Colorectal cancer patient undergoes rare, complex surgery while pregnant

By the time Hannah Perry found out she was pregnant, she had been experiencing troubling digestive and bowel symptoms for several months. As the symptoms continued and even worsened, Perry knew something wasn’t right.

But as the weeks went by, Perry’s doctors (at a health system other than MultiCare) were reluctant to perform a colonoscopy, an exam used to detect abnormalities and disease in the colon and rectum. Because Perry was 38, younger than the age patients typically begin colonoscopy screenings, her doctors wanted her to first try dietary changes to rule out conditions like colitis, more commonly seen in younger patients.

But that approach wasn’t sitting right with Perry.

“I thought I needed a colonoscopy, and I didn’t want to wait longer for my pregnancy to progress even further,” she says. “I had already started thinking I might have a tumor, since it felt like a blockage.”

Luckily for Perry, she’s a fighter. After a lot of negotiation, she was able to get approved for a sigmoidoscopy, which is similar to a colonoscopy but examines only the lower part of the colon.

When that test revealed the presence of cancerous cells, Perry was referred to MultiCare for treatment. Doctors there performed another, more comprehensive colonoscopy, during which they in fact found a large tumor that tested positive for cancer.

By that point, Perry was 18 weeks pregnant.

After Perry’s diagnosis of colorectal cancer, she was referred to Laila Rashidi, MD, a colorectal surgeon with MultiCare Colon and Rectal Surgery – Tacoma.

“Dr. Rashidi is wonderful,” Perry says. “When I met her for the first time, she pulled up her chair and met me eye to eye, with her hands on my knees. She looked at me and talked to me as a human being instead of just a doctor,”

Dr. Rashidi explained that Perry would need surgery to remove the tumor. Because the tumor was in Perry’s sigmoid (lower) colon, it was sitting directly under the baby, a rare circumstance. Complicating things further, it was impossible to know how advanced Perry’s cancer was without doing a CT scan, which is too risky to perform on pregnant patients.

Perry felt uneasy about subjecting her baby to the surgery, which would take five to six hours and was an unprecedented procedure due to the location of the tumor.

“It was just scary,” Perry says. “At first I didn’t think I could go through with it until after the baby was born. But my husband was the voice of reason. He took my hand and said, ‘What if the cancer is advanced and you wait so long that it’s too late for chemotherapy? Who do you want telling this story to our son: me or you?’ I knew I wanted to make it through this so that I could tell my son myself. So, I called the office the next day to schedule the surgery.”

A pioneering surgery

These days, Dr. Rashidi is able to perform most of her colorectal surgeries robotically, a minimally invasive robotic technique that requires only a few small incisions instead of a large cut across the abdomen.

Because Perry’s stomach was still growing with her pregnancy, Dr. Rashidi knew that from a healing standpoint, minimally invasive surgery would be much better for her, and for the baby. But the way the tumor was situated, just above the baby, meant that removing the tumor without inadvertently puncturing the uterus would be challenging.

Treating colorectal cancer in pregnant women is not a common occurrence for surgeons. By now, Perry was 22 weeks pregnant and Dr. Rashidi could find nothing in published medical literature documenting minimally invasive surgery for colorectal cancer on a pregnant patient with a tumor located where Perry’s was.

The main problem was that for Dr. Rashidi to access the tumor, she would need to push the uterus out of the way — and surgical tools are either too hot or sharp to safely do so. Finally, she and her surgical assistant, Callan Kosnik, PA, settled on a pioneering approach: using a hand instead of a surgical tool.

“We decided that the best approach would be make a small incision for Callan to use her hand to hold the uterus up and away, because there’s sensation and she would know much pressure to use,” says Dr. Rashidi. “But I needed to have robotic instruments — needles and very hot objects — close to her hand for about 45 minutes. So, I had to be really cautious not to hurt her, and she really had to trust me. It was truly a team effort how we did it.”

A successful outcome

Perry’s surgery was a success. Dr. Rashidi removed the tumor with clean margins, along with a number of lymph nodes to test for cancer. The baby stayed safe, and Perry was discharged from the hospital after less than two days.

However, because cancer was found in seven of Perry’s lymph nodes, she needed to undergo chemotherapy. So she delivered her baby at 34 weeks, a few weeks earlier than normal, in order to be able to receive timely treatment.

When Perry’s baby boy, Wyatt, was born in May 2019, he was healthy but weighed only four pounds. He stayed in the Neonatal Intensive Care Unit (NICU) at MultiCare Tacoma General Hospital for 38 days before Perry and her husband could finally take him home. Perry began chemotherapy while Wyatt was still in the NICU, and finished her treatment in December of that year.

Today, Perry’s scans show that she is cancer-free. She has enough energy to chase around Wyatt, who is now a toddler.

“The name Wyatt means ‘brave in war,’” Perry says. “I didn’t know that until we brought him home, but it’s fitting because he did go through a battle. We both did, but we’ve come through it and we’re good now.”

She adds, “Because of our faith in Jesus Christ we were able to trust that everything would work out as God intended for us. We use this experience as a positive, to strengthen our faith and trust God in all things.”

Colorectal cancer increasing in young adults

Colorectal cancer is on the rise in young adults and is now a leading cause of cancer death among people under 50 in the United States, with rates of new diagnoses still climbing in this age group. This alarming rise of colorectal cancer in young adults prompted the American Cancer Society to change their recommendation for colorectal cancer screening to start at age 45 instead of 50 for individuals at average risk.

“I am seeing young patients diagnosed with late-stage colorectal cancer who have none of the typical risk factors,” says Dr. Rashidi. “We are seeing more and more patients under 50 with colorectal cancer.”

Don’t delay care

Early detection through regular screening is one of the best ways to prevent colorectal cancer. Unfortunately, the pandemic has caused many people to delay or completely skip essential health care screenings. According to a recent article published by Advisory Board, health care systems are preparing for a wave of advanced cancer diagnoses due to the impact of the pandemic on screening and diagnostic testing.

If you are 45 or older, talk to your primary care provider about which screening test is best for you. Depending on your situation they may recommend a stool test, colonoscopy or other screening option. A referral is typically needed to schedule a colonoscopy and other colorectal cancer screening tests, and procedures are usually covered by most insurance carriers. Contact your insurer to find out what is covered under your plan.

In addition, reach out to your doctor if you experience symptoms such as a persistent change in bowel habits, rectal bleeding, ongoing abdominal discomfort or a feeling that your bowel doesn’t empty completely.

Learn more about colorectal cancer symptoms, screening and prevention, or find a MultiCare primary care provider near you.