I had had three very easy pregnancies, but this one was hard. I figured this was payback. I started bleeding a bit more, and things became a little more painful as the pregnancy progressed. I also started to get diarrhea. That worried me because it can lead to dehydration, which in turn can spark early labor. So I went back to my primary care doctor. He thought my symptoms were still probably within the normal spectrum of pregnancy, but I told him they weren't.
He sent me to a GI specialist right away, who was also concerned about the risk of dehydration. The specialist thought I could have ulcerative colitis and wanted to start me on treatment with steroids, but then decided to do a scan first to verify the diagnosis. Two days later, I was at Advocate Christ Medical Center for the test, which was like a truncated version of a colonoscopy. You could tell right away; the tumor was right there.
I then had a full colonoscopy, and I was diagnosed with stage 2 colorectal cancer. Because I thought it was just ulcerative colitis, I had gone to the scan by myself. My husband was at home with our three kids. Here I was at the hospital by myself being diagnosed with cancer. I was in disbelief. I remember thinking, Are you freaking kidding me? Overall, I felt healthy.
Six weeks after giving birth, I returned to spin class and started jogging again. In December , my kids and I flew from our home in Florida to visit my family in Louisiana for the holidays. By the time our plane landed, my hemorrhoids were flaring up, or so I thought.
None of the traditional remedies helped. By Dec. Sixteen hours later, the doctor held my hand and told me I had stage IIIc rectal cancer. It had spread to my uterus, cervix and vagina. I cried. I asked if I would die. The doctor said no. Treating advanced rectal cancer like mine would be complicated, the doctor who performed my colonoscopy warned. It would require specialists in gastroenterology and gynecology. He urged me to go to MD Anderson.
Days later, I arrived in Houston for a consultation with gastrointestinal medical oncologist Arvind Dasari, M. He prescribed four rounds of a combination chemotherapy regimen called FOLFOX, which includes the drugs folinic acid, fluorouracil and oxaliplatin. I soon would be having surgery, and the aim of the chemotherapy was to shrink the tumor to make it easier for the surgeon to get all the cancer out. Once the tumor had shrunk, Dr. Dasari referred me to colorectal surgeon Y.
Nancy You, M. The cancer came out of the blue. Tristram is much more philosophical: "Some people feel like they're in control when they grate lemon over everything they eat, whereas you're not in control of which chemotherapy drugs you're taking.
Anyway, most people don't get in touch with lifestyle advice or anything related to raw fruit. A lot of Tristram's friends have been really great, whether or not they know what to say. The people who have an optimistic story to tell are even better. I thought that would be great. You try so hard to remove your body hair, usually. Another girl emailed whose friend of a friend had exactly the same as me, and she was pregnant as well.
She had her whole colon removed, but she's fine now. Apart from how funny Tristram's comic is, it's hard to pinpoint what makes it so magnetic. Its mood is quite mercurial, but you can't follow it without questioning your own interest. If it were just voyeuristic, that would leave you feeling a bit of a scumbag.
But there is something in the way it's pitched, the deft gear changes, the honesty, that makes you feel, as a reader, like a companion on her journey, rather than a spectator. Tristram is quite droll about the demands of the narrative, and describes the distance it puts between her and the disease as a kind of relief. Writing the comic does feel like dwelling on it, but that's the one thing I don't mind dwelling on. I keep thinking, 'God, it would make a better ending if I died.
I discovered I had colon cancer while I was pregnant. At 31, Matilda Tristram was looking forward to having her first baby. Then she discovered she had cancer. Four case reports demonstrated adverse events within one week of endoscopy. These four cases were likely related in one, possibly related in one and unlikely related in two of the cases. The first case describes a patient who was diagnosed with ulcerative colitis upon sigmoidoscopy in the sixth week of pregnancy.
In the 28th week of pregnancy she exhibited signs of exacerbation and she underwent another sigmoidoscopy with biopsies. Following the second sigmoidoscopy, colonic perforation was suspected and an emergency caesarean section and exploratory laparotomy was performed.
No colonic perforation was seen intraoperatively [ 11 ]. A live, healthy baby of g was delivered. This adverse event was classified as likely to be related to the LGE. The second patient was 33 weeks pregnant with twins, when she underwent two subsequent colonoscopies for the treatment and decompression of acute colonic pseudo-obstruction.
She was already being treated with nifedipine upon presentation for inhibition of premature contractions, and nifedipine was stopped upon hospital admission. One day after the last colonoscopy at gestational week 34, she went into spontaneous labor and delivered healthy twins [ 85 ]. The third patient underwent sigmoidoscopy because of abdominal pain and distention in the 34th gestational week.
Upon endoscopy, the splenic flexure appeared necrotic and the patient immediately underwent laparotomy with an emergency caesarean section [ 74 ]. This adverse event is unlikely related to the LGE. The fourth patient was diagnosed with a malignancy of unknown origin, and in the metastatic workup a colonoscopy was performed in gestational week A poorly differentiated signet cell adenocarcinoma of the transverse colon was found, and after 4 days of dexamethasone administration for fetal lung maturation an elective caesarean section was performed [ 77 ].
