Objective: Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. Methods: This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. Results: A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. Conclusions: CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.

This study aimed to evaluate our center’s experience in diagnosing and managing placenta accreta spectrum (PAS) in a high-risk population, focusing on prenatal ultrasound features associated with PAS severity and maternal outcomes. We conducted a retrospective analysis of 102 high-risk patients with confirmed placenta previa who delivered at our center between 2018 and 2023. Patients underwent transabdominal and transvaginal ultrasound scans, assessing typical sonographic features. Binary and multivariate logistic regression analyses were performed to identify sonographic markers predictive of PAS and relative complications. Key ultrasound features—retroplacental myometrial thinning (<1 mm), vascular lacunae, and retroplacental vascularization—were significantly associated with PAS and a higher risk of surgical complications. An exceedingly rare sign, the “riddled cervix” sign, was observed in only three patients with extensive cervical or parametrial involvement. Those patients had the worst surgical outcomes. This study highlights the utility of specific ultrasound features in stratifying PAS risk and guiding clinical and surgical management in high-risk pregnancies. The findings support integrating these markers into prenatal diagnostic protocols to improve patient outcomes and inform surgical planning.

Introduction: Cancer during pregnancy is a rare event and often presents at an advanced stage due to delayed diagnosis. Clinical symptoms are frequently misattributed to normal pregnancy changes, leading to diagnostic challenges. Moreover, concerns regarding fetal safety limit the use of certain imaging modalities and treatment options. Managing cancer in pregnancy requires careful coordination across specialties to balance maternal treatment with fetal preservation. Case-report: We present the case of a pregnant woman diagnosed in the second trimester with advanced metastatic colorectal cancer. The disease involved multiple intra-abdominal sites, and the patient was managed through a multidisciplinary approach. Chemotherapy with FOLFOX scheme was administered during the second and third trimester of pregnancy, leading to a favorable clinical and radiologic response. Delivery was planned at term, with no complications for the newborn. Postpartum oncologic management was continued without delay. Conclusion: This case highlights the importance of individualized care in such complex scenarios and the feasibility and safety of administering chemotherapy during pregnancy.