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Gao Y, Sun Y. Intestinal perforation due to colorectal cancer during pregnancy: case report and literature review. BMC Pregnancy Childbirth 2024; 24:374. [PMID: 38755532 PMCID: PMC11100117 DOI: 10.1186/s12884-024-06533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Colorectal cancer (CRC) in pregnancy is sporadic. We reported a case of a woman at 23 + 4 weeks of gestation who presented with abdominal pain. The patient underwent an ultrasound and MRI, during which a colonic mass was noted. Considering a probable incomplete intestinal obstruction, a colonoscopy, biopsy, and colonic stenting were performed by a multidisciplinary team. However, sudden hyperthermia and CT demonstrated intestinal perforation, and an emergency caesarean section and colostomy were conducted. The histological analysis confirmed moderately high-grade adenocarcinoma.
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Affiliation(s)
- Yan Gao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
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2
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Cairl NS, Shanker BA. Colon Cancer and the Pregnant Patient. Dis Colon Rectum 2024; 67:355-357. [PMID: 38084899 DOI: 10.1097/dcr.0000000000003191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Nicholas S Cairl
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, Michigan
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3
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Kau NS, Kelly JC, Kim H, Smith R, Fraum TJ, Byrnes K, Trikalinos NA, Aranha O, Li KZ, Liu SA, Suresh R. Treatment of metastatic rectal squamous cell carcinoma in a pregnant patient. BMJ Case Rep 2024; 17:e257984. [PMID: 38378585 PMCID: PMC10882350 DOI: 10.1136/bcr-2023-257984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Rectal squamous cell carcinoma is an exceedingly rare form of rectal cancer, with limited data available regarding its presentation and effective treatment. Rectal cancer occurring during pregnancy is uncommon as well. This is a case of metastatic rectal squamous cell carcinoma presenting in a 22-week pregnant, female patient in her early 30s. The patient was treated with 5-fluorouracil and cisplatin and delivered a healthy male child born via uncomplicated vaginal delivery at 35 weeks. This article demonstrates that despite the rare nature of this cancer, in the already rare context of pregnancy, effective and safe treatment is possible with a multidisciplinary team.
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Affiliation(s)
- Nathan S Kau
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Jeannie C Kelly
- Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Radhika Smith
- Department of Surgery, Division of Colon and Rectal Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Tyler J Fraum
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Kathleen Byrnes
- Department of Pathology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nikolaos A Trikalinos
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Olivia Aranha
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Kevin Z Li
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Shiyuan Anabeth Liu
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rama Suresh
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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4
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Capozza MA, Romano A, Mastrangelo S, Attinà G, Maurizi P, Costa S, Vento G, Scambia G, Ruggiero A. Neonatal outcomes and follow-up of children born to women with pregnancy-associated cancer: a prospective observational study. BMC Pregnancy Childbirth 2024; 24:24. [PMID: 38172776 PMCID: PMC10763329 DOI: 10.1186/s12884-023-06182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the last decade, there has been a growing number of cases of children born from pregnancy-associated cancer (PAC), however there are currently insufficient data on the follow up to be observed in this category of newborns. Objective of the study was to evaluate the neonatal outcomes of infants born to mother with PAC, the potential adverse effect of chemotherapy during pregnancy and the risk of metastasis to the fetus. METHODS Maternal clinical data and neonatal outcomes of child born to mothers diagnosed with PAC were collected; infants were divided into those were and were not exposed to chemotherapy during fetal life and their outcomes were compered. RESULTS A total of 37 newborn infants from 36 women with PAC were analyzed. Preterm delivery occurred in 83.8% of the cases. No significant differences in neonatal outcomes were found between infants who were and were not exposed to chemotherapy during pregnancy. The median follow-up period was 12 months. CONCLUSIONS PAC treatment during the second or third trimester does not seem to be dangerous for the fetus, however infants born from PAC must be carefully evaluated for to rule out the consequences of chemotherapy and exclude the presence of metastasis. Long-term follow-up, especially in children exposed to chemotherapy, should be encouraged to obtain relevant data on long-term toxicity.
