Case of colorectal cancer in a 32-year-old in the third trimester of pregnancy
Colorectal carcinoma is one of the most prevalent types of cancer in the world, however, occurs infrequently in women with an estimated incidence of 0.002% and 0.008%. Moreover, colorectal cancer during pregnancy may present with the following concerns. The primary concern of treatment outcomes, in addition to investigating the disease’s origin, is the child’s survival. However, another concern is that conventional management options are limited during pregnancy. This article highlights the case of bowel obstruction due to stenotic sigmoid colon cancer in a 32-year-old patient in her 3rd trimester of pregnancy.
The detection of colorectal cancer is more prevalent in older patients in Western countries during routine examinations. However, the diagnosis is likely to be delayed in younger patients either because of a lack of awareness of physicians to the possibility or due to common presenting symptoms. Similarly, it is challenging to differentiate between common pregnancy signs and cancer symptoms which becomes a major diagnostic challenge for obstetricians. Colorectal cancer during pregnancy present with common symptoms, for example, abdominal pain, meteorism and obstruction that should be identified with the differential diagnosis of pregnancy obstruction.
In case of suspicion of colorectal cancer, a multidisciplinary approach should be used
Similarly, another issue with the diagnosis of colorectal cancer is the safety of the fetus and avoiding the risk of fetal damage and abortion. Another issue in colorectal cancer during pregnancy is that treatment options are often limited.
However, no standardised therapeutic models exist to date because of a scarcity of the data available. In addition, different factors are taken into consideration when implementing adequate therapy. Similarly, chemotherapy may be necessary depending on the type of cancer. If surgery is needed urgently, the fetus and tumour may be considered to establish appropriate surgical treatment. In some cases, robotic surgical management is also recommended if the tumour is primary and resectable. This article highlights the case of colorectal cancer in the third trimester with a novel approach for treating colorectal cancer.
A 32-year-old woman presented to the Emergency Department at 28.8 weeks of pregnancy. She had no family history of cancer and presented with complaints of a 4-day history of nausea, vomiting and constipation. The patient’s clinical examination showed that she had a distended abdomen with signs of pain and a considerable accumulation of gas in the GI tract. There were no signs of abnormalities on the general physical examination. Doctors further referred the patient for laboratory examinations, all of which were within the reference range.
The patient underwent a week of consecutive treatment at the Department of Gynaecology and Obstetrics due to a suspicion of pregnancy-related constipation. Doctors referred the patient for further investigations. Similarly, because of the acute fetal deterioration and threatened prematurity, betamethasone was used to induce lung maturation at gestational week 29.4. Due to the progression of ileus symptoms, detection of a distended large intestine by sonography and ineffective symptomatic therapy, doctors further referred the patient for magnetic resonance imaging. Magnetic resonance imaging was significant for a massively distended large intestine with a stenotic process in the sigmoid colon.
Treatment and prognosis
The patient was advised an emergency recto-sigmoidoscopy which showed a stenotic cancerous structure in the sigmoid colon, measuring 20 cm from the anus. Histological findings confirmed the diagnosis of sigmoid adenocarcinoma. A multidisciplinary team of specialists was consulted. All neonatal aspects were considered owing to the high risk of premature complications, for example, cerebral haemorrhage, necrotising enterocolitis, pulmonary hypoplasia and high comorbidity of an oncological resection in an acute mechanical ileus situation. Based on 2 steps, the doctors defined an interval surgical approach.
After the procedure, the patient remained at the hospital for 12 days postoperatively owing to the prematurity of the baby. Despite the resulting prematurity and treatment, the baby was born healthy with an appropriate birth weight for the gestational age. The baby was admitted to the neonatal clinic under observation for 6 days. There were no signs of postoperative complications. The mother and baby were discharged with no complications. The patient was further referred for outpatient genetic counselling.
Source: American Journal of Case Reports