Introduction: Colorectal cancer in pregnancy is associated with diagnostic and therapeutic challenges which mostly lead to late diagnosis in advanced stages and poor prognosis. Objectives: To study the various presentations and the clinical outcome of pregnant women with rectal cancer and to sensitize the concerned doctors about this rare possibility in pregnancy. Methedology: A retrospective analysis of 4 cases of rectal cancer in pregnancy during a 7 year period (March 2006 – March 2013) was done. These cases were managed with a multidisciplinary approach at S. S. Institute of Medical Sciences and Research Centre, Davangere. Result: Mean age at presentation was 29 years, bleeding per rectum was their common symptom, two of them being below 20 weeks of gestation. Flexible sigmoidoscopy showed the lesion details and aided biopsy for confirmation. Abdominopelvic ultrasonography helped to detect peritoneal metastasis, serum CEA levels were in the range of 40- 60 ng/dl. Two of them were in stage III, one in stage II and another in stage IV. Only one patient had an emergency caesarean at 32 weeks, while the remaining had medical termination of pregnancy. Surgery in the form of anterior resection with end to end anastomosis followed by chemotherapy was the standard mode of management in three patients while, one patient needed additional radiotherapy for distant metastasis. One patient with stage IV disease had a Transverse loop diversion colostomy with palliative chemotherapy and palliative pain relief. One patient died within 6 months of diagnosis due to advanced disease, others still on follow up. Conclusion: Colorectal cancer in pregnancy is rare, often presents in an advanced stage, a multidisciplinary approach with recommended guidelines will optimize the outcome in pregnancy. More randomized trials are required to standardize management protocols. 

Keywords: Colorectal carcinoma in pregnancy; CEA in pregnancy.