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Affiliation(s)
- Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simonetta Costa
- Neonatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Dipartimento Scienze Della Salute Della Donna, del Bambino E Di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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Wu M, Otsuka K, Furusawa Y, Otsuka I, Suemitsu T. Diagnosis and Treatment of Metastatic Colon Cancer in Pregnancy First Presenting as Multiple Liver Masses: A Case Report. Cureus 2024; 16:e53218. [PMID: 38293677 PMCID: PMC10826457 DOI: 10.7759/cureus.53218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
Colorectal cancer (CRC) is the second most common cancer in women in Japan. However, it is uncommon during pregnancy. CRC diagnosis during pregnancy is often complicated and delayed due to the overlapping of symptoms, such as abdominal pain and nausea, with those of pregnancy and the limitations placed on potential diagnostic imaging and testing because of concerns for the fetus. A 39-year-old woman was referred from a local hospital at 32 weeks gestation after persistent right abdominal pain, which prompted an ultrasound that showed multiple liver lesions suggestive of malignancy. A combination of non-contrast computed tomography, non-contrast magnetic resonance imaging, contrast-enhanced ultrasound, and colonoscopy was utilized to make a definitive diagnosis; ultimately, colonoscopy confirmed the diagnosis of colon cancer with liver metastasis. A discussion within a multidisciplinary team led to the decision to deliver at 34 weeks by cesarean section and a left hemicolectomy was performed after delivery. The neonate was admitted to the neonatal intensive care unit due to prematurity but had no other complications. Chemotherapy was promptly initiated, and treatment was continued on an outpatient basis. Diagnostic algorithms for CRC during pregnancy are not yet well-established; however, the prognosis of CRC during pregnancy is poor, and clinicians should not hesitate to perform the necessary testing and consult experts in fields such as neonatology, medical oncology, internal medicine, and gastrointestinal surgery. Early diagnosis and intervention are essential for optimizing outcomes for both the mother and the fetus.
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Affiliation(s)
- Mengjia Wu
- Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, JPN
| | - Koji Otsuka
- Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, JPN
| | | | - Isao Otsuka
- Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, JPN
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6
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Ullah F, Pillai AB, Omar N, Dima D, Harichand S. Early-Onset Colorectal Cancer: Current Insights. Cancers (Basel) 2023; 15:3202. [PMID: 37370811 DOI: 10.3390/cancers15123202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Over the past decade, the incidence of colorectal cancer has increased in individuals under the age of 50 years. Meanwhile, the incidence has gradually decreased in the older population. As described herein, we reviewed the available literature to summarize the current landscape of early-onset colorectal cancer, including risk factors, clinicopathological presentation, genetic makeup of patients, and management. Currently, early-onset colorectal cancer is treated similarly as late-onset colorectal cancer, yet the available literature shows that early-onset colorectal cancer is more aggressive and different, and this remains a significant unmet need. A detailed understanding of early-onset colorectal cancer is needed to identify risk factors for the increased incidence and tailor treatments accordingly.
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Affiliation(s)
- Fauzia Ullah
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Ashwathy Balachandran Pillai
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Najiullah Omar
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Danai Dima
- Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Seema Harichand
- Department of Internal Medicine, Mission Cancer + Blood, University of Iowa, Des Moines, IA 50309, USA
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7
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Constantin A, Constantin R, Achim F, Socea B, Predescu D. Pregnancy and Gastric Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111909. [PMID: 37296761 DOI: 10.3390/diagnostics13111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30-39 years (and not exceptionally 40-49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due to the overlap between neoplasm symptomatology and the clinical picture of pregnancy. A paraclinical evaluation may also be difficult depending on the trimester of the pregnancy. Diagnosis is also delayed by practitioners' hesitation to use invasive investigations (imaging, endoscopy, etc.) due to fetal safety concerns. Therefore, digestive cancers are often diagnosed during pregnancy in advanced stages, where complications such as occlusions, perforations, and cachexia have already arisen. In this review, we highlight the epidemiology, clinical aspects, paraclinical evaluation, and particularities of the diagnosis and treatment of gastric cancer during pregnancy.
