Metastatic colon adenocarcinoma in pregnancy

Abstract

Colon cancer in pregnancy is rare. Symptoms are nonspecific; hence, patients are often diagnosed at an advanced stage with poor prognosis. We present a 40-year-old multigravid who had recurrent severe abdominal pain. She underwent surgeries at 9 and 21 weeks age of gestation with an initial assessment of ovarian malignancy. Further workup showed metastatic adenocarcinoma to the pelvis with colonic primary. Chemotherapy was subsequently deferred due to COVID-19 infection. She eventually developed partial gut obstruction and underwent bowel diversion with intraoperative fetal monitoring at 31 weeks age of gestation. Although the fetus developed growth restriction, the pregnancy was successfully carried to term with a good outcome. Palliative chemotherapy was started postpartum and she completed eight cycles. Unfortunately, she succumbed to death after 1 year due to pulmonary metastases. Despite challenges in diagnosis and management, this case shows that it is possible to have a good outcome in a pregnancy complicated by advanced-stage colon cancer.