Colorectal cancer: Difference between revisions
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==Background== | ==Background== | ||
[[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]] | [[File:Diameters of the large intestine.png|thumb|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]] | ||
[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | [[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]] | ||
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[[File:Colon cancer 2.jpg|thumb|Colorectal cancer on gross pathology.]] | [[File:Colon cancer 2.jpg|thumb|Colorectal cancer on gross pathology.]] | ||
*Colorectal cancer is extremely common | *Colorectal cancer is extremely common | ||
==Clinical Features== | ==Clinical Features== | ||
*Asymptomatic, frequently grow slowly for long period of time before symptomatic | *Asymptomatic, frequently grow slowly for long period of time before symptomatic | ||
*[[Lower GI bleeding]] (occult or visible BRBPR/hematochezia | *[[Special:MyLanguage/Lower GI bleeding|Lower GI bleeding]] (occult or visible BRBPR/hematochezia | ||
*[[Fatigue]], generalized [[weakness]] due to anemia | *[[Special:MyLanguage/Fatigue|Fatigue]], generalized [[Special:MyLanguage/weakness|weakness]] due to anemia | ||
*Change in bowel habits, [[constipation]], tenesmus in rectal cancer | *Change in bowel habits, [[Special:MyLanguage/constipation|constipation]], tenesmus in rectal cancer | ||
*[[bowel obstruction|Obstruction]] if mass large enough (left colon > right) | *[[Special:MyLanguage/bowel obstruction|Obstruction]] if mass large enough (left colon > right) | ||
**[[Abdominal pain]] | **[[Special:MyLanguage/Abdominal pain|Abdominal pain]] | ||
***Focal pain or [[Peritonitis]] if perforation | ***Focal pain or [[Special:MyLanguage/Peritonitis|Peritonitis]] if perforation | ||
*Signs/symptoms of metastatic disease (e.g. [[hepatomegaly]], [[ascites]], [[lymphadenopathy]]) may be initial presentation | *Signs/symptoms of metastatic disease (e.g. [[Special:MyLanguage/hepatomegaly|hepatomegaly]], [[Special:MyLanguage/ascites|ascites]], [[Special:MyLanguage/lymphadenopathy|lymphadenopathy]]) may be initial presentation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Lower GI bleeding DDX}} | {{Lower GI bleeding DDX}} | ||
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{{LLQ DDX}} | {{LLQ DDX}} | ||
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{{Anorectal DDX}} | {{Anorectal DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*CBC, [[LFTs]], coags if bleeding or signs of hepatic involvement | |||
*CBC, [[Special:MyLanguage/LFTs|LFTs]], coags if bleeding or signs of hepatic involvement | |||
*CT abdomen- not definitive but may catch large mass or other alternative diagnoses | *CT abdomen- not definitive but may catch large mass or other alternative diagnoses | ||
*Definitive diagnosis not likely to be made in ED, but suggestion of malignancy may be made on imaging if large mass seen | *Definitive diagnosis not likely to be made in ED, but suggestion of malignancy may be made on imaging if large mass seen | ||
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**Serum CEA | **Serum CEA | ||
**Surgical pathology | **Surgical pathology | ||
==Management== | ==Management== | ||
*Transfuse [[pRBCs]] prn for anemia | |||
*Transfuse [[Special:MyLanguage/pRBCs|pRBCs]] prn for anemia | |||
*Consult surgery for obstruction or perforation | *Consult surgery for obstruction or perforation | ||
**May also help coordinate outpatient diagnostic workup | **May also help coordinate outpatient diagnostic workup | ||
==Disposition== | ==Disposition== | ||
*Discharge if clinically stable | *Discharge if clinically stable | ||
==See Also== | ==See Also== | ||
*[[Anorectal disorders]] | |||
*[[Special:MyLanguage/Anorectal disorders|Anorectal disorders]] | |||
==External Links== | ==External Links== | ||
*https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/colorectal-cancer | *https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/colorectal-cancer | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] [[Category:Heme/Onc]] | [[Category:GI]] [[Category:Heme/Onc]] | ||
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Latest revision as of 21:56, 4 January 2026
Background
Average inner diameters and ranges of different sections of the large intestine.[1]
- Colorectal cancer is extremely common
Clinical Features
- Asymptomatic, frequently grow slowly for long period of time before symptomatic
- Lower GI bleeding (occult or visible BRBPR/hematochezia
- Fatigue, generalized weakness due to anemia
- Change in bowel habits, constipation, tenesmus in rectal cancer
- Obstruction if mass large enough (left colon > right)
- Abdominal pain
- Focal pain or Peritonitis if perforation
- Abdominal pain
- Signs/symptoms of metastatic disease (e.g. hepatomegaly, ascites, lymphadenopathy) may be initial presentation
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- CBC, LFTs, coags if bleeding or signs of hepatic involvement
- CT abdomen- not definitive but may catch large mass or other alternative diagnoses
- Definitive diagnosis not likely to be made in ED, but suggestion of malignancy may be made on imaging if large mass seen
- Colonoscopy with biopsy
- Serum CEA
- Surgical pathology
Management
- Transfuse pRBCs prn for anemia
- Consult surgery for obstruction or perforation
- May also help coordinate outpatient diagnostic workup
Disposition
- Discharge if clinically stable
See Also
External Links
References
- ↑ Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.