The clinical features of colorectal carcinoma manifest due to the tumor itself or due to a local and metastatic spread of the tumor. However, it must be remembered that a certain proportion of patients are asymptomatic and are only detected incidentally or during screening. The common clinical manifestations arising from the tumor are rectal bleeding, change in bowel habits, rectal/ abdominal mass, anemia, weight loss, abdominal pain, pelvic pain, and urinary symptoms [1] [2] [3].

Rectal bleeding is a common manifestation. This presents as either drops of fresh blood or as blood streaked on the stools [4]. Dark-colored blood, in general, is more likely to be associated with colorectal cancer than bright red-colored blood [5]. Sometimes, bleeding can occur in an occult fashion without the patient having taken any notice. However, long-term blood loss, even in minute quantities, leads to symptoms of anemia [6].

Change in bowel habits is yet another common symptom. This presents as diarrhea, constipation, a sensation of incomplete evacuation, and tenesmus.

Other symptoms due to a local and metastatic spread of colorectal carcinoma are the pelvic pain, back pain, urinary symptoms, and yellowish discoloration of the sclera.

Related signs that may be identified on general physical examination are cachexia, paleness, and jaundice. Abdominal examination may help in the detection of ascites and hepatomegaly.

Digital rectal examination is the most specific test in physical examination and it may reveal the size of the tumor and features such as ulceration and local spread. It may also reveal a change in anal sphincter tone, which will indicate whether the tumor has spread locally to involve the nerves. Proctoscopy will help to further visualize the tumor.

• Weight Loss

  loss and abdominal pain ≥50yrs with unexplained rectal bleeding ≥60yrs with iron‑deficiency anaemia or change in bowel habit Positive occult blood screening test *As opposed to upper GI malignancies, progressive weight loss is usually only present in [teachmesurgery.com]

  A 16-year-old girl presented to our unit with crampy abdominal pain, change in bowel habit, a subjective impression of weight loss and a single episode of haematochezia. [ncbi.nlm.nih.gov]

  The common clinical manifestations arising from the tumor are rectal bleeding, change in bowel habits, rectal/ abdominal mass, anemia, weight loss, abdominal pain, pelvic pain, and urinary symptoms. Rectal bleeding is a common manifestation. [symptoma.com]

  loss with no known reason Fatigue Nausea or vomiting Because you may not have symptoms at first, it's important to have screening tests. [medlineplus.gov]

• Fatigue

  Four months later the patient was admitted to the gastroenterology department for further examination because of chronic fatigue, subfebrile temperature and a positive fecal occult blood test. [ncbi.nlm.nih.gov]

  Common in Colorectal Cancer survivors Consider evaluating for alternative Fatigue cause (e.g Anemia, Hypothyroidism ) VIII. [fpnotebook.com]

  Diarrhea or constipation A feeling that your bowel does not empty completely Blood (either bright red or very dark) in your stool Stools that are narrower than usual Frequent gas pains or cramps, or feeling full or bloated Weight loss with no known reason Fatigue [medlineplus.gov]

  […] completely Bright red or very dark blood in the stool Stools that look narrower or thinner than normal Discomfort in the abdomen, including frequent gas pains, bloating, fullness, and cramps Weight loss with no known explanation Constant tiredness or fatigue [cancer.net]

• Familial Adenomatous Polyposis

  […] member known to have familial adenomatous polyposis. [nccs.com.sg]

  FAP – Familial Adenomatous Polyposis Familial adenomatous polyposis (FAP) is a genetic disorder that causes hundreds to thousands of polyps to line the colon. [colonclub.com]

  Figure 13 A case of familial adenomatous polyposis. [jgo.amegroups.com]

  Familial adenomatous polyposis Familial adenomatous polyposis is an autosomal dominant disorder characterised by the formation of multiple colorectal adenomas. [surgwiki.com]

  A case of familial adenomatous polyposis. [ncbi.nlm.nih.gov]

• Pathologist

  There was an acceptable level of agreement (κ = 0.64) between the pathologists for both the markers in case of colorectal adenocarcinoma metastasis. [ncbi.nlm.nih.gov]

  To find out the grade of colorectal cancer, a pathologist looks at a tissue sample from the tumour under a microscope. [cancer.ca]

• Weakness

  RESULTS: Our results confirm that the nuclear VDR expression is strongest in normal colorectal mucosa and in hyper plastic polyps, is gradually weakened in low and high grade adenoma while it is extremely weak or absent in colorectal carcinoma. [ncbi.nlm.nih.gov]

  Shared Symptoms and Diagnosis Both colon and rectal cancer are likely to cause many of the same symptoms, including: Stomach or gas pains Constipation or diarrhea Black, dark, or red colored stools, which can all indicate blood Feeling weak or tired Doctors [webmd.com]

  As a person loses blood over time, they will develop anemia, or lowered red blood cell count, causing them to feel tired and weak. Unexplained weight loss is another sign that a cancer may be present, but this is by no means exclusive to CRC. [pharma.bayer.com]

