Adenocarcinoma of the ascending colon in a 31-year-old pregnant woman: A case report

RATIONALE: Colorectal cancer (CRC) is the 2nd most common type of cancer in females and the 3rd in males, worldwide. It occurs rarely during pregnancy and is often associated with poor prognosis, due to the unspecific manifestations until advanced stage. Majority of CRC are localized in the rectum (63%) and the sigmoid colon (20%) during pregnancy. PATIENT CONCERNS: In thisstudy, we report the case of a pregnant woman who was diagnosed with adenocarcinoma of the ascending colon at her 33rd gestational week. She was referred to our department from local hospital with low fever and right-sided flank pain, which had lasted for nearly half a year and severely aggravated for 5 days. Previous prenatal examinations contributed the pain to kidney stones or uterine contractions. DIAGNOSES: After a caesarean section and tumor resection of a mass at the hepatic flexure of colon, tumor histology of frozen section confirmed the diagnosis of ulcerative adenocarcinoma of the ascending colon with a diameter of 10 cm. Final pathologic evaluation showed a grade 1 adenocarcinoma with negative lymph nodes (16/0), R0 resection, pT4b pN0 M0 and Dukes B stage. INTERVENTIONS: A healthy female infant was delivered by caesarean section, right after which a right hemicolectomy and ileostomy was performed. Pathology examination proved an early stage adenocarcinoma with no lymphatic metastasis. Patient received chemotherapy with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) after recovery smoothly and got discharged 1 month after surgery. OUTCOMES: Patient showed no relapse or progression during the follow-up time of 2 years after operation and chemotherapy. LESSONS: Rare occurrence of CRC during pregnancy and limited experience concerning its diagnosis and treatment bring obstacle to both patients and physicians. Symptoms as constipation and abdominal pain must be inspected carefully. With a perfect coordination between different disciplines, CRC with pregnancy can be ideally treated with better prognosis.