Colorectal Cancer in Pregnancy: Case Discussions and Real-World Data as well as literature review on current knowledge.

Abstract

Colorectal cancer during pregnancy is a rare event; but given the well-recognised increasing incidence of young onset colorectal cancer and delayed child-bearing seen in the western world, it is anticipated to sharply increase in the next two decades. In this paper the authors analyse three cases of colorectal cancer occurring in pregnancy, including the therapeutic approach and relevant outcomes. Two of the three cases received chemotherapy during pregnancy, all three children were born premature with one child having a significantly low birth weight. A review of our institutions referrals related to early onset colorectal cancer (EOCRC) revealed a 50% increased incidence in the last decade in line with worldwide trends of increase in this population. This paper also reviews the literature related to EOCRC in pregnancy and current diagnosis and management recommendations. Challenges with the therapeutic approach are experienced when symptoms are masked by the pregnancy, and when the diagnostic workup needs to weigh benefits to mother with harms to child. There is a clear and increasing need for consensus guidelines and further research into this field.