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Affiliation(s)
- Adrian Constantin
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Roxana Constantin
- Department of Obstetrics and Gynecology, Sanador Hospital, 010991 Bucharest, Romania
| | - Florin Achim
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragos Predescu
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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8
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Saraiva MR, Rosa I, Claro I. Early-onset colorectal cancer: A review of current knowledge. World J Gastroenterol 2023; 29:1289-1303. [PMID: 36925459 PMCID: PMC10011966 DOI: 10.3748/wjg.v29.i8.1289] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/18/2022] [Accepted: 02/15/2023] [Indexed: 02/28/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Although most prevalent among older people, its incidence above 50 years old has been decreasing globally in the last decades, probably as a result of better screening. Paradoxically, its incidence in patients below 50 years old [early-onset CRC (EO-CRC)] has been increasing, for reasons not yet fully understood. EO-CRC’s increasing incidence is genre independent but shows racial disparities and has been described to occur worldwide. It follows a birth-cohort effect which probably reflects a change in exposure to CRC risk factors. Its incidence is predicted to double until 2030, which makes EO-CRC a serious public health issue. Both modifiable and non-modifiable risk factors have been identified - some are potential targets for preventive measures. EO-CRC is often diagnosed at advanced stages and histological features associated with poor prognosis have been described. EO-CRC presents some distinctive features: Microsatellite in-stability is common, but another subtype of tumours, both microsatellite and chromosome stable also seems relevant. There are no age-specific treatment protocols and studies on EO-CRC survival rates have shown conflicting data. Due to the higher germline pathological mutations found in EO-CRC patients, an accurate genetic risk evaluation should be performed. In this review, we summarize the current evidence on epidemiological, clinical, histopathological and molecular features of EO-CRC and discuss the contribution of genetics and lifestyle risk factors. We further comment on screening strategies and specific dimensions to consider when dealing with a younger cancer patient.
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Affiliation(s)
- Margarida R Saraiva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa 1099-023, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa 1099-023, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa 1099-023, Portugal
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9
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Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy. Cancers (Basel) 2022; 14:cancers14133103. [PMID: 35804875 PMCID: PMC9264939 DOI: 10.3390/cancers14133103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this paper we perform an introduction about pregnancy-associated cancer (PAC) and transplacental passage of antineoplastic agents. Furthermore, we describe therapeutic use and potential toxic effects of chemotherapeutic drug (alkylating agents, antimetabolites agents, anthracyclines, topoisomerase inhibitors, antimitotic agents, actinomycin-D, bleomycin) and targeted agents during pregnancy. This manuscript may be a useful and practical guide for the management of PAC, which is a challenge for clinicians that have to consider alike maternal benefits and fetal potential risks correlated to the antineoplastic treatment. Abstract The incidence of PAC is relatively infrequent among pregnant women. However, it has gradually increased in recent years, becoming a challenging area for clinicians that should take into account in the same way maternal benefits and fetal potential risks correlated to the antineoplastic treatment. None of the antineoplastic drugs is completely risk-free during the pregnancy, the timing of exposure and transplacental transfer properties influence the toxicity of the fetus. Despite the lack of guidelines about the management of PAC, several studies have described the use and the potential fetal and neonatal adverse events of antineoplastic drugs during pregnancy. We provide a review of the available literature about the transplacental passage and fetal effects of chemotherapy and targeted agents, to guide the clinicians in the most appropriate choices for the management of PAC.
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10
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Prentice R, Al-Ani A, Cherry T, Dixon-Douglas J, Eccles-Smith J, Matheson J, Tie J, Thevathasan I, McCormick JJ, Christensen B. Evaluation and management of rectal bleeding in pregnancy. Med J Aust 2021; 215:377-382. [PMID: 34601746 DOI: 10.5694/mja2.51267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures). More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women. Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non-pregnant state. Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥ 50 µg/g) signifies a need for further diagnostic evaluation. Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy. Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes.
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Affiliation(s)
- Ralley Prentice
- Monash Health, Melbourne.,St Vincent's Hospital Melbourne, Melbourne, VIC
| | | | | | | | | | | | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Jacob J McCormick
- Royal Melbourne Hospital, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
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11
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Story L, Rafique S, Samadi N, Mawdsley J, Singh B, Banerjee A. Lower gastrointestinal bleeding in pregnancy: Differential diagnosis, assessment and management. Obstet Med 2021; 14:129-134. [PMID: 34646340 PMCID: PMC8504301 DOI: 10.1177/1753495x20948300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both fetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy.
