was the principal cause of late direct obstetric death.
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Dhull AK, Gogia P, Atri R, Dhankhar R, Kaushal V, Singh S, Sen R, Pal M, Lathwal A. Exploring signet-ring cells in pregnant female. J Gastrointest Oncol 2015; 6:E10-5. [PMID: 25830043 DOI: 10.3978/j.issn.2078-6891.2014.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Primary signet-ring cell carcinoma (SRCC) of the colon and rectum are rare form, which present at an advanced stage and have poor prognosis. Different treatment policies of SRCC during different gestational age of pregnancy are explored from the literature. CASE STUDY A 26-year-old young pregnant female with 10-week gestation presented with constipation and blood in stools and on per rectal examination a tender circumferential stricture was present 2 cm above the anal verge. Magnetic resonant imaging (MRI) pelvis of the patient revealed rectal thickening, the biopsy of which revealed characteristic appearance of "linitis plastica" and diagnosed as poorly differentiated adenocarcinoma with signet ring morphology with wide spread positivity for cytokeratin & p53. With this diagnosis, patient underwent medical termination of pregnancy (MTP). DISCUSSION SRCC of the colon comprises about only 1% of all cases of colon cancer. When compared with other types of adenocarcinoma, patients with SRCC in the colon are younger and more likely to experience lymph node metastasis. Its incidence in pregnancy is estimated to be less than 0.1%. Certainly, any pregnant patient who reports rectal bleeding or has hemoccult positive stool on examination deserves careful evaluation to rule out cancer. The complex treatment of colorectal cancer in pregnancy is based on the gestational age of the fetus, tumor stage and need for emergent vs. elective management.
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Affiliation(s)
- Anil Kumar Dhull
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Gogia
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Atri
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dhankhar
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Kaushal
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Singh
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Sen
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Pal
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Lathwal
- 1 Department of Radiation Oncology, 2 Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, India ; 3 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India ; 4 Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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Al-Ibrahim A, Parrish J, Dunn E, Swallow C, Maxwell C. Pregnancy and maternal outcomes in women with prior or current gastrointestinal malignancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:34-41. [PMID: 24444285 DOI: 10.1016/s1701-2163(15)30681-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To review the fetal and maternal outcomes of women with a diagnosis of gastrointestinal (GI) cancer before or during pregnancy. METHODS We conducted a retrospective cohort study of pregnant women referred to a single tertiary care centre with a current or previous diagnosis of GI malignancy. Maternal, obstetric, and infant data were recorded. RESULTS We identified 18 pregnancies in 13 women. Nine women were found to have a GI malignancy during pregnancy (group 1). There was an indirect maternal death in this group in a woman with advanced gastric adenocarcinoma. Nine unique pregnancies occurred in eight women with diagnosis and management of GI malignancies before their pregnancies (group 2). CONCLUSION GI malignancies are difficult to diagnose and manage during pregnancy and are usually advanced at the time of diagnosis. Surgery can be performed during pregnancy if necessary, with chemotherapy and radiotherapy usually deferred to the postpartum period. Women who have had a prior GI malignancy have special circumstances related to the type of surgery performed and previous exposure to chemotherapy. These patients may benefit from a multidisciplinary team effort to optimize their care.
