{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:00:08Z","timestamp":1789196408685,"version":"build-2803163510"},"reference-count":99,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/diagnostics14050559","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T04:03:50Z","timestamp":1709697830000},"page":"559","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9330-6414","authenticated-orcid":false,"given":"Arianna","family":"Galante","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2918-3608","authenticated-orcid":false,"given":"Marco","family":"Cerbone","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2623-4166","authenticated-orcid":false,"given":"Francesco","family":"Mannavola","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Marinaccio","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"},{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca Maria","family":"Schonauer","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"},{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3522-4648","authenticated-orcid":false,"given":"Miriam","family":"Dellino","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-8068","authenticated-orcid":false,"given":"Gianluca Raffaello","family":"Damiani","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Pinto","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"},{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-372X","authenticated-orcid":false,"given":"Gennaro","family":"Cormio","sequence":"additional","affiliation":[{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"},{"name":"Gynecologic Oncology Unit, Istituto Tumori Bari Giovanni Paolo II IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2390-4582","authenticated-orcid":false,"given":"Ettore","family":"Cicinelli","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"},{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-1619","authenticated-orcid":false,"given":"Antonella","family":"Vimercati","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"},{"name":"Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Murgia, F., Marinaccio, M., Cormio, G., Loizzi, V., and Cicinelli, R. (2019). Pregnancy related cancer in Apulia. A population based linkage study. Eur. J. Obstet. Gynecol. Reprod. Biol. X, 3.","DOI":"10.1016\/j.eurox.2019.100025"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Schwab, R., Anic, K., and Hasenburg, A. (2021). Cancer and pregnancy: A comprehensive review. Cancers, 13.","DOI":"10.3390\/cancers13123048"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1634\/theoncologist.2002-0279","article-title":"Coexistence of pregnancy and malignancy","volume":"7","author":"Pavlidis","year":"2002","journal-title":"Oncologist"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1200\/JCO.2008.17.4110","article-title":"Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: A registry-based cohort study","volume":"27","author":"Stensheim","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/AOG.0b013e3182a057a2","article-title":"Incidence of pregnancy-associated cancer in Denmark, 1977\u20132006","volume":"122","author":"Eibye","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1093\/annonc\/mdz228","article-title":"Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting","volume":"30","author":"Amant","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e100037","DOI":"10.1200\/EDBK_100037","article-title":"Patient-Centered Care in the Management of Cancer During Pregnancy","volume":"43","author":"Sorouri","year":"2023","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"vi160","DOI":"10.1093\/annonc\/mdt199","article-title":"Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up\u2020","volume":"24","author":"Peccatori","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_9","unstructured":"The International Agency for Research on Cancer IARC (2023, January 23). Global Cancer Observatory. Available online: https:\/\/gco.iarc.fr\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_11","first-page":"e8261","article-title":"Colorectal cancer diagnosed during pregnancy with delayed treatment","volume":"12","author":"Cao","year":"2020","journal-title":"Cureus"},{"key":"ref_12","unstructured":"National Cancer Institute Statistics (2023, July 08). The Surveillance, Epidemiology, and End Results (SEER) Program, Available online: https:\/\/seer.cancer.gov\/index.html."