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Affiliation(s)
- L Story
- Department of Women and Children's Health King's College, London, UK.,Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Rafique
- King's College London Medical School, London, UK
| | - N Samadi
- King's College London Medical School, London, UK
| | - J Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Singh
- Department of Surgery, University Hospitals Leicester, Leicester, UK
| | - A Banerjee
- Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Rogers JE, Woodard TL, Gonzalez GMN, Dasari A, Johnson B, Morris VK, Kee B, Vilar E, Nancy You Y, Chang GJ, Bednarski B, Skibber JM, Rodriguez-Bigas MA, Eng C. Colorectal cancer during pregnancy or postpartum: Case series and literature review. Obstet Med 2021; 15:118-124. [DOI: 10.1177/1753495x211041228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/15/2022] Open
Abstract
Background Colorectal cancer in young adults is on the rise. This rise combined with delayed childbearing increases the likelihood of colorectal cancer diagnosed during pregnancy or in the postpartum period. Methods Electronic health records were used to identify individuals with colorectal cancer in pregnancy or the postpartum period from 1 August 2007 to 1 August 2019. Results Forty-two cases were identified. Median age at diagnosis was 33 years. Most (93%) were diagnosed in an advanced stage (III or IV) and had left-sided colorectal cancer tumors (81%). Molecular analysis was completed in 18 (43%) women with microsatellite status available in 40 (95%). The findings were similar to historical controls. Sixty percent were diagnosed in the postpartum period. Common presenting symptoms were rectal bleeding and abdominal pain. Conclusion Currently there is no consensus recommendation regarding how to manage colorectal cancer during pregnancy. Given the overlapping symptoms with pregnancy, patients often present with advanced disease. We encourage all health care professionals caring for pregnant women to fully evaluate women with persistent gastrointestinal symptoms to rule out colorectal cancer.
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Affiliation(s)
- Jane E Rogers
- U.T. M.D. Anderson Cancer Center Pharmacy Clinical Programs, USA
| | - Terri L Woodard
- Department of Gynecologic Oncology and Reproductive Medicine, U.T. M.D. Anderson Cancer Center, USA
| | | | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - Benny Johnson
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - Bryan Kee
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - Eduardo Vilar
- Department of Clinical Cancer Prevention, U.T. M.D. Anderson Cancer Center, USA
| | - Y. Nancy You
- Department of Surgical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - George J. Chang
- Department of Surgical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - Brian Bednarski
- Department of Surgical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | - John M. Skibber
- Department of Surgical Oncology, U.T. M.D. Anderson Cancer Center, USA
| | | | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, USA
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13
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Goidescu IG, Nemeti G, Preda A, Kovacs T, Surcel M, Eniu DT, Cruciat G, Mureșan D. Krukenberg tumor in pregnancy: a rare case and review of the literature. J Matern Fetal Neonatal Med 2021; 35:7290-7295. [PMID: 34470118 DOI: 10.1080/14767058.2021.1946788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Krukenberg's tumor diagnosed in pregnancy is an uncommon situation that raises both diagnosis and medical management issues. We performed a review of the existing literature regarding this pathology, diagnostic means and therapeutic approaches, motivated by a case in our own practice. A 35-year-old primigravida was diagnosed with an adnexal mass during the first trimester prenatal ultrasound. Ultrasound revealed a 10 cm right adnexal mass with multiple septae, richly vascularized, whose presence and characteristics were confirmed by magnetic resonance imaging. Due to the progressively increasing tumor size, laparoscopy was performed with right adnexectomy and peritoneal biopsies. Histopathology diagnosed a metastatic ovarian tumor from a mucinous colorectal adenocarcinoma. After delivery the patient was further investigated and diagnosed with sigmoid cancer. Even though ovarian cancer in pregnancy is rare, adnexal ultrasound is mandatory when scanning during the first trimester to rule out the presence of associated fallopian or ovarian masses.
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Affiliation(s)
- Iulian G Goidescu
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Nemeti
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreia Preda
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tunde Kovacs
- Imogen Clinical Research Centre, Cluj-Napoca, Romania
| | - Mihai Surcel
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan T Eniu
- Department of Surgical Oncology and Oncological Gynecology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gheorghe Cruciat
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Mureșan
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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14
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Jain A, Madu CO, Lu Y. Phytochemicals in Chemoprevention: A Cost-Effective Complementary Approach. J Cancer 2021; 12:3686-3700. [PMID: 33995644 PMCID: PMC8120178 DOI: 10.7150/jca.57776] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer is one of the leading causes of death across the world. Although conventional cancer treatments such as chemotherapy and radiotherapy have effectively decreased cancer progression, they come with many dose-limiting side-effects. Phytochemicals that naturally occur in spices, fruits, vegetables, grains, legumes, and other common foods are surprisingly effective complements to conventional cancer treatments. These biologically active compounds demonstrate anticancer effects via cell signaling pathway interference in cancerous cells. In addition, phytochemicals protect non-cancerous cells from chemotherapy-induced side-effects. This paper addresses the not only the potential of phytochemicals quercetin, isoflavones, curcumin, catechins, and hesperidin in terms of cancer treatment and protection against side-effects of chemotherapy, but also methods for increasing phytochemical bioavailability.
