Cruveilhier reported the first instance of rectal carcinoma in pregnancy in the year 1842. Cancer incidence has been estimated at around 1 in every 1,000 pregnancies. Colorectal cancer is the 7th most common type of cancer diagnosed in pregnancy, with an estimated incidence of 1 in 13,000 pregnancies by the 1990's. The numbers translate to 30 new instances each year in the nation of Canada. There are no more recent epidemiologic data on the incidence of colorectal cancer in pregnancy. The mean age of diagnosis in one large review was 31.
Colorectal cancer (also known as colon cancer, rectal cancer or bowel cancer) is the development of cancer in the colon or rectum (parts of the large intestine). It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers.
Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and feeling tired all the time.
A diagnosis of cancer during pregnancy can be a potentially devastating situation, one associated with serious physical and emotional stress for a woman who is pregnant and her family members. The decision concerning abortion as a therapeutic choice could increase the burden. Early diagnosis and treatment are important with colorectal cancer during pregnancy.
In many instances, colon cancer in women happens without any symptoms at all. For this reason, it is crucially important that women are screened on a regular basis by their doctors for colorectal cancer - even if they are not experiencing any symptoms whatsoever. Along with assessment of a woman's medical history and testing through a physical examination, there are several different tests that a doctor might perform to better detect colon cancer and polyps in a woman's large intestine. The tests may be used to determine if any polyps are present so they can be removed quickly and reduce a woman's risk of cancer.
One of the earliest symptoms of colon cancer is bleeding. Small tumors found in the colon are likely to bleed occasionally. Trace amounts of blood; however, are often times only detected through chemical testing of the person's stool. The bleeding is referred to as, 'occult bleeding,' because it is minimal and invisible to the naked eye. When tumors in a woman's colon become larger, they may change the frequency and texture of her stool. Additional common symptoms of colon cancer may include the following:
Another important symptom to look out for is narrow stools caused by colon cancer. Narrow or thin stools are important to note because they represent significant changes in a person's large intestine. If narrow stools last for greater than two weeks and are accompanied by any of the symptoms above, it is vital for a woman to visit their doctor promptly.
When stool first enters a person's colon, it is in a liquid instead of a solid form. The thick liquid can easily flow over blockages into more narrow areas of the person's large intestine. As waste moves throughout the colon towards the person's rectum, water is absorbed from the stool so it becomes solid. The further the stool travels throughout the person's colon, the more solid it becomes.
When stool becomes a solid, it is hard for it to maneuver around narrow areas and blockages in a person's colon. If a tumor is located in the middle part of the colon or in the person's rectum, it is difficult for stool to pass through the large intestine. In order for stool to pass through, it has to squeeze through a narrow opening causing thin and long stools. The thin or narrow stools might be a significant warning sign of a tumor, or a serious blockage in the person's colon.
It is important to visit a doctor promptly about narrow stools if more than three days have passed since the last bowel movement. It is also concerning if a person has experienced thin stools for more than two weeks, or if they have noticed a significant change in their bowel movements. If you have narrow stool and see blood in or on the stool, it is vital to contact a doctor immediately. If narrow stools are accompanied by bloating, abdominal pain, or cramps that are persistent it could also indicate symptoms of polyps or colon cancer in need of quick medical attention or removal.
The American Society of Gastrointestinal Endoscopy guidelines indicate that in situations in which therapeutic intervention is needed, endoscopy offers a fairly safe alternative to surgical or radiologic intervention. Endoscopy during pregnancy should be performed only when there is a strong indication and should be postponed to the second trimester if possible. Maternal over-sedation, with resulting hypotension or hypoventilation, or maternal positioning that may lead to the compression of the inferior vena cava by the uterus, may possibly lead to decreased uterine blood flow and fetal hypoxia. Additional possible risks to the fetus include teratogenesis and premature birth.
After a person has received a diagnosis, the evaluation of women who are pregnant with colorectal carcinoma is similar to the evaluation of women who are not pregnant. Examination requires:
Magnetic resonance imaging (MRI) is a substitute for computed tomography in staging when needed. When advanced rectal cancer is diagnosed in the latter stages of pregnancy, careful assessment of the tumor site and cancer stage is made in order to ensure the tumor will not obstruct labor and vaginal delivery.
No reports exist concerning negative fetal outcomes due to the malignancy itself, even if widespread metastatic disease is present. Metastasis to the placenta was reported one time in maternal colorectal malignancy. While a complete evaluation of the placenta is recommended, there is no evidence to support periodic follow-up of the child. There is a 78% rate of fetal survival in pregnancies complicated by colorectal carcinoma. Maternal colorectal malignancy may affect the outcome of a woman's pregnancy. Only 25 of 32 pregnancies complicated by colon tumors resulted in healthy, live-born infants in a study. Deaths were due to prematurity, stillbirth, or termination.
When a woman receives a diagnosis of colorectal cancer during pregnancy, multidisciplinary involvement of the woman's obstetrician, colorectal surgeon, perinatologist, medical and radiation oncologists and others is vital to achieving the goal of early delivery that allows for the soonest possible treatment of her cancer. Treatment and prognosis by cancer stage are not different from those in the general population. There are a number of factors to consider when planning management such as the location of the tumor, gestational age, elective versus emergency presentation, the stage of the tumor, complications related to the tumor, or pregnancy, as well as the woman's decision. Colon cancer in pregnancy is often diagnosed at an advanced stage when surgical management and chemotherapy are just barely effective.
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