Rectal carcinoma presenting during pregnancy is rare with a reported i
ncidence of 0.002%. Management of such an emotionally charged conditio
n can be difficult, especially when the twin goals of curing the disea
se and preserving the pregnancy are divergent. Four cases of rectal ca
rcinoma presenting during pregnancy are reported. In the first or seco
nd trimester of pregnancy, it is possible to resect the tumour with pr
eservation of pregnancy, and in the third trimester, it is best to bri
ng the pregnancy to term before removing the tumour. Unfortunately, th
e prognosis for such rectal cancer is poor.