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Affiliation(s)
- Ali Al-Ibrahim
- Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON
| | | | - Evelyn Dunn
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Carol Swallow
- Division of General Surgery, Mount Sinai Hospital, University of Toronto, Toronto ON
| | - Cynthia Maxwell
- Maternal Disease in Pregnancy Program, Mount Sinai Hospital, University of Toronto, Toronto ON
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Jeppesen JB, Østerlind K. Successful twin pregnancy outcome after in utero exposure to FOLFOX for metastatic colon cancer: a case report and review of the literature. Clin Colorectal Cancer 2011; 10:348-52. [PMID: 21803658 DOI: 10.1016/j.clcc.2011.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/18/2011] [Accepted: 01/24/2011] [Indexed: 10/17/2022]
Abstract
There is limited experience in treating advanced colorectal cancer diagnosed during pregnancy because it is a rare occurrence; however, the incidence of colorectal cancer complicating pregnancy is expected to increase in the future. The combination of cancer and pregnancy is complicated and causes many dilemmas and concerns for the physician and patient. A delay in treatment may compromise maternal survival; however, therapy for the cancer may be harmful to the fetus. We present a case of a 26-year-old woman pregnant with twins who was diagnosed with metastatic colon cancer and treated with 5-fluorouracil, leukovorin, and oxaliplatin (FOLFOX) from 13 weeks gestational age to birth. The patient gave birth to healthy twins without malformations at 33 weeks gestational age. At follow-up examination, the 2-year-old twins are developing normally. The patient herself died 1 year after the initial cancer diagnosis. This shows a case in which the administration of FOLFOX during the second and third trimester of pregnancy caused no fetal harm. These findings are similar to those of previous studies in which systemic chemotherapy administered during the second and third trimester was relatively safe. However, we know that chemotherapy should be avoided during the first trimester.
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Affiliation(s)
- Johanne Bakker Jeppesen
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark.
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8
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Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg 2011; 23:80-9. [PMID: 21629625 DOI: 10.1055/s-0030-1254294] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pregnancy causes anatomic and physiologic changes in the gastrointestinal tract. Pregnant women with intestinal disease such as Crohn disease or ulcerative colitis pose a management challenge in clinical diagnosis, radiologic evaluation, and treatment secondary to potential risk to the fetus. Heightened physician awareness on possible etiologies such as appendicitis, diverticulitis, and rarely colorectal cancer is required for rapid diagnosis and treatment to improve maternal/fetal outcome. A multidisciplinary approach to evaluation is a necessity because radiologic procedures and treatment medications commonly used in nonpregnant patients may have a potential harmful effect on the fetus. The authors review several gastrointestinal conditions encountered during pregnancy and address presentation, diagnosis, and treatment of each condition.
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Affiliation(s)
- Sherri A Longo
- Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
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9
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Abstract
With an incidence of 950,000 pregnancies per year in France, the likelihood of seeing one or more surgical abdominal diseases during pregnancy is high. The goal of this update was to describe the management of four different settings in the pregnant woman: colorectal cancer, laparoscopic surgery, gastrointestinal emergency surgery, and bariatric surgery.
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Affiliation(s)
- A Germain
- Service de chirurgie générale, digestive et endocrinienne, CHU Nancy-Brabois, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France.
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10
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Ghosh D, Boama V. Undiagnosed rectal tumour--a rare cause of obstructed labour in the second stage. BMJ Case Rep 2010; 2010:2010/aug24_1/bcr0220102768. [PMID: 22767473 DOI: 10.1136/bcr.02.2010.2768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Colorectal cancer presenting in pregnancy is extremely rare. Here the authors present the case of a 25-year-old woman who was diagnosed with second-stage obstructed labour secondary to a large rectal tumour. Decision for emergency caesarean section was made for labour dystocia. Histology later confirmed villous adenocarcinoma of the rectum. The patient died from metastatic rectal cancer within 2 years of diagnosis.
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Affiliation(s)
- Donna Ghosh
- Department of Obstetrics & Gynaecology, Royal Cornwall Hospital, Truro, UK.
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11
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Kanate AS, Auber ML, Higa GM. Priorities and uncertainties of administering chemotherapy in a pregnant woman with newly diagnosed colorectal cancer. J Oncol Pharm Pract 2008; 15:5-8. [PMID: 18753184 DOI: 10.1177/1078155208094101] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The absence of treatment standards for the use of chemotherapy in pregnancy is due, in part, to the fact that cancer in the gravid female is relatively uncommon. METHOD A case (of a pregnant woman with newly diagnosed colorectal cancer) is presented to explore this area of medical uncertainty. RESULT Managed by a multi-disciplinary team, successful prolongation of gestation was achieved with an oxaliplatin-based chemotherapy regimen. CONCLUSION A perspective of the ongoing conflict between prolonging the mother's life and preserving fetal development is highlighted. Although not life-saving, administration of chemotherapy in this woman was life-sparing.
