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Galante A, Cerbone M, Mannavola F, Marinaccio M, Schonauer LM, Dellino M, Damiani GR, Pinto V, Cormio G, Cicinelli E, Vimercati A. Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis. Diagnostics (Basel) 2024; 14:559. [PMID: 38473031 DOI: 10.3390/diagnostics14050559] [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: 12/06/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. METHODS This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. RESULTS A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. CONCLUSIONS CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.
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Affiliation(s)
- Arianna Galante
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Mannavola
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Luca Maria Schonauer
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Vincenzo Pinto
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Gennaro Cormio
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
- Gynecologic Oncology Unit, Istituto Tumori Bari Giovanni Paolo II IRCCS, 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
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Arup G, Shravan N. Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review. Curr Oncol 2023; 30:9448-9457. [PMID: 37999104 PMCID: PMC10669942 DOI: 10.3390/curroncol30110684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.
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Affiliation(s)
- Ganguly Arup
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Narmala Shravan
- Department of Hematology and Oncology, DHR Health Oncology Institute, Edinburg, TX 78539, USA;
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Saeed MF, Almubarak T, Khalaf S, Aslan A, Juma IM. A Review of the Literature, the Detection and Treatment of Colorectal Cancer during Pregnancy: A Case Study! Euroasian J Hepatogastroenterol 2023; 13:159-162. [PMID: 38222959 PMCID: PMC10785130 DOI: 10.5005/jp-journals-10018-1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background Colorectal cancer (CRC) during pregnancy is rare and presents diagnostic and therapeutic challenges. Aim This case report focuses on a patient who presented with colorectal cancer during pregnancy. Case description A 45-year-old female primigravid, pregnant woman, in the 20th week of gestation presented with complaints of multiple episodes of bloody diarrhea and tenesmus for the past 3 weeks. This was accompanied by poor appetite and weight loss (15 kg) since the onset of pregnancy. The patient also complained of lower back and abdominal pain. Investigations confirmed an obstructing rectosigmoid mass (15 cm) that could not be passed. The patient's pregnancy was terminated, and chemotherapeutic treatment was initiated. Clinical significance With the clinical manifestations of CRC during pregnancy being non-specific, tumors are usually discovered at an advanced stage. This poses a challenge for physicians to treat such cases. This case contributes to the growing literature on pregnancies complicated by CRC and highlights the importance of high clinical suspicion and the need for a multidisciplinary team in tailoring treatment regimens in accordance with patient-centered care. Conclusion This case report highlights the rarity of colorectal cancer during pregnancy and the challenges faced in the diagnoses and treatment. How to cite this article Saeed MF, Almubarak T, Khalaf S, et al. A Review of the Literature, the Detection and Treatment of Colorectal Cancer during Pregnancy: A Case Study! Euroasian J Hepato-Gastroenterol 2023;13(2):159-162.
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Affiliation(s)
- Mirza Faraz Saeed
- Department of General Surgery, King Hamad University Hospital, Muharraq, Bahrain
| | - Taima Almubarak
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Sara Khalaf
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Ahmet Aslan
- Department of Radiology, King Hamad University Hospital, Muharraq, Bahrain
| | - Isam Mazin Juma
- Department of General Surgery, King Hamad University Hospital, Muharraq, Bahrain
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Kane SV, Reau N. Clinical advances: pregnancy in gastroenterologic and hepatic conditions. Gut 2023; 72:1007-1015. [PMID: 36759153 DOI: 10.1136/gutjnl-2022-328893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
The fields of gastroenterology and hepatology, along with endoscopic practice, have seen significant changes and innovations to practice in just the past few years. These practice changes are not limited to gastroenterology, but maternal fetal medicine and the care of the pregnant person have become increasingly more sophisticated as well. Gastroenterologists are frequently called on to provide consultative input and/or perform endoscopy during pregnancy. To be able to provide the best possible care to these patients, gastroenterologists need to be aware of (and familiar with) the various nuances and caveats related to the care of pregnant patients who either have underlying gastrointestinal (GI) conditions or present with GI and liver disorders. Here, we offer a clinical update with references more recent than 2018, along with a few words about SARS-CoV-2 infection and its relevance to pregnancy.
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Affiliation(s)
- Sunanda V Kane
- Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Nancy Reau
- Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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