Patients frequently delay self-referral, as the presenting features of bowel cancer can overlap with those of pregnancy itself.
Abdominal pain, constipation, vomiting, anaemia, and rectal bleeding are all common presenting symptoms of both bowel cancer and pregnancy. Rectal bleeding can also be attributed to haemorrhoids, which are common in pregnant women.
Specialists may delay diagnostic tests because of inattention to the potential significance of symptoms owing to the perceived rarity of bowel cancer in the younger population, and potential foetal risks.
Most cases of bowel cancer are therefore diagnosed later in pregnancy when more widespread metastasis has occurred.
Pregnancy affects the clinical presentation, evaluation, therapy, and prognosis of bowel cancer.
When diagnosis of bowel cancer is made during pregnancy, multidisciplinary involvement of the obstetrician, perinatologist, colorectal surgeon, and radiation and medical oncologists is essential to achieving the goal of early delivery that allows for the earliest treatment of the patient’s cancer.
The exact reasons for why bowel cancer is often diagnosed in more advanced stages during pregnancy is still associated with lots of unanswered questions.
A possible association between neoplastic cell growth and proliferation and gestation may have a role to play. Factors such as pregnancy hormones (estrogen, progesterone), p53 protein abnormality and cyclooxygenase enzyme have also all been implicated. However, further research is required.
Most importantly, you are never too young to have bowel cancer, and bowel cancer is being diagnosed in women while pregnant or shortly afterwards.
No one knows your body better than you, so regardless of whether you are pregnant or not, if something isn’t right and you are experiencing any possible bowel cancer symptoms, discuss your concerns with your doctor as soon as possible.
If caught in time, 90 per cent of bowel cancer cases can be successfully treated.
It is important not to miss a critical early diagnosis that might put both mother and baby at serious risk.
In May 2018, around the time of her daughter's first birthday, Bridget (34) was diagnosed with stage IIIa bowel cancer.
The mother of two shares her kick ass story to help raise awareness of bowel cancer in women, and inspire other women living with advanced bowel cancer.
"My name is Bridget. I am 34 years old and a mum of a 3 and 1 year old. In May 2018 my world was rocked, when I was diagnosed with stage IIIa bowel cancer. I will always remember the date, because it was my daughter’s first birthday. At the time it was very important to me to delay my colonoscopy because I didn’t want the anaesthetic to affect my breast milk. Funny the things that used to be so important.
Numerous symptoms led me to that colonoscopy; urgency, frequency, bleeding, bloating, pain etc. I had had these symptoms for years however they were always explained as something else, ovarian tumours, IBS, back to back pregnancies, difficult deliveries and/or post-natal complications. No one ever suspected Bowel Cancer, however every time a doctor suggested a reason and told me “not to worry, it’ll naturally fix itself,” I knew there was something else going on. I didn’t feel right and at the end of the day Cancer has no bias, it will go and be where and when it wants.
Another contributing reason for delaying my colonoscopy was I thought what I was experiencing was normal and I was too embarrassed to be completely honest about my toileting. It wasn’t until one night I was finally brutally honest about all my symptoms and actually showed my husband my stool. He immediately made me call my GP to organise my colonoscopy as soon as possible. Imagine if I had the courage to do that, even a few months prior.
My treatment has been aggressive. I started with a re-section of my bowel to remove the cancer and surrounding lymph nodes. I also had an ileostomy (poo bag) formed in this surgery. I then started the first round of 12 rounds of chemotherapy which was scheduled for every fortnight. The ileostomy was reversed after three months, as I had complications with scar tissue and I finished my last round of chemotherapy on the 11th of January 2019. I am now officially in remission.
Having chemotherapy every fortnight really played with my emotions and mental well-being. I would finally start feeling like myself, just to go back to hospital and ‘get sick’ all over again. It was difficult to remain positive and I deeply hated the chemo pump as part of my protocol. I could feel it and smell it slowly drip poison into my body every 90 seconds for two days. The worst of the side effects was not being able to eat, drink or touch cold things whilst being perpetually nauseous. I couldn’t find relief in a simple glass of water. Through this time, I would pretend that I was fine for my family and friends, but it was horrible and scary, more so than I would like to admit.
Being a mum of two young children, made this journey so much harder and easier at the same time. Harder, because I couldn’t rest, take the time for self-care and constantly feeling extreme guilt that I was always relying on others help. But also far easier as I had something to wake up for everyday, to motivate me and no choice but to keep fighting. My biggest fear is that I would lose my close relationship with my children, but the one on one time became more special and important.
Nowadays the craziness of chemotherapy seems like a distant memory and at times feels like it never happened. Surreal, like it happened to someone else.
I still have side effects and symptoms that plague my everyday life. Constant pins and needles in my fingers and toes, an electric jolt through my body every time I move my head up and down. Also due to the re-section I have to retrain my bowels. This is a very slow and painful process, but most of all, embarrassing. So it feels like I’m back at the beginning, if not further behind.
I was warned at the beginning of my treatment the most difficult thing would be that I wouldn’t look ‘sick’. As strange as that sounds it is true. I look as I always do, until I see the menagerie of scars. It is a blessing and a curse, I can disguise in a crowd, but people expect me to be back to normal. It is a very frustrating place to be.
I have learned many life lessons during this chapter. Most of all, I have learned to put my health first and not to procrastinate because it may be embarrassing or require change. Just because it’s your normal, doesn’t mean it is normal. If you don’t feel right, it never hurts to have a conversation."