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Affiliation(s)
- Abraham S Kanate
- Mary Babb Randolph Cancer Center, Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, WV 26506, USA
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12
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Lolis ED, Likoudis P, Voiniadis P, Hassiakos D, Samanides L. Synchronous rectal and colon cancer caused by familial polyposis coli during pregnancy. J Obstet Gynaecol Res 2007; 33:199-202. [PMID: 17441896 DOI: 10.1111/j.1447-0756.2007.00510.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The management of colon and rectal cancer during pregnancy is controversial and challenging. Rectal or colon cancer during pregnancy is a very rare event. A 29-year-old woman, pregnant with her second child, was diagnosed with rectal cancer causing bowel obstruction and synchronous colon cancer during the 27th week of gestation. Both cancers occurred as a result of familial polyposis. This is the first case of synchronous rectal and colon cancer caused by familial polyposis during pregnancy reported in the published literature. We discuss the therapeutic interventions and the surgical management of the cancer in relation to the gestation.
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Affiliation(s)
- Evangelos D Lolis
- Second Department of Surgery, Athens University Medical School Arteion Hospital, Athens, Greece.
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Parangi S, Levine D, Henry A, Isakovich N, Pories S. Surgical gastrointestinal disorders during pregnancy. Am J Surg 2007; 193:223-32. [PMID: 17236852 DOI: 10.1016/j.amjsurg.2006.04.021] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2005] [Revised: 04/21/2006] [Accepted: 04/21/2006] [Indexed: 11/21/2022]
Abstract
All gastrointestinal (GI) disorders can present during pregnancy, and in fact 0.2% to 1.0% of all pregnant women require non-obstetrical general surgery. All of the clinical decision-making skills of the experienced surgeon must come into play in order to make the correct therapeutic decisions when evaluating the pregnant patient with a GI disorder that potentially requires surgery. While in general the principles of diagnosing and treating a pregnant woman with an acute surgical abdominal problem remain the same as those governing the treatment of the non-pregnant patient, some important differences are present and can pose problems. As a general rule the condition of the mother should always take priority because proper treatment of surgical diseases in the mother will usually benefit the fetus as well as the mother.
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Affiliation(s)
- Sareh Parangi
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Chêne G, Tardieu AS, Favard A, Lebel A, Voitellier M. [Colorectal cancer discovered during pregnancy]. ACTA ACUST UNITED AC 2006; 35:504-12. [PMID: 16940921 DOI: 10.1016/s0368-2315(06)76425-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Colorectal carcinoma during pregnancy is very rare. Prognosis is severe because of the advanced stage due to delay in diagnosis and the aggressiveness of this widespread metastatic disease. We report the case of colon metaststic adenocarcinoma during a twin pregnancy with a good outcome. In the light of epidemiology, pathogeny and immunology, the diagnostic challenge for clinicians is distinguishing pregnancy symptoms from the warning signs of colorectal cancer and, we describe recommended medical and surgical management.
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Affiliation(s)
- G Chêne
- Département de Chirurgie Digestive et Viscérale, Centre Hospitalier de Vichy, boulevard Denière, BP 2757, 03201 Vichy Cedex.
