Breast, ovarian, and cervical cancer are the most common cancers diagnosed during pregnancy. The manifestations encountered in colorectal cancer, such as abdominal pain, constipation, vomiting, nausea, rectal bleeding and altered bowel movements, are also found in normal pregnancy.
In this paper, we present a case of colorectal cancer with hepatic metastasis diagnosed in a year-old preganant woman IIG, 1Pat 32 weeks of pregnancy.
Keywords pregnancy, hpv tongue treatment cancer, metastasis, teratogencity, chemotherapy Rezumat Incidenţa cancerului colorectal în timpul sarcinii este mică, de un caz la 1.
Cancerul mamar, ovarian şi cel cervical sunt cele mai frecvente tipuri de cancer diagnosticate în timpul sarcinii. Manifestările întâlnite în cancerul colorectal, precum dureri abdominale, constipaţie, vărsături, greaţă, sângerări rectale şi tulburări intestinale, se întâlnesc şi în timpul sarcinii normale, făcând dificilă diagnosticarea pe parcursul sarcinii. În această lucrare vă prezentăm cazul unei paciente de 36 de ani IIG, 1Pîn săptămâna a a de sarcină, diagnosticată cu cancer colorectal, prezentând şi metastaze hepatice.
Cuvinte cheie cancer colorectal metastaze teratogenitate chimioterapie Introduction The incidence of colorectal cancer during pregnancy is reduced, being estimated at approximately one in every preganancies Breast, ovarian and cervical cancer are the most common cancers diagnosed during pregnancy 2.
The manifestations encountered in genotipuri papiloma cancer, such as abdominal pain, constipation, vomiting, nausea, rectal bleeding and altered bowel movements, are also found in normal pregnancy 5.
Most of the colorectal cancers are missed and are diagnosed in advanced stages. Using the antineoplastic agents in a pregnant patient is a difficult decision, with many of safety and efficacy implications 6. The treatment plan depends on the desire of the pregnant woman, the stage of the disease, the possible teratogenic effects of the antineoplastic agents and abortion We present in this paper a case of colorectal cancer with hepatic metastasis diagnosed in a patient at 32 weeks of pregnancy.
Figure 1. She also had constipation and anemia. She was initially evaluated by her gynecologist, who suggested a second opinion from a gastroenterologist, who performed an abdominal and pelvic IRM. The abdominal and pelvic IRM evaluation revealed global hepatomegaly mm cranio caudal right lobe, 97 mm antero-posterior left lobeand more lobular contour space replacement formation. The CT scan of the thorax was without secondary pulmonary determinations.
There was no family history of cancer. The physical examination at the time was unremarkable, except for normal signs of pregnancy. The patient was anemic at the time of presentation, the colon cancer hepatic resection level was 9. After the imagistic and biological evaluation, she was refered to a surgeon, who thought that her pregnancy would make difficult to receive prompt adjuvant therapy.
The patient was only week pregnant at the time of diagnosis. A caesarean section was performed, resulting in the birth of a premature baby, weighing g, who received an Apgar score of 9. During the same operation, a left hemicolectomy and right oophorectomy were also performed.
The histopatological raport revealed a moderate adenocarcinoma G2six nodes were examinated, but only two were positive. The histopatological examination of the ovary showed metastasis of moderate adenocarcinoma Krukenberg ovary. Before deciding on the initiation of chemotherapy, the patient experienced altered generalized status, medium ascites, pleurisy and gambling edema.
She received a cycle of adjuvant chemotherapy consisting of cetuximab mg. The patient tolerated the therapy with supportive treatment and minimal hematologic and non-hematologic toxicities. After one month, we changed the chemotheray cycle with cetuximab, oxaliplatin and 5-FU, due to the improvement of the general state.
Colon cancer hepatic resection follow-up CT scan after three months showed evolution in mild numerical regression of liver lesions. The hepatomegaly was maintained.
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Fine fluid blade in dimensional regression. Without bone metastases. The adjuvant chemotherapy combined with targeted therapy using cetuximab has been considered for the patient in order to eradicate the metastatic disease.
Discussion Despite the low incidence rate of 0. Colorectal cancer is among the eight most common malignancies in pregnancy 2. Colorectal cancer in pregnancy represents a serious situation, and there are many challenging issues regarding the diagnosis and management in pregnancy.
Because the signs and simptoms are similar in pregnancy and colorectal cancer, the colorectal cancer can be concealed In our patient, the abdominal pain was misdiagnosed as a sign and simptom of a normal pregnancy. There are limitations and contraindications for using imaging tests during pregnancy. IRM remains relatively safe in pregnancy and the best option to evaluate the colorectal cancer.
Serum CEA is an important test used in the evaluation of patients with colorectal cancer CEA levels during pregnancy may be elevated and can be used for monitoring the response of the treatment 15, Due to the fact that colorectal cancer is encoutered in the eldery and rarerly in young patients, it is assumed that there are a number of predisposing factors, such as Lynch syndrome, Peutz-Jeghers syndrome and inflammatory bowel disease Another challenging issue is the treatment, which should be started as early for the mother, and is based on colon cancer hepatic resection gestational age and tumor stage.
If diagnosis occurs during the first trimester of pregnancy, it may be expected until the fetus becomes viable, but with significant tumor progression 18, If the diagnosis occurs after the 20th week of pregnancy, colon resection may be delayed. Chemotheray is safer in the second and third trimesters, when organogenesis is complete There are no human data for the effect of cetuximab in pregnancy The ovarian metastatic disease from colorectal cancer is another challenge.
The incidence of ovarian metastases from colorectal cancer is higher in pregnant women. The survival of the pregnant woman with ovarian metastases is poor.
Nesbitt et al. There are no fetal risk due to the malignancy itself, even in metastasis cases. The pregnant woman with colorectal cancer has a poor prognosis. A review of 15 cases revealed that all patients with colorectal cancer presented in stage IV, and these patients died in 12 months after delivery Conclusions Colorectal cancer colon cancer hepatic resection pregnancy represents a diagnostic and therapeutic challenge.
Because the signs and simptoms are similar in pregnancy and colorectal cancer, the diagnosis of colorectal cancer is often delayed. The therapeutic decison colon cancer hepatic resection a pregnant patient with colorectal cancer should involve a multidisciplinary team, and there must be taken into account the life of the unborn child and the survival of the mother.
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