This adverse event was unlikely related to the LGE. One case report and one case series did not report at what gestational week the LGE was performed and were therefore not categorized. One woman delivered a live baby of gram prematurely at A temporal relation was not found, and the authors do not link this adverse event to the sigmoidoscopy. In the case series, 2 out of 5 women underwent sigmoidoscopy, and one woman delivered a live baby prematurely.
It is not reported if this woman underwent LGE [ 89 ]. A sensitivity analysis was performed by elongating the time span for the temporal relation between adverse events and the LGE. Initially, all adverse events were temporally related to the LGE if they occurred within one week after the LGE, however this analysis will classify all adverse events within three weeks of the LGE as temporally related.
In the first trimester, this approach yielded no extra temporally related adverse events. In the second trimester, one additional temporally related adverse event was detected. In this case, the mother was diagnosed with advanced colorectal carcinoma during pregnancy and died together with the fetus two weeks after hospital admission around gestational week 23 [ 45 ].
This adverse event was unlikely to be related to the LGE. Finally, in the third trimester another seven temporally related adverse events were detected. Six premature deliveries were unlikely related to the LGE, as they were all elective caesarean sections [ 76 , 78 - 80 , 87 ] or induced labor [ 66 ].
The seventh patient suffered from ulcerative colitis and underwent LGE for assessment of disease activity in gestational week Endoscopy showed the colon to be severely inflamed and two weeks later the patient delivered a premature baby of grams [ 64 ]. This adverse event is classified as probably related to the LGE. The objective of this systematic review was to assess the risk of LGE in all trimesters of pregnancy.
Three retrospective cohort studies investigated the safety of LGE during pregnancy. Of these, two studies describe the same study population, and report no difference in birth outcomes and adverse events between the study and the control group. None of the reported fetal and maternal adverse events showed a temporal or an etiological relation with the LGE [ 8 , 10 ]. Although these studies report no adverse events related to LGE, it remains unclear in which trimester the LGE was performed.
The third study [ 3 ], on which the recent endoscopy guidelines [ 9 ] seem to be based, focuses exclusively on colonoscopies during pregnancy. The authors conclude that colonoscopies during pregnancy are probably safe to perform, but limit their conclusion to the second trimester because of insufficient data in the first and third trimester.
Prior to this study in , the authors identified 17 case reports on colonoscopy during pregnancy and add these data to their own conclusion that there is still insufficient evidence to claim safety of colonoscopy in each trimester [ 3 ]. In total six 6. Out of these 79 case reports 42 case reports described 51 colonoscopies in 49 patients during pregnancy, distributed equally across the trimesters 21, 16 and 14 colonoscopies in trimester 1, 2 and 3, respectively.
Three temporally and etiologically related adverse events occurred in these 49 patients 6. Although the evidence level of these case reports is low, these data suggest colonoscopy during pregnancy is probably safe to perform. This finding is in agreement with the primary conclusion of the included studies. However, the data from our included case reports in fact suggests colonoscopy to be of similar low risk in each trimester.
In addition, we identified 37 case reports, describing 49 sigmoidoscopies in 43 patients. In this subset of patients, also three temporally and etiologically related adverse events occurred in these 43 patients 7.
Furthermore, in our view, postponing LGE during pregnancy or even until after pregnancy might hamper the patient and the pregnancy more than the LGE itself. A diagnostic delay will inevitably induce an unwanted therapeutic delay, and therefore the risks of LGE during pregnancy must be weighed against the expected benefits.
Consequently, elective endoscopies e. Safety research during pregnancy is always a challenging field, as prospective studies are rarely, and experimental studies are almost never performed. Therefore, we rely on retrospective studies and case series to support our conclusions and guidelines.
Although the evidence in this systematic review is anecdotal and more controlled studies are needed, this review appears to be the most extensive overview of available studies on this subject. The major limitation of this exhaustive systematic review is the lacking of a solid control group for the summarized case reports. Furthermore, the majority of case reports describe severely ill patients in whom the true effect of LGE during pregnancy is hard to untangle.
In addition, none of the case reports primarily aimed to describe the effect of LGE during pregnancy, rendering these effects subject to our interpretation. Type of bowel preparation and sedation are not mentioned in the majority of included case reports, and their effects cannot be taken into consideration.
Also, mild and more subtle adverse events due to LGE could have been easily missed. We therefore focused on serious adverse events like spontaneous abortion, stillbirth and premature delivery. In conclusion, we underline that LGE should only be performed during pregnancy when strongly indicated and is probably of low risk. Postponing LGE during pregnancy to the second trimester or puerperium however, is unnecessary and in most cases unwanted because of the therapeutic delay which might hamper the pregnancy outcomes more than the LGE itself.
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