Colon Cancer Clinical Presentation: History, Physical Examination (original) (raw)

History

Because of increased emphasis on screening practices, colon cancer is now often detected before it starts to cause symptoms. In more advanced cases, common clinical presentations include iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits, and intestinal obstruction or perforation. Right-sided lesions are associated with younger age, and common presenting signs include bleeding and/or diarrhea. Left-sided tumors are associated with older age, and patients commonly present with bowel obstruction.

In patients younger than 50 years old—an age group that is experiencing rising rates of colorectal cancer (see Overview/Epidemiology)—a study that used data from England's Clinical Practice Research Datalink found that abdominal pain was the most common presenting symptom of colorectal cancer. Compared with other age groups, these younger patients had the lowest percentage of typical ‘red-flag’ signs and symptoms (ie, rectal bleeding, anemia, change in bowel habits, diarrhea, abdominal mass). Instead, these patients were more likely to have presented to their primary care provider, in the year before diagnosis, with nonspecific symptoms. [45]

Similarly, a matched case-control study of 5075 incident colorectal cancers in patients younger than 50 years identified abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia within three months to two years before diagnosis as red-flag clinical manifestations in this age group. The presence of any one of those clinical manifestations was associated with 1.94-fold higher risk; any two, with 3.59-fold higher risk, and three or more, with 6.52-fold higher risk, with stronger associations for younger ages. [46]

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Physical Examination

Physical examination findings can be very nonspecific (eg, fatigue, weight loss) or normal early in the course of colon cancer. In more advanced cases, any of the following may be present:

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Author

Coauthor(s)

Vassiliki Liana Tsikitis, MD, MBA, MCR, FACS, FASCRS Professor of Surgery, Head, Division of Gastrointestinal and General Surgery, Vice Chair, Diversity Equity and Inclusion, Department of Surgery, Oregon Health and Science University School of Medicine

Vassiliki Liana Tsikitis, MD, MBA, MCR, FACS, FASCRS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Colon and Rectal Surgeons, Association of Women Surgeons, European Society of Coloproctology, International Society of Surgery, Mayo Clinic Alumni Association, Pacific Coast Surgical Association, Society for Surgery of the Alimentary Tract, Society of University Surgeons, The Priestley Society, Western Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, The Scientific Research Honor Society, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Additional Contributors