Management and outcome of colorectal cancer during pregnancy: report of 41 cases

Figures & data

Table 1. Patient characteristics (n = 41).

Characteristic	Value
Age at diagnosis, years
Median (range)	32 (24–43)
Parity
Nulliparous	12 (30.8)
Multiparous	27 (69.2)
Not reported	2
BMI
Median (range)	23 (19–32)
Smoking
Yes	9 (24.3)
No	28 (75.7)
Not reported	4
Predisposing conditions
Lynch syndrome	1 (2.4)
FAP	0 (0)
IBD	1 (2.4)
CRC in family history	12 (29.3)

Data presented as n (%), unless stated otherwise.

Abbreviations: FAP: familial adenomatous polyposis; IBD: inflammatory bowel disease; CRC: colorectal cancer.

Table 2. Clinical presentation and diagnosis (n = 41).

Characteristic	Value
Clinical presentation
Acute	10 (24.4)
Bowel obstruction   Bowel perforation   Suspected ovarian torsion   Acute appendicitis	4 (9.8)
	3 (7.3)
	2 (4.9)
	1 (2.4)
Non-acute∗	31 (75.6)
Rectal bleeding   Abdominal pain   Change in bowel habits   Loss of weight   Right shoulder pain   Abdominal mass	19 (46.3)
	7 (17.1)
	2 (4.9)
	1 (2.4)
	1 (2.4)
	1 (2.4)
Trimester of diagnosis
First trimester	13 (31.7)
Second trimester	19 (46.3)
Third trimester	9 (22.0)
Diagnosis
Endoscopy	27 (65.9)
Surgery	10 (24.4)
Imaging∗∗	4 (9.8)

Data presented as n (%).

∗Some patients presented with multiple symptoms.

∗∗Imaging includes MRI (n = 3) and CT-scan (n = 1).

Table 3. Tumour characteristics (n = 41).

Characteristic	Value
Tumour site
Colon cancer	27 (65.9)
Right colon   Left colon	6 (14.6)
	21 (51.2)
Rectal cancer	14 (34.1)
Stage, TNM
I	4 (9.8)
II	7 (17.1)
III	13 (31.7)
IV	17 (41.5)
Histological subtype
Adenocarcinoma	36 (92.3)
Mucinous adenocarcinoma	1 (2.6)
Signet-ring cell carcinoma	1 (2.6)
Squamous cell carcinoma	1 (2.6)
Not reported	2
Grade
Well differentiated	5 (20.0)
Moderately differentiated	12 (48.0)
Poorly differentiated	8 (32.0)
Undifferentiated	0 (0)
Not reported	16
Lymph nodes
Number removed (median, range)
Colon cancer   Rectal cancer	18 (7–32)
	19 (9–52)

Data presented as n (%), unless stated otherwise.

Table 4. Summary of diagnosis, treatment, obstetric, neonatal and maternal outcomes of the colon cancer patients with acute clinical presentation.

Case	Diagnosis		Treatment			Obstetric and neonatal outcome					Maternal outcome
	Trimester	Stage	Treatment in pregnancy	Treatment after pregnancy	Radical treatment	Pregnancy ending	Delivery mode	Premature	Small for gestational age	Congenital malformations	Alive/Dead	Recurrence	FU/Death after diagnosis (days)
1	2	III	Relieving stoma	Multivisceral resection, adjuvant CT (5-FU + FA)	Yes	Livebirth	Induced vaginal	Yes	Unknown	Unknown	Alive	No	229
2	2	II	Right hemicolectomy	Adjuvant CT (5-FU, FOLFOX)	Yes	Unknown	Unknown	Unknown	Unknown	Unknown	Alive	Yes	1343
3	2	IV	Left hemicolectomy and resection of solitary omental metastasis	Adjuvant CT (FOLFOX)	Yes	Livebirth	CS	Yes	No	None	Alive	No	4152
4	2	III	Left hemicolectomy	Adjuvant CT (CAPOX)	Yes	Livebirth	Induced vaginal	Yes	No	None	Alive	No	1395
5	2	IV	Diagnostic laparoscopy (ovarian metastasis)	Left hemicolectomy, palliative CT (CAPOX)	No (persistent disease)	TOP	NA	NA	NA	NA	Dead	NA	380
6	3	II	Right hemicolectomy	None	Yes	Livebirth	Spontaneous vaginal	No	Yes	None	Alive	No	67
7	2	II	Right hemicolectomy	Adjuvant CT (FOLFOX)	Yes	Livebirth	CS	No	No	None	Alive	No	667
8	1	IV	Right hemicolectomy and resection of solitary peritoneal metastasis, adjuvant CT (5-FU + FA, 2 cycles)	Adjuvant CT (FOLFOX, bevacizumab)	Yes	Livebirth	CS	No	No	None	Alive	No	3789
9	1	III	Appendectomy (adenocarcinoma), right hemicolectomy	Adjuvant CT (FOLFOX)	Yes	Miscarriage	NA	NA	NA	NA	Alive	No	1069
10	2	IV	Oophorectomy (ovarian metastasis), sigmoid resection, palliative CT (FOLFOX, 4 cycles)	None	No (persistent disease)	Livebirth	Induced vaginal	Yes	Yes	None	Dead	NA	93
Total  (n=10)			Treatment in pregnancy (n=10)	Treatment after pregnancy (n=8)	Radical treatment (n=8)	Livebirth (n=7)	CS (n=3), Vaginal (n=4)	Premature (n=4)	Small for gestational age (n=2)	Congenital malformations (n=0)	Alive (n=8)	Recurrence (n=1)	FU∗
													868 (67 - 4152)

