Pregnancy and Colorectal Cancer, from Diagnosis to Therapeutical Management - Short Review

FOLFOXIRI in Pregnant Women with Colorectal Cancer: A Case Report and Review of the Literature

“…CRC in pregnancy is often complicated by the late stage of diagnosis, due to vague symptoms and masking of the symptoms by pregnancy [ 1 ]. Additionally, the possibility of fetal harm may sometimes discourage clinicians from pursuing a diagnostic workup and could conceivably contribute to a delay in diagnosis [ 7 ]. Diagnosis at an advanced stage further increases the risk for complications, such as obstruction, perforation, or hemorrhage [ 7 ].…”

“…Additionally, the possibility of fetal harm may sometimes discourage clinicians from pursuing a diagnostic workup and could conceivably contribute to a delay in diagnosis [ 7 ]. Diagnosis at an advanced stage further increases the risk for complications, such as obstruction, perforation, or hemorrhage [ 7 ]. Both patients in this case report were greater than 30 years of age at diagnosis and presented with vague gastrointestinal symptoms which were refractory to initial therapy, leading to complications of chronic blood loss anemia, tenesmus, and partial bowel obstruction.…”

“…If the cancer is diagnosed at an early gestational age, termination of pregnancy may be recommended to expedite therapy. Alternatively, termination may be deferred as long as the mother understands and accepts the risk of disease progression [ 7 ].…”

“…However, in some cases of metastatic CRC, chemotherapy may be considered in early pregnancy to reduce tumor burden and allow the fetus to reach a viable gestational age [ 3 ]. In these situations, the patient must understand the potential palliative intent balanced with the potential risk of harm to the fetus [ 7 ]. In the second or third trimesters, chemotherapy is generally safer but is associated with an increased incidence of small for gestational age fetuses [ 9 ].…”

“…Chemotherapy is often continued until a gestational age of 35 weeks or 3 weeks before the expected due date [ 7 ]. This is recommended so as to avoid the increased risk of chemotherapy-related complications, such as bone marrow suppression, hemorrhage, and maternal and fetal death during delivery [ 5 , 15 ].…”