Presentation, management, and outcome of the pregnant female with colorectal cancer.
389 Background: Most patients diagnosed with colorectal cancer (CRC) are older than 60 years old. However, there remains a population of women of reproductive age (17-49) who develop CRC. Few publications have described the presentation, management and outcome of patients who initially present while pregnant.The objective of this study is to assess the presentation, management and outcome of women aged 17-49 with a particular focus on the pregnant patient. Presenting symptoms, time from presentation to diagnosis, management of disease, and overall survival were the main endpoints of this study. Methods: A retrospective chart review was conducted of 72 women aged 18-49 who were treated for CRC between 2005 and 2009 at a single institution. We compared the non-pregnant women (n = 66, group A) with the pregnant women (n = 6, group B). Results: The median age at presentation was 43 and 36.5 years in group A and group B, respectively. All six patients in group B presented with significant anemia, severe abdominal pain, and bright red blood per rectum during pregnancy while 25% of group A were asymptomatic. Although all 6 of the group B patients presented while pregnant, five patients were diagnosed in the postpartum period. Only 1/6 patients were diagnosed while pregnant, in the 3rd trimester. Median time from presentation to diagnosis was 10 days in group A, and 175 days in group B. Definitive treatment for the group B women included resection with C-section (n = 1), resection followed by systemic chemotherapy (n = 3), and resection only (n = 2). 72% of group A and 100% of group B patients presented with advanced disease (stages III and IV). Median overall survival for the entire cohort was 24.4 months; 26.1 months for group A and 7.8 months for group B. There was one long-term survivor amongst the group B patients (5.3 years), who has had two recurrences. Conclusions: Overall, the majority of women aged 18-49 presented with advanced stages of CRC. Specifically, 5/6 pregnant women presented with stage IV disease. Given that many of the symptoms of CRC mimic symptoms of pregnancy, a higher index of suspicion of CRC may minimize the delay in diagnosis, decrease the proportion of higher stage cancers, and improve the cancer outcome in this cohort of patients. No significant financial relationships to disclose.