gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Metastatic Colon Cancer in pregnancy: a treatment concept

Meeting Abstract

  • corresponding author presenting/speaker Isabelle Himsl - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Grosshadern, München, Deutschland
  • Miriam Lenhard - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Grosshadern, München
  • Franz von Koch - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Grosshadern, München
  • Matthias Wichmann - Chirurgie, LMU Grosshadern, München
  • Andreas Schulze - Neonatologie, LMU Grosshadern, München
  • Uwe Hasbargen - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Grosshadern, München
  • Klaus Friese - Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Grosshadern, München

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPE232

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkk2006/06dkk342.shtml

Veröffentlicht: 20. März 2006

© 2006 Himsl et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: The estimated incidence of colorectal cancer during pregnancy is 0.002%. This type of cancer tends to have a poor prognosis that is attributable to delays in diagnosis and advanced disease at diagnosis. This diagnostic delay is related to the fact that symptoms of colon cancer, such as rectal bleeding, nausea, vomiting and constipation, may mimic common pregnancy associated conditions.

Case report: A 40-year-old 5th gravida 2nd para in the 26th gestational week underwent laparotomy for acute abdomen at another hospital following persistent constipation during her pregnancy. The MRI scan revealed a 5,0x4,2cm mass of the sigma with adjacent lymphadenopathy and suspicion of hepatic metastasis. After antenatal steroid prophylaxis sigmoidoscopy showed complete obstruction located 25cm proximal the anus. The biopsy confirmed a highgrade atypia with suspicion of adenocarcinoma of the sigma. The subsequent working diagnosis was stage IV rectal carcinoma in pregnancy at 25+4/7 wks. The therapeutic approach was consented among multiple subspecialities. The patient underwent laparotomy with resection of the sigma-rectum with descendostomia and the pregnancy was preserved. The patient is receiving 5-FU 2g/qm q1w for adjuvant treatment. Pretermed delivery and completion of the oncologic staging is scheduled for 32+0/7 wks.

Discussion: Colorectal cancer at this stage of pregnancy represents a dilemma. Early delivery and aggressive anticancer treatment must be balanced against the risks of prematurity. The complex treatment of colorectal cancer in pregnancy must take into account the maturity of the fetus, tumor stage and the need for emergent vs elective surgery. If the diagnosis occurs in the first trimenon of pregnancy, significant tumor progression may occur if surgery is delayed until the fetus is viable. In the 2nd and third trimenon resection may be delayed until after the infant is delivered.

Conclusion: Colorectal cancer in pregnancy presents a diagnostic and therapeutic challenge.

The treatment regimen requires a multidisciplinary approach involving experts in obstetrics, neonatology, gastrointestinal surgery, and medical oncology.