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.cgh.2016.10.038","article-title":"Advanced-stage colorectal cancer in persons younger than 50 years not associated with longer duration of symptoms or time to diagnosis","volume":"15","author":"Chen","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1093\/jnci\/djab124","article-title":"A comprehensive comparison of early-onset and average-onset colorectal cancers","volume":"113","author":"Cercek","year":"2021","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/cncr.27755","article-title":"Adjuvant chemotherapy for stage III colon cancer in the oldest old","volume":"119","author":"Abraham","year":"2013","journal-title":"Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","article-title":"Toxicity and response criteria of the Eastern Cooperative Oncology Group","volume":"5","author":"Oken","year":"1982","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.6004\/jnccn.2022.0051","article-title":"Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Benson","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_20","unstructured":"RoB 2, ROBINS-I, ROBINS-E, and ROB ME (2023, August 18). Risk of Bias Visualization Tool. Available online: https:\/\/www.riskofbias.info\/welcome\/robvis-visualization-tool."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_22","first-page":"e935920","article-title":"Bowel Obstruction Due to Stenotic Sigmoid Colon Cancer in a 32-Year-Old Patient Presenting in the Third Trimester of Pregnancy: A Case Report of an Interval Surgical Approach","volume":"23","author":"Czigany","year":"2022","journal-title":"Am. J. Case Rep."},{"key":"ref_23","first-page":"258","article-title":"Colonic mucinous adenocarcinoma in a pregnant woman presented as pseudo Sister Mary Joseph\u2019s nodule: A case report","volume":"77","author":"Tarik","year":"2022","journal-title":"Med. J. Malays."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"885","DOI":"10.21037\/jgo-21-31","article-title":"Colorectal cancer in pregnancy: A case report and literature review","volume":"12","author":"Yang","year":"2021","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_25","first-page":"3085413","article-title":"Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome","volume":"2020","author":"Maqueira","year":"2020","journal-title":"Case Rep. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e925673","DOI":"10.12659\/AJCR.925673","article-title":"Good Outcome of Early-Stage Rectal Cancer Diagnosed during Pregnancy","volume":"21","author":"Alkhamis","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.clcc.2020.02.013","article-title":"Chemotherapy during Pregnancy for Advanced Colon Cancer: A Case Report","volume":"19","author":"Frydenberg","year":"2020","journal-title":"Clin. Color. Cancer"},{"key":"ref_28","first-page":"8894722","article-title":"Colon Adenocarcinoma during Pregnancy: A Case Report and Review of the Literature","volume":"2020","author":"Petruzzelli","year":"2020","journal-title":"Case Rep. Obs. Gynecol."},{"key":"ref_29","first-page":"e9491","article-title":"Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report","volume":"12","author":"Sravanthi","year":"2020","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1159\/000504472","article-title":"Colorectal Signet Ring Cell Carcinoma in a Young Pregnant Woman","volume":"13","year":"2020","journal-title":"Case Rep. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/1753495X18755958","article-title":"Metastatic colorectal cancer during pregnancy: A tertiary center experience and review of the literature","volume":"12","author":"Lee","year":"2019","journal-title":"Obs. Med."},{"key":"ref_32","first-page":"307","article-title":"Colon cancer in pregnancy: A diagnostic and therapeutic challenge","volume":"60","author":"Munteanu","year":"2019","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_33","first-page":"3682980","article-title":"Nonobstetrical Acute Abdomen during Pregnancy as a Consequence of Colorectal Carcinoma Perforation: Case Report and Review of the Literature","volume":"2019","author":"Stasenko","year":"2019","journal-title":"Case Rep. Gastrointest. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1056\/NEJMcpc1712230","article-title":"Case 32-2018: A 36-Year-Old Pregnant Woman with Newly Diagnosed Adenocarcinoma","volume":"379","author":"Murphy","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13707","DOI":"10.1097\/MD.0000000000013707","article-title":"Adenocarcinoma of the ascending colon in a 31-year-old pregnant woman: A case report","volume":"97","author":"Xu","year":"2018","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/1753495X17704611","article-title":"Colon cancer presenting as pseudo-obstruction during pregnancy\u2014A case report","volume":"10","author":"Makhijani","year":"2017","journal-title":"Obs. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e9354","DOI":"10.1097\/MD.0000000000009354","article-title":"Advanced gastrointestinal carcinoma with massive ascites and hydrothorax during pregnancy: A case report and review of the literature","volume":"96","author":"Ye","year":"2017","journal-title":"Medicine"},{"key":"ref_38","first-page":"e1190","article-title":"Colorectal Cancer Presenting with Constipation During Pregnancy","volume":"9","author":"Jones","year":"2017","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ejogrb.2016.05.051","article-title":"Colon cancer in pregnancy\u2014A difficult diagnosis","volume":"203","author":"Gabriel","year":"2016","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.amsu.2016.04.018","article-title":"Advanced colorectal cancer resulting in acute bowel obstruction during pregnancy; A case report","volume":"8","author":"Ossendorp","year":"2016","journal-title":"Ann. Med. