Difficult Decisions in Colorectal Cancer in Emergency Settings

Critically ill patients and pregnant patients with colorectal cancer represent a group where management decisions are difficult. Critically ill patients with colorectal cancer have been described to be admitted electively after surgery or urgently, with elective admission associated with improved outcomes. Patients with a considerable lifespan should be admitted without limitations as prognosis has been improving, but intensive care admission may be considered for a period (ICU trial) for patients with more stringent criteria. End-of-life discussions should take place as they are an important part of care. Colorectal cancer diagnosed during pregnancy is generally associated with advanced disease and carries a poor prognosis. There is no consensual management algorithm and decisions made in this context should be multidisciplinary. Communication between surgeon and patient is a cornerstone of treatment in these complex scenarios. A framework for this discussion is presented in the end of this chapter.