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Affiliation(s)
- Aayush Jain
- Departments of Biological Sciences, University of Memphis, Memphis, TN 38152. USA
| | - Chikezie O. Madu
- Departments of Biological Sciences, University of Memphis, Memphis, TN 38152. USA
| | - Yi Lu
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN 38163. USA
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15
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Rajput D, Gupta A, Gupta S, Rai A, Shasheendran S. The State of Perplexity During Management of Gall Bladder Malignancy in an Expectant Young Mother. Cureus 2021; 13:e13099. [PMID: 33728121 PMCID: PMC7934605 DOI: 10.7759/cureus.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
During pregnancy, diagnosed cancer causes a major disturbance in the life of a pregnant woman and her family. The advanced stage of illness requiring systemic treatment inevitably leads the treating practitioner, with two lives at risk, into an ethical dilemma. The unborn child can be affected by the application of cancer medication to the mother as it is exposed to fetotoxic drugs. On the other hand, withholding therapy to allow fetal maturity may make the disease of the mother metastatic. Gall bladder carcinoma is often diagnosed as an unresectable disease (metastatic or locally advanced) due to its nonspecific symptomatology and carries the worst prognosis of any gastrointestinal or hepatobiliary neoplasm. We report a case of locally advanced gall bladder cancer (GBC) diagnosed during late pregnancy wherein the mother opted to continue the pregnancy without any intervention. A review of literature has been done to investigate the role of female hormones in a pregnancy complicating GBC with emphasis on management dilemma and the associated pitfalls.
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Affiliation(s)
- Deepak Rajput
- Department of Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Ankit Rai
- Department of Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Sruthi Shasheendran
- Department of Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
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16
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Pini A, Fazi C, Nardini P, Calvani M, Fabbri S, Guerrini A, Forni G, La Marca G, Rosa AC, Filippi L. Effect of Beta 3 Adrenoreceptor Modulation on Patency of the Ductus Arteriosus. Cells 2020; 9:cells9122625. [PMID: 33297453 PMCID: PMC7762377 DOI: 10.3390/cells9122625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 01/09/2023] Open
Abstract
β3-adrenoreceptor (β3-AR), a G-protein coupled receptor, has peculiar regulatory properties in response to oxygen and widespread localization. β3-AR is expressed in the most frequent neoplasms, also occurring in pregnant women, and its blockade reduces tumor growth, indicating β3-AR-blockers as a promising alternative to antineoplastic drugs during pregnancy. However, β3-AR involvement in prenatal morphogenesis and the consequences of its blockade for the fetus remain unknown. In this study, after the demonstrated expression of β3-AR in endothelial and smooth muscle cells of ductus arteriosus (DA), C57BL/6 pregnant mice were acutely treated at 18.5 of gestational day (GD) with indomethacin or with the selective β3-AR antagonist SR59230A, or chronically exposed to SR59230A from 15.5 to 18.5 GD. Six hours after the last treatment, fetuses were collected. Furthermore, newborn mice were treated straight after birth with BRL37344, a β3-AR agonist, and sacrificed after 7 h. SR59230A, at the doses demonstrated effective in reducing cancer progression (10 and 20 mg/kg) in acute and chronic mode, did not induce fetal DA constriction and did not impair the DA ability to close after birth, whereas at the highest dose (40 mg/kg), it was shown to cause DA constriction and preterm-delivery. BRL37344 administered immediately after birth did not alter the physiological DA closure.
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Affiliation(s)
- Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy;
- Correspondence: (A.P.); (L.F.); Tel.: +39-0552758155 (A.P.); +39-050993677 (L.F)
| | - Camilla Fazi
- Department of Health Sciences, University of Florence, 50139 Florence, Italy;
| | - Patrizia Nardini
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy;
| | - Maura Calvani
- Department of Paediatric Haematology-Oncology, A. Meyer University Children’s Hospital, 50139 Florence, Italy;
| | - Sergio Fabbri
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy;
| | - Alessandro Guerrini
- Department of Veterinary Medical Sciences, University of Bologna, 40064 Ozzano dell’Emilia, Italy;
| | - Giulia Forni
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Pediatric Neurosciences, “A. Meyer” University Children’s Hospital, 50139 Florence, Italy; (G.F.); (G.L.M.)
| | - Giancarlo La Marca
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Pediatric Neurosciences, “A. Meyer” University Children’s Hospital, 50139 Florence, Italy; (G.F.); (G.L.M.)
