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 2014, four days after the birth of her third child, Jaime (36) was diagnosed with advanced bowel cancer that had spread to her liver and lungs.
The mother of three shares her kick ass story to help raise awareness of bowel cancer in women, and inspire other women living with advanced bowel cancer.
Jaime’s Kick Ass Story
“I have been having treatment, on and off, since my diagnosis with advanced bowel cancer in 2014 and I live a fulfilling and happy life with advanced cancer!”
“I had no obvious symptoms before I was diagnosed. My diagnosis came about when I was 35 weeks pregnant and all of a sudden, I had severe shoulder tip pain in my right shoulder one night, which I initially put down to referred abdominal pain from the baby. The pain was so severe that I admitted myself to the labour ward in the middle of the night, despite the midwives trying to dismiss my pain as simply being muscle soreness.”
“Fortunately, my obstetrician was not so dismissive and ordered a CT scan because he thought that there was something wrong with my lungs. That initial CT scan showed up shadows on my lungs and shadows on my liver. So I was referred for a liver ultrasound which reported many dark shadows throughout my liver.”
“A specialist maternity specialist was called in and checked me over and was insistent that there was nothing wrong with me because I looked so healthy, had gained weight in the pregnancy, had no obvious symptoms apart from minor constipation and the baby appeared to be a healthy size too.”
“We left it that I would deliver the baby in a few weeks’ time, when he was full term and then do some further investigation into the dark shadows across my liver and lungs! My obstetrician, my husband and I had a sixth sense that all was not actually ok, and we decided together that the baby should be delivered early at 37 weeks and we would in fact start the further investigations then.”
“So, I delivered a perfectly healthy baby boy by caesarean section and had two perfect days with him before our family life changed forever. My obstetrician was fantastic and behind the scenes assembled a team of people to take over my care once the baby had been born. On the day of Lenny’s birth, he said to me “we are all a bit worried about what is going on with you, but let’s not forget that today you are having a baby – so let’s focus on that celebration today”.
“Two days after Leonard was born I was sent for a liver biopsy, which confirmed that the dark shadows were cancer and the primary source was bowel cancer.”
“I was quickly scheduled in for a colonoscopy, which showed I had a large tumour in my sigmoid colon on the verge of causing a complete obstruction. So, recovering from my c-section and having a tube running out my bottom to allow some waste to escape my bowel, I was sent down for a Pet-CT scan, which lit up the massive bowel tumour, loads of tumours on my liver and a couple of lesions on my lungs.”
“Meanwhile, baby Lenny was having a lovely time in the neonatal ward being looked after by the fabulous nurses there who cuddled him, fed him and gave him his first bath because I couldn’t do it. I will be forever grateful to ALL the hospital staff for looking after my family in the worst weeks of our lives.”
“After my diagnosis, I was swept along by the multidisciplinary team of gastroenterologist, colorectal surgeon, oncologist, liver surgeon and others. It is all a bit of a blur, but I remember my oncologist introducing himself to me and telling me we would get to know each other quite well over the coming 10 years!”
“The main issue was my liver – it was on the verge of shut down. So, my team decided that I would have an ileostomy created to give my bowel a break and I would commence Folfox chemotherapy straight away in a bid to shrink my liver tumours to make liver surgery possible down the track.”
“I was lucky that one portion of my liver was relatively clear of tumours to enable a resection. I would have a bowel resection after a few months of chemotherapy and eventually a liver resection and ileostomy reversal. And so that is what happened, as soon as my ileostomy started working properly and I had a grip on what that entailed, I started chemo. Two weeks after rocking up to hospital to have my baby, I was going home as a mother of three children under three and a cancer patient.”
“Family members flew in from around the world to help while I was in hospital and during my treatment. Friends and family rallied to help us, as I completed three months of Folfox chemotherapy with Avastin (the Oxaliplatin over winter was awful, even in mild Perth) and took a short break to have my bowel resection to remove the primary tumour.”
“I then had another four months of chemotherapy and took a break to have my liver resection and ileostomy reversal, which was successful. At the time of the liver resection, the chemo had melted away most of what was left of the liver tumours and the lung tumours had shrunk to almost non-existence.”
“After my liver resection, I took a break from treatment to see what would happen – would the tumours grow back, how many metastases would pop up?”
“Unfortunately, a naughty lesion appeared in my lymph nodes in my lungs near my oesophagus, which could not be treated with RFA. I underwent cyber knife treatment on the misbehaving lymph node, which was also successful. I also went on a course of Capecitabine oral chemotherapy, which was so manageable compared to the intravenous therapy.
“I then had a little break from treatment and we cherry picked off lesions as they grew in my lungs with RFA until one scan revealed that a few more had appeared – it was time to get back on hard core chemo, which was so disappointing.”
“I went back on Folfox with Avastin for six months. After six months I went back to taking Capecitabine tablets with an infusion of Avastin every three weeks.”
“I remain on this regime today and although I would prefer not to have cancer and be taking medication – the alternative is so much worse. I treat my condition as I would any chronic medical condition…I take medication and get on with it.”
“There have been so many lows over the past three and a half years, but there have also been so many silver linings out of being diagnosed with advanced cancer.”
“I have realised that I am tougher than I thought possible, my husband is even more amazing than I could ever have imagined, and my children are more resilient than I could have wished for.”
“We try and keep up a normal family life – we continue to go on holidays, socialise with friends, go to the park and beach and generally do things other families do. We have a lot of fun.”
“As a woman, I still get hung up on looking my best. Cancer does not change that – it just makes it a little bit harder to feel body confident! I have struggled with my changing body, which has been rattled by steroids and criss-crossed with surgery scars. This remains an ongoing struggle for me.”
“My team of specialists are amazing and I trust my oncologist implicitly. I encourage everyone to find a specialist that they feel comfortable with – you need to be able to discuss confronting subjects with this person. So if possible, try and choose a team you feel comfortable with as it is hard enough dealing with cancer.”
“My story is not amazing and unfortunately not particularly rare, yet it is my own.”
“It is not the same as someone’s uncle Max… who died or someone else’s mate who survived cancer because they turned vegan and took up meditation.”
“I try very hard to keep to my own path and block out the bad news stories that you inevitably hear or read about. I also try to stay off google and definitely don’t rely on outdated statistics.”
“I have many friends who have been through or are going through similar (yet different) battles and their strength continues to inspire me.”