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15
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Minter A, Malik R, Ledbetter L, Winokur TS, Hawn MT, Saif MW. Colon cancer in pregnancy. Cancer Control 2005; 12:196-202. [PMID: 16062167 DOI: 10.1177/107327480501200310] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Colorectal cancer (CRC) is one of the 3 most common types of cancer in women, but CRC during pregnancy is rare, with a reported incidence of approximately 0.002%. Synchronous colon cancer during pregnancy presents a diagnostic and therapeutic challenge for clinicians because there are no generally accepted guidelines regarding diagnosis or treatment. The diagnosis is challenging because the presenting signs/symptoms of CRC are often attributed to the usual complications of pregnancy, which could delay the diagnosis and allow the cancer to progress to an advanced stage. Carcinogenesis of colon cancer in pregnancy is not clear, but a few studies suggest that the increased levels of estrogen and progesterone related to pregnancy stimulate the growth of CRC with their receptors. The aim of treatment is to start therapy for the mother as early as possible and to simultaneously deliver the baby at the earliest time allowable. The management mandates a multidisciplinary approach involving experts in obstetrics, neonatology, gastrointestinal surgery, and medical oncology. The medical community should be able to diagnose colon cancer earlier in pregnancy in order to improve prognosis. The primary care physician or obstetrician should refer the pregnant patient with significant gastrointestinal symptoms to the gastroenterologist for evaluation. Likewise, the gastroenterologist should be prepared to perform sigmoidoscopy (preferably without endoscopic medications) for significant lower gastrointestinal symptoms such as persistent rectal bleeding. Herein, the author reviews the literature concerning the diagnosis and treatment of CRC in pregnancy and discusses the role of newer agents approved for the treatment of CRC.
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Affiliation(s)
- M Wasif Saif
- Section of Medical Oncology, Yale University School of Medicine, 333 Cedar Street, FMP 116, New Haven, CT 06520, USA.
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Lin JT, Wang WS, Yen CC, Liu JH, Yang MH, Chao TC, Chen PM, Chiou TJ. Outcome of colorectal carcinoma in patients under 40 years of age. J Gastroenterol Hepatol 2005; 20:900-5. [PMID: 15946138 DOI: 10.1111/j.1440-1746.2005.03893.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Colorectal carcinoma in patients under 40 years of age usually has a poor prognosis. Controversies still exist regarding the features and the prognosis of colorectal cancer in young patients. METHODS The records of 45 patients with histologically confirmed colorectal carcinoma treated between 1992 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed. The relevance of sex, duration of symptoms, tumor site, histological type, lymph node involvement, Karnofsky performance status (KPS), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels at the diagnosis and tumor stage to overall survival (OS) were determined by univariate analysis, and their independent significance were tested by multivariate analysis. RESULTS Most patients presented with an advanced tumor stage (24% Dukes' C and 66% Dukes' D). Colon carcinoma constituted 76% of the colorectal tumors. Family history was present in two patients and did not affect the OS. Two patients were found to have colon carcinoma during pregnancy. The 5-year survival rate in patients with Stage B, C, and D were 25, 16 and 0%, respectively. With aggressive treatment, patients with early stage carcinoma achieved longer survival. Eleven patients received resection of metastatic carcinoma of the liver, lung and ovary. Adjuvant chemotherapy with irinotecan/5-fluorouracil-based chemotherapy seemed to improve the OS in such patients, though the OS was still poorer than in patients with early stage tumors. In univariate analysis, KPS (P = 0.0001), lymph node involvement (P = 0.0024), CEA (P = 0.0423) and LDH levels (P = 0.0126) at the diagnosis and tumor stage (P = 0.0122) proved to be significant predictors of overall survival. Multivariate analyses revealed that KPS > or =70% (P = 0.007) and normal LDH levels at diagnosis (P = 0.004) were predictive of overall survival in this population. CONCLUSIONS The present study shows that performance status and preoperative LDH levels were the major determinants for survival in patients with colorectal carcinoma under 40 years of age and the present series also suggests that surgical resection of metastatic colorectal carcinoma followed by adjuvant chemotherapy might be beneficial in certain patients. The data also suggests that current treatment modalities for young patients with advanced colorectal cancer might not be effective and more effective therapeutic regimens might be needed. Thus, it is important for surgeons to recognize the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.