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s13256-015-0621-9","article-title":"Chemotherapeutic treatment of colorectal cancer in pregnancy: Case report","volume":"9","author":"Makoshi","year":"2015","journal-title":"J. Med. Case Rep."},{"key":"ref_42","first-page":"340","article-title":"Discovery of a small bowel tumor following an acute intestinal obstruction in a pregnant woman: Report of a case","volume":"20","author":"Chouaib","year":"2015","journal-title":"Pan Afr. Med. J."},{"key":"ref_43","first-page":"170","article-title":"Sigmoid colon cancer in pregnancy\u2014A case report","volume":"94","author":"Hoch","year":"2015","journal-title":"Rozhl. Chir."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s12029-012-9463-5","article-title":"Rectal cancer in pregnancy: A case report and review of the literature","volume":"44","author":"Dogan","year":"2013","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S239","DOI":"10.1007\/s12029-012-9394-1","article-title":"Colorectal Cancer in Pregnancy: Driven by Pregnancy-Associated Growth Factors?","volume":"43","author":"Ho","year":"2012","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.clcc.2011.06.003","article-title":"Successful twin pregnancy outcome after in utero exposure to FOLFOX for metastatic colon cancer: A case report and review of the literature","volume":"10","author":"Jeppesen","year":"2011","journal-title":"Clin. Color. Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s00280-008-0731-9","article-title":"Administration of oxaliplatin to a pregnant woman with rectal cancer","volume":"63","author":"Gensheimer","year":"2009","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1078155208094101","article-title":"Priorities and uncertainties of administering chemotherapy in a pregnant woman with newly diagnosed colorectal cancer","volume":"15","author":"Kanate","year":"2009","journal-title":"J. Oncol. Pharm. Pr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/AOG.0b013e3181a1d478","article-title":"Irinotecan use during pregnancy","volume":"114","author":"Taylor","year":"2009","journal-title":"Obs. Gynecol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"402","DOI":"10.3816\/CCC.2008.n.054","article-title":"Collision tumor of the large bowel in the context of advanced pregnancy and ulcerative colitis","volume":"7","author":"Duffy","year":"2008","journal-title":"Clin. Color. Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1080\/01443610701241159","article-title":"Cancer of the descending colon during pregnancy","volume":"27","author":"Mechery","year":"2007","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/j.1447-0756.2007.00510.x","article-title":"Synchronous rectal and colon cancer caused by familial polyposis coli during pregnancy","volume":"33","author":"Lolis","year":"2007","journal-title":"J. Obs. Gynaecol. Res."},{"key":"ref_53","first-page":"504","article-title":"Colorectal cancer discovered during pregnancy","volume":"35","author":"Tardieu","year":"2006","journal-title":"J. Gynecol. Obs. Biol. Reprod."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/uog.3810","article-title":"Intussusception: A rare cause of abdominal pain in pregnancy","volume":"28","author":"Penney","year":"2006","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1111\/j.0001-6349.2005.0243c.x","article-title":"Colorectal cancer presenting with uncommon soft tissue invasion during pregnancy","volume":"84","author":"Harma","year":"2005","journal-title":"Acta Obs. Gynecol. Scand."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/107327480501200310","article-title":"Colon cancer in pregnancy","volume":"12","author":"Minter","year":"2005","journal-title":"Cancer Control"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/01443610410001661020","article-title":"Advanced sigmoid colon cancer in pregnancy presented as an abscess","volume":"24","author":"Papathanasiou","year":"2004","journal-title":"J. Obs. Gynaecol."},{"key":"ref_58","first-page":"75","article-title":"Colon cancer during pregnancy. A case report","volume":"46","author":"Ozet","year":"2001","journal-title":"J. Reprod. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1055\/s-2007-993919","article-title":"The incidence of colorectal cancer during pregnancy in Japan: Report of two cases and review of Japanese cases","volume":"15","author":"Kitoh","year":"1998","journal-title":"Am. J. Perinatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1006\/gyno.1996.4549","article-title":"Pregnancy associated with colon carcinoma overexpressing p53","volume":"64","author":"Rojansky","year":"1997","journal-title":"Gynecol. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/0020-7292(94)90027-2","article-title":"Carcinoma of the colon during pregnancy","volume":"44","author":"Vitoratos","year":"1994","journal-title":"Int. J. Gynaecol. Obs."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/0028-2243(93)90257-D","article-title":"Colon carcinoma during pregnancy: A lethal coincidence","volume":"48","author":"Heres","year":"1993","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/BF00730635","article-title":"Intussusception caused by a carcinoma of the cecum during pregnancy: Report of a case and review of the literature","volume":"23","author":"Shioda","year":"1993","journal-title":"Surg. Today"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/S0025-6196(12)61148-3","article-title":"Colonic cancer during pregnancy: Case report and review of the literature","volume":"67","author":"Heise","year":"1992","journal-title":"Mayo Clin. Proc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/0002-9378(90)90682-W","article-title":"Colon cancer in pregnancy with elevated maternal serum alpha-fetoprotein level at presentation","volume":"163","author":"Gonsoulin","year":"1990","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/0020-7292(89)90826-6","article-title":"Perforated adenocarcinoma of the colon during pregnancy","volume":"30","author":"Jaffe","year":"1989","journal-title":"Int. J. Gynaecol. Obs."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/0090-8258(86)90318-5","article-title":"Carcinoma of the colon presenting as bilateral ovarian tumors during pregnancy","volume":"24","author":"Tsukamoto","year":"1986","journal-title":"Gynecol. Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1001\/archsurg.1985.01390290110020","article-title":"Colorectal carcinoma in pregnancy","volume":"120","author":"Nesbitt","year":"1985","journal-title":"Arch. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00007611-198403000-00027","article-title":"Colonic cancer in pregnancy","volume":"77","author":"Hill","year":"1984","journal-title":"South. Med. J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00432-002-0406-6","article-title":"Cancer in pregnancy: Maternal-fetal conflict","volume":"129","author":"Oduncu","year":"2003","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0301-2115(99)00229-8","article-title":"Maternal complications after caesarean section in HIV infected women","volume":"90","author":"Vimercati","year":"2000","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"28","DOI":"10.14740\/wjon1177","article-title":"Cancer during pregnancy: The oncologist overview","volume":"10","author":"Hepner","year":"2019","journal-title":"World J. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1159\/000448139","article-title":"Prenatal Diagnosis of Twin Pregnancies with Complete Hydatidiform Mole and Coexistent Normal Fetus: A Series of 13 Cases","volume":"82","author":"Giorgione","year":"2017","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"bjgpopen19X101674","DOI":"10.3399\/bjgpopen19X101674","article-title":"Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: A cross-sectional study in general practice","volume":"3","author":"Lutterodt","year":"2019","journal-title":"BJGP Open"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bpobgyn.2015.10.005","article-title":"Difficulties with diagnosis of malignancies in pregnancy","volume":"33","author":"Vandecaveye","year":"2016","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Vimercati, A., De Nola, R., Trerotoli, P., Metta, M., Cazzato, G., Resta, L., and Malvasi, A. (2022). COVID-19 Infection in Pregnancy: Obstetrical Risk Factors and Neonatal Outcomes-A Monocentric, Single-Cohort Study. Vaccines, 10.","DOI":"10.3390\/vaccines10020166"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1148\/rg.323115120","article-title":"Quality initiatives: Guidelines for use of medical imaging during pregnancy and lactation","volume":"32","author":"Tremblay","year":"2012","journal-title":"RadioGraphics"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"(2017). Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet. Gynecol., 130, e210\u2013e216.","DOI":"10.1097\/AOG.0000000000002355"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Han, S., Lotgerink, A., Gziri, M., Van Calsteren, K., Hanssens, M., and Amant, F. (2012). Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: A systematic review. BMC Med., 10.","DOI":"10.1186\/1741-7015-10-86"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1001\/jamaoncol.2015.1883","article-title":"Presymptomatic Identification of Cancers in Pregnant Women During Noninvasive Prenatal Testing","volume":"1","author":"Amant","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1200\/JCO.21.02260","article-title":"Noninvasive Prenatal Test Results Indicative of Maternal Malignancies: A Nationwide Genetic and Clinical Follow-Up Study","volume":"40","author":"Heesterbeek","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.jmig.2018.06.008","article-title":"Safety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study","volume":"26","author":"Shigemi","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"249.e1","DOI":"10.1016\/j.ajog.2019.09.036","article-title":"Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: Results of a randomized controlled trial","volume":"222","author":"Obermair","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/ijc.2910340214","article-title":"Pregnancy in association with a newly diagnosed cancer: A population-based epidemiologic assessment","volume":"34","author":"Haas","year":"1984","journal-title":"Int. J. Cancer"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1001\/jamaoncol.2022.1795","article-title":"Assessment of severe maternal morbidity and mortality in pregnancies complicated by cancer in the US","volume":"8","author":"Matsuo","year":"2022","journal-title":"JAMA Oncol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.biocel.2018.09.016","article-title":"Trophoblast: The central unit of fetal growth, protection and programming","volume":"105","author":"Staud","year":"2018","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Triarico, S., Rivetti, S., Capozza, M.A., Romano, A., Maurizi, P., Mastrangelo, S., Attin\u00e0, G., and Ruggiero, A. (2022). Transplacental passage and fetal effects of antineoplastic treatment during pregnancy. Cancers, 14.","DOI":"10.3390\/cancers14133103"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.1016\/j.ajog.2015.08.042","article-title":"Why is placentation abnormal in preeclampsia?","volume":"213","author":"Fisher","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1038\/nm.3012","article-title":"Mechanisms of implantation: Strategies for successful pregnancy","volume":"18","author":"Cha","year":"2012","journal-title":"Nat. Med."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Benoit, L., Mir, O., Vialard, F., and Berveiller, P. (2021). Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents. Cancers, 13.","DOI":"10.3390\/cancers13061238"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2165\/00003088-199528030-00005","article-title":"Placental transfer of drugs administered to the mother","volume":"28","author":"Pacifici","year":"1995","journal-title":"Clin. Pharmacokinet."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2165\/00003088-200443080-00001","article-title":"Drug transfer and metabolism by the human placenta","volume":"43","author":"Syme","year":"2004","journal-title":"Clin. Pharmacokinet."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1002\/bdra.23029","article-title":"The all-or-none phenomenon revisited","volume":"94","author":"Adam","year":"2012","journal-title":"Birth Defects Res. Part A Clin. Mol. Teratol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s00404-011-1930-x","article-title":"A singular observation of a giant benign Brenner tumor of the ovary","volume":"284","author":"Ruggiero","year":"2011","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_95","first-page":"iv22","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/MEG.0000000000000863","article-title":"Colorectal cancer diagnosed during pregnancy: Systematic review and treatment pathways","volume":"29","author":"Pellino","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_97","unstructured":"National Toxicology Program (2013). NTP Monograph: Developmental Effects and Pregnancy Outcomes Associated with Cancer Chemotherapy Use During Pregnancy. NTP Monogr., i-214. NIH Publication No. 13-5956."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S1470-2045(18)30059-7","article-title":"Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: A 20-year international cohort study of 1170 patients","volume":"19","author":"Verheecke","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1080\/00015458.2018.1493821","article-title":"Infertility and Pregnancy (INCIP) on this particular manuscript. Management and outcome of colorectal cancer during pregnancy: Report of 41 cases","volume":"119","author":"Cardonick","year":"2019","journal-title":"Acta Chir. Belg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/559\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:09:57Z","timestamp":1760105397000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,6]]},"references-count":99,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["diagnostics14050559"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14050559","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,6]]}}}