| | - Arianna Carolina Rosa
- Department of Scienza e Tecnologia del Farmaco, University of Turin, 10125 Turin, Italy;
| | - Luca Filippi
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence: (A.P.); (L.F.); Tel.: +39-0552758155 (A.P.); +39-050993677 (L.F)
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17
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Castellanos MI, Childress KJ, Ramirez M, Venkatramani R. Fetal exposure to capecitabine and temozolomide during the first trimester: A case report. J Gynecol Obstet Hum Reprod 2020; 49:101881. [PMID: 32712180 DOI: 10.1016/j.jogoh.2020.101881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
Literature on the outcome of pregnancy after exposure to capecitabine and temozolomide during the first trimester is scarce. Chemotherapy administration in the first trimester is generally not recommended due the potential risks to the fetus including fetal death and major congenital malformations. Capecitabine and temozolomide are oral chemotherapy agents and pregnancy category D medications, thus the use of these agents in pregnancy is not recommended. We present the case of a 17-year-old female who while receiving cancer treatment, had unintentional exposure to capecitabine and temozolomide during the first trimester of pregnancy, and subsequently delivered a healthy infant.
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Affiliation(s)
- Maria I Castellanos
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
| | - Krista J Childress
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, 30322, United States.
| | - Mildred Ramirez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, United States.
| | - Rajkumar Venkatramani
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
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18
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Frydenberg H, Harsem NK, Ofigsbø Å, Skoglund H, Brændengen M, Kaasa S, Guren MG. Chemotherapy During Pregnancy for Advanced Colon Cancer: A Case Report. Clin Colorectal Cancer 2020; 19:141-144. [PMID: 32222353 DOI: 10.1016/j.clcc.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 01/15/2023]
Affiliation(s)
| | | | - Åsa Ofigsbø
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Hanne Skoglund
- Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - Morten Brændengen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo and European Palliative Care Research Centre, Oslo, Norway
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway.
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19
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Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book 2020; 40:1-14. [PMID: 32315236 DOI: 10.1200/edbk_279901] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.
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Affiliation(s)
| | | | | | | | - Nilofer S Azad
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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20
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Boucher JE. Chemoprevention: An Overview of Pharmacologic Agents and Nursing Considerations. Clin J Oncol Nurs 2019; 22:350-353. [PMID: 29781458 DOI: 10.1188/18.cjon.350-353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer chemoprevention involves the use of synthetic and biologic agents as targeted therapies for disease prevention, reduction, or suppression. Mechanisms of blocking or suppressing cancer-related pathways include processes of carcinogenesis, chronic inflammatory responses, DNA modulation, and signal transduction. This column provides an update on pharmacologic agents and nursing considerations for chemoprevention.
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21
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Oncological outcome of peripartum colorectal carcinoma-a single-center experience. Int J Colorectal Dis 2019; 34:899-904. [PMID: 30915541 DOI: 10.1007/s00384-019-03278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to analyze disease presentation, management, and oncological outcomes of patients diagnosed with peripartum colorectal cancer (CRC). METHODS Retrospective cohort study of all consecutive women of childbearing age (18-45 years) between 2002 and 2014 diagnosed with CRC adenocarcinoma at a tertiary academic institution. Patients who experienced pregnancy within 12 months of their diagnosis (peripartum period, group 1) were compared to the remaining patients of the cohort (group 2). Overall survival (OS) was compared between the two groups through Kaplan-Meier estimates. RESULTS Out of 555 consecutive women with a mean age of 37.8 + 6 years, 31 (5.6%) were diagnosed with CRC in the peripartum period. Of these, all patients were symptomatic during pregnancy due to bleeding, abdominal pain, or constipation; however, only 11 CRC (35.5%) were diagnosed during pregnancy, 1 (3.2%) during C section, and the remaining (61.3%) postpartum. TNM stage at presentation was I in 6 patients (19.4%), II in 4 patients (13.9%), III in 8 patients (25.8%), and IV in 13 patients (41.9%). Surgical resection was performed in 23 patients (74.2%): 2 while pregnant, 2 at the time of C section, and the remainder postpartum. Across all stages, OS was 95% at 1 year and 62% at 5 years and did not differ between the two comparative groups (p = 0.16). CONCLUSIONS A suspicious attitude towards cancer-related symptoms during pregnancy is crucial to prevent delayed evaluation for CRC.