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Affiliation(s)
- Jen-Tsun Lin
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, #201 Sec. 2 Shi-Pai Road, Shi-Pai, Taipei 112, Taiwan
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Cappell MS. From Colonic Polyps to Colon Cancer: Pathophysiology, Clinical Presentation, and Diagnosis. Clin Lab Med 2005; 25:135-77. [PMID: 15749236 DOI: 10.1016/j.cll.2004.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiologists, basic researchers, clinicians, and public health administrators unite! Develop and implement a simple, safe, and effective preventive and screening test for colon cancer. The public will willingly and enthusiastically accept such a test. Many thousands of lives are at stake every year.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
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Cappell MS. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps. Med Clin North Am 2005; 89:1-42, vii. [PMID: 15527807 DOI: 10.1016/j.mcna.2004.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A review of the pathophysiology, clinical presentation, and diagnosis of colon cancer and colonic polyps is important and timely. This field is rapidly changing because of breakthroughs in the molecular basis of carcinogenesis and in the technology for colon cancer detection and treatment. This article reviews colon cancer and colonic polyps, with a focus on recent dramatic advances, to help the pri-mary care physician and internist appropriately refer patients for screening colonoscopy and intelligently evaluate colonoscopic findings to reduce the mortality from this cancer.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
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Abstract
Numerous medical, surgical, psychiatric, gynecologic, and obstetric disorders can cause abdominal pain during pregnancy. The patient history, physical examination, laboratory data, and radiologic findings usually provide the diagnosis. The pregnant woman has physiologic alterations that affect the clinical presentation, including atypical normative laboratory values. Abdominal ultrasound is generally the recommended radiologic imaging modality; roentgenograms are generally contraindicated during pregnancy because of radiation teratogenicity. Concerns about the fetus limit the pharmacotherapy. Maternal and fetal survival have recently increased in many life-threatening conditions, such as ectopic pregnancy, appendicitis, and eclampsia, because of improved diagnostic technology, better maternal and fetal monitoring, improved laparoscopic technology, and earlier therapy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Abstract
Cancers in pregnancy are uncommon but do occur with an average frequency of 1 in 1,000 births. This gives rise to opposing emotional reactions in these women: they are happy they are pregnant, but usually devastated when they hear they have cancer. The major reasons for suspecting that pregnancy adversely affects the clinical course of cancer is the immunologic tolerance that characterizes both conditions. It has been pointed out that normal pregnancy and cancer are the only two biologic conditions in which the antigenic tissues is tolerated by a seemingly intact system. It may be stated that the mechanisms that insure the survival of fetus during pregnancy presumably also favors the progress of the neoplasia. Management requires individualization with careful thought as whether termination is necessary or whether continuing with the pregnancy is possible prior to definitive treatment. The physician's aim must be to cure the cancer and deliver live, healthy infants. This is one question when a joint decision is probably best reached among the obstetrician, surgical and medical oncologists and other disciplines. The life-threatening cancer should be managed both for the diagnosis and treatment as in the non-pregnant state. An early small cancer gives a better prognosis than an advanced cancer. The same holds for the non-pregnant patient. The survival in the non-pregnant patient stage for stage is the same as for the pregnant patient. However, all too often in the pregnant state the cancer is more advanced than in the non-pregnant patient. The disease must be evaluated and treated in full light of its exact location in conjunction with an understanding of the natural history within the context of the pregnancy with the potentially viable unborn infant. Concern that maternal cancer may metastasize to the fetus is not justified from a review of the accumulated literature. Infrequency of fetal involvement has led to speculation about biologic protective mechanisms that may exist for the placenta and the fetus and the role circulatory separation in the placenta and immunologic responses of the fetus may play. The association of cancer in pregnancy represents a major physiologic process for the maintenance of the race and a major pathologic process that accounts for numerous deaths. It presents a controlled growth and an uncontrolled growth in the same host.
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Affiliation(s)
- H R Barber
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, USA
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Abstract
When cancer occurs during pregnancy, a conflict exists between the family's hopes and dreams for the future and the reality of the diagnosis of a potentially terminal illness. The nurse has a pivotal role in the assessment and management of the pregnant oncologic patient's physical and emotional health. The perinatal nurse must assure that the care experienced by the family balances the reality of a potentially life-threatening illness with the joy that accompanies the birth of a baby.
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Affiliation(s)
- D A Blackwell
- Department of Family and Community Health Nursing in the College of Nursing at the University of South Carolina, Columbia 29208, USA
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