CAPOX: capecitabine + oxaliplatin; CS: caesarean section; CT: chemotherapy; FA: folinic acid; FOLFOX: folinic acid +5-fluorouracil + oxaliplatin; 5-FU: 5-fluorouracil; NA: not applicable; TOP: termination of pregnancy.

* Median (range).

Table 5. Summary of diagnosis, treatment, obstetric, neonatal and maternal outcomes of the colon cancer patients with non-acute clinical presentation (n = 17).

Case	Diagnosis		Treatment			Obstetric and neonatal outcome					Maternal outcome
	Trimester	Stage	Treatment in pregnancy	Treatment after pregnancy	Radical treatment	Pregnancy ending	Delivery mode	Premature	Small for gestational age	Congenital malformations	Alive/Dead	Recurrence	FU/Death after diagnosis (days)
11	1	III	Sigmoid resection	Adjuvant CT (5-FU + FA)	Yes	TOP	NA	NA	NA	NA	Alive	No	2697
12	2	I	None	Sigmoid resection∗	Yes	Livebirth	CS	Yes	Yes	None	Alive	No	1075
13	1	IV	None	None	No (persistent disease)	Livebirth	CS	Yes	Unknown	None	Dead	NA	342
14	2	IV	None	Palliative CT (FOLFIRI + bevacizumab)	No (persistent disease)	TOP	NA	NA	NA	NA	Dead	NA	708
15	3	IV	None	None	No (persistent disease)	TOP	NA	NA	NA	NA	Alive	NA	12
16	2	III	Sigmoid resection, adjuvant CT (5-FU, 3 cycles)	Adjuvant CT (FOFLOX)	Yes	Livebirth	CS	Yes	No	None	Dead	Yes	912
17	3	IV	None	Left hemicolectomy∗, palliative CT (CAPOX + bevacizumab)	No (persistent disease)	Livebirth	CS	Yes	No	None	Dead	NA	317
18	2	IV	Neoadjuvant CT (5-FU + FA, 3 cycles)	Left hemicolectomy and liver resection, adjuvant CT (FOLFOX)	Yes	Livebirth	Induced vaginal	Yes	Yes	None	Alive	No	242
19	1	IV	Left hemicolectomy, adjuvant CT (5-FU + FA, 4 cycles)	Liver resection	Yes	Livebirth	CS	Yes	Yes	None	Alive	No	1249
20	1	II	Left hemicolectomy	Adjuvant CT (5-FU + FA)	Yes	Miscarriage	NA	NA	NA	NA	Alive	No	3112
21	1	II	Left hemicolectomy, adjuvant CT (FOLFOX, 3 cycles)	Adjuvant CT (FOLFOX)	Yes	Livebirth	Induced vaginal	No	No	None	Alive	No	300
22	1	III	Sigmoid resection, adjuvant CT (FOLFOX, 9 cycles)	None	Yes	Livebirth	Induced vaginal	No	No	None	Alive	No	335
23	2	I	Left hemicolectomy	Adjuvant CT (5-FU)	Yes	Livebirth	CS	Yes	Yes	None	Alive	No	2062
24	1	I	Left hemicolectomy	None	Yes	Livebirth	CS	Yes	Yes	None	Alive	No	171
25	1	IV	Palliative CT (FOLFOX, 3 cycles)	None	No (persistent disease)	Livebirth	CS	Yes	No	None	Dead	NA	176
26	2	IV	None	None	No (persistent disease)	Livebirth	CS	Yes	Unknown	None	Dead	NA	41
27	2	IV	None	Sigmoid resection∗, palliative CT (5-FU + FA + doxorubicin)	No (persistent disease)	Livebirth	CS	Yes	No	None	Dead	NA	80
Total (n=17)			Treatment in pregnancy (n=10)	Treatment after pregnancy (n=11)	Radical treatment (n=10)	Livebirth (n=13)	CS (n=10), Vaginal (n=3)	Premature (n=11)	Small for gestational age (n=5)	Congenital malformations (n=0)	Alive (n=10)	Recurrence (n=1)	FU^∗∗
													335 (12 - 3112)

CAPOX: capecitabine + oxaliplatin; CS: caesarean section; CT: chemotherapy; FA: folinic acid; FOLFOX: folinic acid +5-fluorouracil + oxaliplatin; FOLFIRI: folinic acid +5-fluorouracil + irinotecan; 5-FU= 5-fluorouracil; NA:not applicable; TOP:termination of pregnancy.