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22
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A Japanese survey of malignant disease in pregnancy. Int J Clin Oncol 2018; 24:328-333. [PMID: 30368627 DOI: 10.1007/s10147-018-1352-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years, the incidence of malignant disease in pregnancy has been increasing, but there are few large-scale surveys of malignant disease in pregnancy in Japan. The aim of this study was to survey malignant disease occurring during pregnancy in Japan. METHODS Malignant disease in pregnancy was defined as diagnosis or treatment for malignant disease, except in situ carcinoma during pregnancy, or within 1-year postpartum. First, a primary survey questionnaire of the incidence of malignant disease in pregnancy and the number of deliveries over the course of 2014 was sent to 510 medical centers in Japan. Second, the survey questionnaires on the incidence of malignant diseases in pregnancy were collected and analyzed in detail. RESULTS Of the 510 medical centers, 411 (81%) responded to the survey. There were 215,372 deliveries and 189 incidents (0.09%) of malignant disease in pregnancy. Of the 189 patients with malignancy, 157 detailed responses about the patients were received. The most frequently encountered cancer types were cervical cancer (36%), breast cancer (24%), and ovarian cancer (15%). During the 2 years after delivery, 15 patients (1 with breast cancer, 2 with ovarian cancer, 3 with hematologic malignancy, 4 with intestinal cancer, and 5 with others) died of the disease; most of them had advanced disease. In particular, 88% of the patients with intestinal cancers at diagnosis had advanced disease, and half of them died of disease. CONCLUSIONS In Japan, the most common malignancies in pregnancy in order of frequency are cervical cancer, breast cancer, and ovarian cancer. Early diagnosis and appropriate management of cancer during pregnancy are important for improving maternal and neonatal outcomes, because advanced diseases have a poor prognosis.
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23
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Murphy JE, Shampain K, Riley LE, Clark JW, Basnet KM. Case 32-2018: A 36-Year-Old Pregnant Woman with Newly Diagnosed Adenocarcinoma. N Engl J Med 2018; 379:1562-1570. [PMID: 30332577 DOI: 10.1056/nejmcpc1712230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Janet E Murphy
- From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School - both in Boston
| | - Kimberly Shampain
- From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School - both in Boston
| | - Laura E Riley
- From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School - both in Boston
| | - Jeffrey W Clark
- From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School - both in Boston
| | - Kristen M Basnet
- From the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., J.W.C.), Radiology (K.S.), Obstetrics and Gynecology (L.E.R.), and Pathology (K.M.B.), Harvard Medical School - both in Boston
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24
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Abstract
This article reviews some of the more common types of cancer that may be encountered during pregnancy. It reviews the unique challenges with the diagnosis and treatment of breast, cervical, hematologic, and colon cancers in pregnant patients.
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Affiliation(s)
- Anna McCormick
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Erika Peterson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226, USA
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25
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Lee SF, Burge M, Eastgate M. Metastatic colorectal cancer during pregnancy: A tertiary center experience and review of the literature. Obstet Med 2018; 12:38-41. [PMID: 30891091 DOI: 10.1177/1753495x18755958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background Colorectal cancer during pregnancy is rare. Diagnosis may be delayed and clinicians are faced with unique challenges when formulating management plans, having to consider the well-being of both fetus and mother. Cases Our series outlines five cases of metastatic colorectal cancer during pregnancy. There was one patient who presented in each of the first, second and third trimesters, whilst the remaining were post-partum. Diagnosis was difficult as the patients were either asymptomatic or their symptoms were misconstrued as features of pregnancy. Two patients received chemotherapy while pregnant but only one had a successful delivery. Survival of patients in this series ranged between 1 and 35 months from diagnosis. Conclusion Women with gestational colorectal cancer are often diagnosed at an advanced stage and have a poor prognosis.
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Affiliation(s)
- Shu Fen Lee
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Melissa Eastgate
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
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26
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Colorectal cancer during pregnancy. GINECOLOGIA.RO 2018. [DOI: 10.26416/gine.22.4.2018.2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Ye W, Tang Y, Yao C, Shi J, Xu Y, Jiang J. Advanced gastrointestinal carcinoma with massive ascites and hydrothorax during pregnancy: A case report and review of the literature. Medicine (Baltimore) 2017; 96:e9354. [PMID: 29390520 PMCID: PMC5758222 DOI: 10.1097/md.0000000000009354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Gastrointestinal carcinoma is rare during pregnancy. It is usually diagnosed at an advanced stage because special gastrointestinal symptoms are generally overlooked during pregnancy, and there are many limitations and contraindications for using diagnostic tools during pregnancy. PATIENT CONCERNS We present a case of a 29-year-old patient with 27 weeks and 5 days of gestation due to massive ascites and hydrothorax. DIAGNOSES The patient was diagnosed with an advanced gastrointestinal cancer. Pathological report showed poorly differentiated tumor with the signet ring cell component. INTERVENTIONS Caesarean section was performed. At the same time, an abdominal exploration showed that the omentum was like biscuits . There were extensive and firm intestinal adhesions, and many tumor lesions were found on the surface of greater curvature of stomach, spleen, intestine, peritoneum, ascending colon and descending colon. OUTCOMES Gastrointestinal surgeon was invited during operation, and palliative gastrectomy was not performed because of extensive metastases. The patient died 30 days after caesarean section. LESSONS This study present a case with advanced gastrointestinal cancer during pregnancy. We suggest that endoscopic exam is recommended if the patient is highly suspicious.
