With almost 100,000 new cases estimated to occur in the United States in 2017 (with equal gender predilection), colon carcinoma is among the most commonly diagnosed malignant diseases in the Western World [1] [2]. The incidence rate seems to be highest among the elderly individuals (between 60-70 years of age), and several risk factors have been established, most important being physical inactivity, obesity and increased body weight, cigarette smoking, overt alcohol consumption and certain dietary habits, such as excessive intake of animal fats and reduced fiber in nutrition [3] [4] [5]. Countries belonging to the developed world (Canada, Denmark, Sweden, the United States, and several other) report the highest prevalence rates [3] [4] [5] The clinical presentation of colon carcinoma is usually nonspecific and up to several months may pass before the diagnosis is even suspected [6] [7]. One of the reasons is the insidious and nonspecific onset of gastrointestinal complaints such as abdominal pain, fatigue, weakness, and changes in bowel habits (both constipation and diarrhea) [4] [5] [8]. This is typical for right-sided colonic cancers, whereas left-sided carcinomas of the colon more frequently produce symptoms that are highly suggestive of a neoplastic process in the large intestine - rectal bleeding and anemia [4] [9]. In addition, cramping, anorexia, and abdominal discomfort may be reported [4] [8]. As anemia becomes more severe and clearly stems from iron depletion due to continuous bleeding, cardiac manifestations (angina pectoris and palpitations) can appear, in which case immediate suspicion toward colon carcinoma, especially in elderly men and women, should be mounted [4] [5].

• Fatigue

  The secondary outcomes will be: physical measurements, QoL, level of physical activity, executive functions, fatigue, body composition, blood test, energy expenditure. [clinicaltrials.gov]

  One of the reasons is the insidious and nonspecific onset of gastrointestinal complaints such as abdominal pain, fatigue, weakness, and changes in bowel habits (both constipation and diarrhea). [symptoma.com]

  As you’ve probably noticed, fatigue, chills and nausea can indicate the presence of numerous different conditions, including the flu. [marcianolegal.com]

  The symptoms of anemia include weakness, easy fatiguability, shortness of breath and palpitations. These symptoms are explained by the anatomy of ascending colon. [livestrong.com]

  Side effects include fatigue, nausea, increased risk of infection, anemia, and peripheral neuropathy (tingling or numbness of the fingers and toes). [emedicinehealth.com]

• Fever

  A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. [ncbi.nlm.nih.gov]

  Several days later, the patient developed fever and neck stiffness suspicious for bacterial meningitis. A lumbar puncture procedure was performed. [bmcneurol.biomedcentral.com]

  Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea. [mayoclinic.org]

  People with these malignancies may feel a mass in the right abdomen, have abdominal pain, fever, profuse sweating--especially at night--and anemia. The symptoms of anemia include weakness, easy fatiguability, shortness of breath and palpitations. [livestrong.com]

• Malaise

  The second is a case of a 79-year-old Caucasian woman, who presented with several weeks of malaise, nausea, and diarrhea leading to diagnosis of a stage IIB medullary colon carcinoma now receiving chemotherapy. [ncbi.nlm.nih.gov]

  Clinics - Change bowel habits including constipation and diarrhea - Melena - Abdominal pain - Anemia due to chronic low-grade bleeding - Weight loss - Fever - Malaise. [atlasgeneticsoncology.org]

• Short Stature

  He is the product of a consanguineous marriage and suffered from intrauterine growth retardation and failure to thrive with persistent short stature and microcephaly. [hindawi.com]

• Pleural Effusion

  If lung metastases are present there may be pleural effusions causing breathlessness. Effusions may require drainage. Colon Cancer (Adenocarcinoma of the Colon) References Braunwald E, Fauci AS, Kasper DL, et al. [healthengine.com.au]

  effusions and 1 patient had consolidation). [ncbi.nlm.nih.gov]

• Constipation

  People may experience some chronic pain and anemia along with intermittent constipation. [livestrong.com]

  The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome. [ncbi.nlm.nih.gov]

  Diets that are low in fiber, like those in the developed world, often lead to constipation. Constipation in turn leads to increased pressure in the intestines, along with straining during bowel movements. [marcianolegal.com]

  Constipation : When bowel movements are infrequent or difficult. [m.webmd.com]

  When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. [asge.org]

• Diarrhea

  Diarrhea : Stools that are frequent, loose, or watery are commonly called diarrhea. Most diarrhea is due to self-limited, mild infections of the colon or small intestine. [m.webmd.com]

  The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome. [ncbi.nlm.nih.gov]

  Diverticulitis may also cause constipation or diarrhea fevers and chills nausea or vomiting What causes diverticulosis and diverticulitis? Experts are not sure what causes diverticulosis and diverticulitis. [niddk.nih.gov]

  Chemotherapy can cause anemia, weakness, tiredness, hair loss, nausea and vomiting, diarrhea, nerve damage and pain, and mouth sores. Radiation therapy also has side effects. [getpalliativecare.org]