* Tumour resection at the time of caesarean section.

** Median (range).

Table 6. Summary of diagnosis, treatment, obstetric, neonatal and maternal outcomes of the rectal cancer patients (n = 14).

Case	Diagnosis		Treatment			Obstetric and neonatal outcome					Maternal outcome
	Trimester	Stage	Treatment in pregnancy	Treatment after pregnancy	Radical treatment	Pregnancy ending	Delivery mode	Premature	Small for gestational age	Congenital malformations	Alive/Dead	Recurrence	FU/Death after diagnosis (days)
28	3	I	None	RT (25 Gy), proctocolectomy	Yes	Livebirth	CS	Yes	No	Unknown	Alive	No	784
29	3	IV	None	RT (25 Gy)	No (persistent disease)	Livebirth	Induced vaginal	No	No	Unknown	Dead	NA	134
30	3	IV	None	Palliative CT (CAPOX, bevacizumab), relieving stoma	No (persistent disease)	Livebirth	CS	No	No	None	Dead	NA	561
31	3	III	None	LAR∗, adjuvant CT (FOLFOX)	Yes	Livebirth	CS	Yes	No	None	Alive	No	718
32	2	III	Neoadjuvant CT (FOFLOX, 3 cycles)	LAR, adjuvant CT (capecitabine)	Yes	Livebirth	CS	Yes	No	None	Alive	No	743
33	2	II	Neoadjuvant CT (5-FU + FA, 3 cycles)	RT, LAR, adjuvant CT (FOFLOX)	Yes	Livebirth	CS	Yes	No	None	Alive	No	217
34	1	III	LAR, adjuvant CT (5-FU + FA, 3 cycles)	Adjuvant radiochemotherapy (50 Gy +5-FU + FA)	Yes	Livebirth	Induced vaginal	Yes	No	Leg length discrepancy	Alive	No	3389
35	3	II	Neoadjuvant CT (5-FU + FA, 4 cycles)	LAR, adjuvant CT (FOLFOX)	Yes	Livebirth	Induced vaginal	Yes	Yes	None	Alive	No	625
36	1	III	Transanal resection	Neoadjuvant radiochemotherapy (50 Gy + capecitabine), LAR, adjuvant CT (FOLFOX)	Yes	Livebirth	Induced vaginal	Yes	No	None	Alive	No	521
37	3	III	Transanal resection	RT (50 Gy), adjuvant CT (5-FU)	Yes	Livebirth	Induced vaginal	Yes	No	None	Alive	Yes	2178
38	2	II	None	LAR, adjuvant CT (5-FU)	Yes	TOP	NA	NA	NA	NA	Alive	No	3731
39	2	IV	None	Neoadjuvant CT (FOLFOX), LAR	No (persistent disease)	Livebirth	CS	Yes	Unknown	None	Dead	NA	417
40	3	IV	None	LAR, palliative CT (epirubicin + cisplatin +5-FU + etoposide)	No (persistent disease)	Livebirth	CS	Yes	No	None	Dead	NA	172
41	3	III	None	Diverting colostomy∗, neoadjuvant radiochemotherapy (50 Gy + capecitabine), multivisceral resection	Yes	Livebirth	CS	Yes	No	None	Alive	No	217
Total (n=14)			Treatment in pregnancy (n=6)	Treatment after pregnancy (n=14)	Radical treatment (n=10)	Livebirth (n=13)	CS (n=8), Vaginal (n=5)	Premature (n=11)	Small for gestational age (n=1)	Congenital malformations (n=1)	Alive (n=10)	Recurrence (n=1)	FU∗∗
													593 (134 - 3731)

CAPOX: capecitabine + oxaliplatin; CS: caesarean section; CT: chemotherapy; FA: folinic acid; FOLFOX: folinic acid +5-fluorouracil + oxaliplatin; 5-FU: 5-fluorouracil; LAR: low anterior resection; NA: not applicable; RT: radiotherapy; TOP: termination of pregnancy.

* Tumour resection at the time of caesarean section.

** Median (range).

Figure 1. Overall 2-year survival, calculated using the Kaplan-Meier method. Dotted lines represent 95% confidence intervals.