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Affiliation(s)
- Wenfeng Ye
- Department of Tumor Biological Treatment
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University
| | - Yanhong Tang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University
| | - Changfang Yao
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University
| | - Junyu Shi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University
| | - Yongjuan Xu
- Department of Obstetrics and Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Jingting Jiang
- Department of Tumor Biological Treatment
- Jiangsu Engineering Research Center for Tumor Immunotherapy
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28
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Abstract
Colorectal cancer is a rare occurrence during pregnancy and can present with symptoms that are common during pregnancy such as constipation.This can make the diagnosis of colorectal cancer during pregnancy difficult. Management of colorectal cancer during pregnancy is similar to the treatment of non-pregnant patients, but with fetal safety in mind. This case report describes a 33-year-old female gravida two para one (G2P1) at 29 weeks gestation who presented with a complete bowel obstruction. Colonoscopy, magnetic resonance imaging (MRI) and later resection showed an obstructing malignancy which was then resected through an exploratory laparotomy with left hemicolectomy. Postoperatively, there was a concern for sepsis, so labor was induced and the baby was delivered vaginally. The patient then continued with chemotherapy with hematology-oncology. High clinical suspicion is needed to diagnose colorectal cancer during pregnancy. Once diagnosed, surgery can be considered if resectable, taking into account gestational age. Fetal safety is a major consideration during treatment.
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Affiliation(s)
- Adriana Jones
- Medical Student, University of Central Florida College of Medicine
| | - Michael R Povlow
- Medical Student, University of Central Florida College of Medicine
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29
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Dauti A, Gerstl B, Chong S, Chisholm O, Anazodo A. Improvements in Clinical Trials Information Will Improve the Reproductive Health and Fertility of Cancer Patients. J Adolesc Young Adult Oncol 2017; 6:235-269. [PMID: 28207285 DOI: 10.1089/jayao.2016.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There are a number of barriers that result in cancer patients not being referred for oncofertility care, which include knowledge about reproductive risks of antineoplastic agents. Without this information, clinicians do not always make recommendations for oncofertility care. The objective of this study was to describe the level of reproductive information and recommendations that clinicians have available in clinical trial protocols regarding oncofertility management and follow-up, and the information that patients may receive in clinical trials patient information sheets or consent forms. A literature review of the 71 antineoplastic drugs included in the 68 clinical trial protocols showed that 68% of the antineoplastic drugs had gonadotoxic animal data, 32% had gonadotoxic human data, 83% had teratogenic animal data, and 32% had teratogenic human data. When the clinical trial protocols were reviewed, only 22% of the protocols reported the teratogenic risks and 32% of the protocols reported the gonadotoxic risk. Only 56% of phase 3 protocols had gonadotoxic information and 13% of phase 3 protocols had teratogenic information. Nine percent of the protocols provided fertility preservation recommendations and 4% provided reproductive information in the follow-up and survivorship period. Twenty-six percent had a section in the clinical trials protocol, which identified oncofertility information easily. When gonadotoxic and teratogenic effects of treatment were known, they were not consistently included in the clinical trial protocols and the lack of data for new drugs was not reported. Very few protocols gave recommendations for oncofertility management and follow-up following the completion of cancer treatment. The research team proposes a number of recommendations that should be required for clinicians and pharmaceutical companies developing new trials.
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Affiliation(s)
- Angela Dauti
- 1 College of Arts and Sciences, Department of Chemistry, New York University , New York City, New York.,2 Population Sciences Department, Dana-Farber Cancer Institute , Boston, Massachusetts.,3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Brigitte Gerstl
- 4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Serena Chong
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Orin Chisholm
- 5 Department of Pharmaceutical Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Antoinette Anazodo
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia .,4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia .,6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital , Randwick, Australia
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