• Abdominal Pain

  The clinical presentation, comprised of abdominal pain, nausea, vomiting, anemia and weight loss is frequently insidious, thus the diagnosis is delayed in the majority of patients. [symptoma.com]

  On the 7th day after admission, her temperature was 38.8°C, she had increased white blood cell count (24 610 cells/mm(3)), and suffered persistent severe abdominal pain. [ncbi.nlm.nih.gov]

  In this case, an 11-year-old girl presented to our institution with abdominal pain, melena, abdominal swelling, and iron deficiency anemia. [mdedge.com]

• Rectal Bleeding

  A 69-year-old man presented with rectal bleeding. Colonoscopy revealed a rectal tumor, whereas biopsy specimens revealed a poorly differentiated carcinoma. During the preoperative evaluation, pancytopenia was detected. [ncbi.nlm.nih.gov]

  One of these complications is rectal bleeding, also called diverticular bleeding. Diverticular bleeding occurs when there is chronic (long-term) injury to the small blood vessels near the diverticula. The other complication is diverticulitis. [my.clevelandclinic.org]

  This is typical for right-sided colonic cancers, whereas left-sided carcinomas of the colon more frequently produce symptoms that are highly suggestive of a neoplastic process in the large intestine - rectal bleeding and anemia. [symptoma.com]

• Nausea

  The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome. [ncbi.nlm.nih.gov]

  Nausea and/or Vomiting: When nausea and vomiting are symptoms of colon cancer, it's usually because a tumor is causing a bowel obstruction, usually in the proximal colon (meaning the end closer to the small intestines). [coloncancer.about.com]

  The clinical presentation, comprised of abdominal pain, nausea, vomiting, anemia and weight loss is frequently insidious, thus the diagnosis is delayed in the majority of patients. [symptoma.com]

  As you’ve probably noticed, fatigue, chills and nausea can indicate the presence of numerous different conditions, including the flu. [marcianolegal.com]

• Bone Pain

  Bone pain: Fractures, bone pain, and high calcium levels (seen on a blood test) may occur if cancer spreads to the bones. Complications There are a few complications that may arise as a result of colon cancer. [coloncancer.about.com]

  MANAGEMENT SECTION (Mon - Fri, 8 AM - 4 PM) Non Cancer Pain Low Back Pain Migraine Dysmenorrhea / menstrual pain Bone pain Nerve Pain Diabetic neuropathic pain Trigeminal neuralgia Post Herpetic Neuralgia INDUSTRIAL CLINIC Medical Consultations Pre-employment [mcuhospital.org]

  […] up blood) Bone pain Confusion or memory problems that get worse Who to see If you have been treated for colorectal cancer, doctors who can evaluate any new symptoms include: Gastroenterologists. [northshore.org]

  If the patient has neurological symptoms, a CAT scan of the brain will be performed, and if the patient is experiencing bone pain, a bone scan also will be performed. [medical-dictionary.thefreedictionary.com]

• Renal Insufficiency

  […] imaging is the most appropriate initial imaging modality in the assessment of suspected diverticulitis, while Ultrasound and magnetic resonance imaging can be useful alternatives in patients who have relative contraindications to CT scan (pregnancy, renal [clevelandclinicmeded.com]

  Given that most patients with lower gastrointestinal hemorrhage are older than 60 years of age, medical comorbidities, including vascular disease and renal insufficiency, may place these patients at high risk for the procedure. [ncbi.nlm.nih.gov]

• Dizziness

  Anemia is diagnosed with a blood test, called a complete blood count (CBC), and may cause symptoms of unusual tiredness, dizziness, palpitations, and shortness of breath. [coloncancer.about.com]

  In a rare individual with brisk and severe bleeding, the blood pressure may drop, causing dizziness, shock, and loss of consciousness. In most patients, bleeding stops spontaneously and they are sent home after several days in the hospital. [medicinenet.com]

  The major symptom of rectal cancer is bleeding from the rectum; other symptoms include anemia, fatigue, shortness of breath, dizziness and/or a fast heartbeat, bowel obstruction, small diameter stools, and weight loss. [emedicinehealth.com]

Early recognition of colon carcinoma is favored, especially if we know that 5-year survival rates range between 40%-60%, depending on the stage [1] [6] [7] [8]. In fact, the degree of tumor invasion and infiltration of adjacent lymph nodes or distant organs are the two predictors of mortality in this patient population, suggesting that advanced stages of the disease carry a poorer prognosis undoubtedly [4]. In all patients with non-specific gastrointestinal (GI) complaints, a thoroughly obtained patient history and a meticulous physical examination can provide sufficient clues to investigate colon carcinoma as a potential cause, especially among the elderly. A complete blood count (CBC) and basic biochemical workup will often identify sideropenic anemia, in which case a fecal occult blood test must be performed. If the test is positive, imaging studies should be employed. Several studies have been listed in the literature as possible modalities for visualization of the tumor, including barium enema and computed tomographic colonography (CTC), but optical colonoscopy (OC) remains the cornerstone in diagnosing colon carcinoma [1] [10]. Moreover, fluorodeoxyglucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), ultrasonography, computed tomography (CT) as well as contrast-enhanced MRI have also been mentioned as valuable procedures in determining the stage of the tumor [1] [4]. A definite diagnosis, however, is made after a biopsy sample is obtained during colonoscopy for microscopic evaluation, and the tumor is classified according to the degree of local (but also distant) tissue invasion by the TNM classification [4] [5]:

• Stage I - Tumor invasion of the mucosa or submucosa (T1 and T2, respectively), without nodal (N0) or metastatic spread (M0).
• Stage II - Proliferation either into the muscularis propria (T3) or the adjacent organs and the peritoneum (T4) with N0 and M0 (also known as stages IIA and IIB).
• Stage III - In the setting of tumor infiltration into 1-3 lymph nodes (N1) and the mucosa/submucosa (T1/T2), the tumor is classified as stage IIIA. In the setting of deeper local invasion (T3/T4), the stage IIIB is reached, and if four or more lymph nodes are infiltrated by the tumor (N2), regardless of the local tissue invasion, colon carcinoma has reached stage IIIC.
• Stage IV - The presence of distant metastases denotes the most advanced stage of the tumor, carrying a very poor prognosis.

• Pleural Effusion

  If lung metastases are present there may be pleural effusions causing breathlessness. Effusions may require drainage. Colon Cancer (Adenocarcinoma of the Colon) References Braunwald E, Fauci AS, Kasper DL, et al. [healthengine.com.au]

  effusions and 1 patient had consolidation). [ncbi.nlm.nih.gov]

Novel treatment strategies such as immunotherapy are being evaluated to further improve the outcomes of colorectal cancer patients. [ncbi.nlm.nih.gov]

Treatment Surgical removal of the tumor is the only radical treatment. This is followed by 6 months of adjuvant chemotherapy for patients with CRC stage III and high-risk stage II. [www2.keelpno.gr]

Even though most of the patients underwent aggressive treatment, the overall prognosis was poor. [ncbi.nlm.nih.gov]

Stage IV - The presence of distant metastases denotes the most advanced stage of the tumor, carrying a very poor prognosis. [symptoma.com]

Metastases from the urinary tract are CK7+/CK20+/ Prognosis Too few cases have been reported to assess prognosis. References 1 Sakamoto K, Watanabe M, De La Cruz C, et al. Primary invasive micropapillary carcinoma of the colon. [e-immunohistochemistry.info]

The etiology is usually considered as traumatic. Carcinoma of the splenic angle is consistently one of the rarest of colon carcinomata, that of the descending colon alone being more rare. [pubs.rsna.org]

This prompted us to report these two cases and review the possibility of an etiological relationship between the two pathological conditions. [saudijgastro.com]

The etiology of colonic diverticulosis is multifactorial and not entirely known. [merckmanuals.com]

Abstract Epidemiology and evidence have demonstrated that colon carcinoma is one of the most common gastrointestinal tumors in the clinic. [ncbi.nlm.nih.gov]

Sciences Research Biennial Book Clinical Trials About Clinical Trials ECRU About Clinical Trials & Epidemiological Sciences Clinical Trials Office Biostatistics and Epidemiology Unit SingHealth Research Education & Training Back to Home Overview Professional [nccs.com.sg]

Information about the Study Design: International epidemiological observational non-interventional study Study population: Patients with pancreas or colorectal carcinoma undergoing surgery Number of patients: 100 participants First patient in: April 2019 [centogene.com]

Found ( 762 ) clinical trials Phase Phase Biofilm Epidemiology and Mechanisms in Colon Cancer This research is being done to learn more about why people get colon cancer. [centerwatch.com]

The aim of this review is to examine the epidemiology of colonic diverticulosis and the incidence of complications, namely acute diverticulitis and diverticular hemorrhage. [karger.com]

CONCLUSION: Strong differential expression of DCC in OA compared with normal chondrocytes hints of a possible role of DCC in the pathophysiology of OA. [mendeley.com]

Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al. [mayoclinic.org]

Although constipation, fecal incontinence and several other associated benign conditions increase in frequency with aging, a paucity of information exists regarding the normal aging effect on gastrointestinal pathophysiology Tumor is an abnormal growth [colorectal-cancer.imedpub.com]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website. [medlineplus.gov]

[…] ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing [ncbi.nlm.nih.gov]

[…] and early detection of cervical cancer: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. [nccn.org]

CAN RECTAL CANCER BE PREVENTED? Rectal cancer is preventable. Nearly all rectal cancer develops from rectal polyps, which are benign growths on the rectal wall. [fascrs.org]

Colorectal Cancer Preventable. Treatable. Beatable. Each year nearly 137,000 people are diagnosed with colorectal cancer, often referred to as colon cancer, in the U.S. and over 50,000 people die from it annually. [asge.org]

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9. Fletcher RH. The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack. BMC Medicine. 2009;7:18.
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