  However, as the disease progresses, patients are bound to experience one or more of the following: Bloody stool Abdominal pains General weakness Fatigue Weight loss with no apparent cause Constipation Episodes of diarrhea It’s important to understand [docdoc.com.sg]

  “go” to save your life) that lasts for more than a few days Unintended or unexplained weight loss (or weight gain) Vomiting Narrow stools – poo looks pencil-thin Change in stools – poo just looks different, smells different Gas, bloating and cramps Weakness [colonclub.com]

• Aspiration

  We present 2 cases of colorectal adenocarcinoma metastatic to the thyroid gland, diagnosed by fine-needle aspiration (FNA). [ncbi.nlm.nih.gov]

  Alternatively, a fine needle aspiration biopsy may be performed in which fluid or a minute amount of tissue is removed from the potentially cancerous tissue. [cureus.com]

  Treat any underlying cause (eg, antibiotics if meningitis is suspected, surgery to remove subdural haematoma, anticonvulsants, etc).[13] Raised intracranial pressure may require mannitol infusion.[14] If there is a risk that the patient may have aspirated [patient.info]

  It entails endometrial aspiration biopsy and transvaginal ovarian ultrasound, respectively, and CA125 blood testing. Screening for ovarian cancer is particularly limited. [surgwiki.com]

• Diarrhea

  Radiation Proctitis ( Diarrhea, bleeding) Endoscopic argon plasma coagulation Sucralfate enemas Hanson (2012) Dis Colon Rectum 55(10): 1081-95 [PubMed] Abdominal Pain Acute pain (esp. [fpnotebook.com]

  This presents as diarrhea, constipation, a sensation of incomplete evacuation, and tenesmus. [symptoma.com]

  He experienced extreme bouts of constipation and diarrhea. There are some common signs and symptoms of colorectal cancer (CRC)… and some not so obvious when you are a young adult! [colonclub.com]

  Symptoms of colorectal cancer include Diarrhea or constipation A feeling that your bowel does not empty completely Blood (either bright red or very dark) in your stool Stools that are narrower than usual Frequent gas pains or cramps, or feeling full or [medlineplus.gov]

• Constipation

  Constipation is commonly prevalent in Kuwait more so in females than males [ 45 ]. Efforts to avoid the constipation may help minimize the CRC risk in this and other similar populations. [bmccancer.biomedcentral.com]

  This presents as diarrhea, constipation, a sensation of incomplete evacuation, and tenesmus. [symptoma.com]

  He experienced extreme bouts of constipation and diarrhea. There are some common signs and symptoms of colorectal cancer (CRC)… and some not so obvious when you are a young adult! [colonclub.com]

  Symptoms of colorectal cancer include Diarrhea or constipation A feeling that your bowel does not empty completely Blood (either bright red or very dark) in your stool Stools that are narrower than usual Frequent gas pains or cramps, or feeling full or [medlineplus.gov]

• Abdominal Pain

  A 36-year-old male presented with symptoms of persisting abdominal pain that had lasted for several months. Histology of the colonic biopsies showed active ulcerative pancolitis with extensive multifocal low- and high-grade dysplasia. [ncbi.nlm.nih.gov]

  Clinical Features The common clinical features of bowel cancer include change in bowel habit, rectal bleeding, weight loss*, abdominal pain, and iron-deficiency anaemia. [teachmesurgery.com]

  The common clinical manifestations arising from the tumor are rectal bleeding, change in bowel habits, rectal/ abdominal mass, anemia, weight loss, abdominal pain, pelvic pain, and urinary symptoms. Rectal bleeding is a common manifestation. [symptoma.com]

• Rectal Bleeding

  The common clinical manifestations arising from the tumor are rectal bleeding, change in bowel habits, rectal/ abdominal mass, anemia, weight loss, abdominal pain, pelvic pain, and urinary symptoms. Rectal bleeding is a common manifestation. [symptoma.com]

  Classically, clinical features vary slightly depending on the location of the cancer: Right-sided colon cancers – abdominal pain, occult bleeding / anaemia, mass in right iliac fossa, and often present late Left-sided colon cancers – rectal bleeding, [teachmesurgery.com]

  Only increased awareness of this malignancy in this age-group and a high index of suspicion can help when a child complains of persistent pain of abdomen, altered bowel habits or rectal bleeding, and may provide diagnosis at an earlier stage, thereby [ncbi.nlm.nih.gov]

  Clinical signs are often nonspecific and may include a change in bowel habits, rectal bleeding, and weight loss. Iron deficiency anemia in men > 50 years and postmenopausal women should be considered a warning sign for CRC. [amboss.com]

• Blood in Stool

  Blood can be rectal bleeding, dark stools or blood on the stool, although the stool will look normal. Passing a large amount of blood *** This is NOT to be taken as medical advice. [colonclub.com]

  stools Colicky abdominal pain due to obstruction Rectum (50%) and sigmoid (30%) Hematochezia ↓ Stool caliber (pencil-shaped stool) Rectal pain Tenesmus Flatulence with involuntary stool loss Symptoms according to stage of disease Colorectal cancer must [amboss.com]

  Blood in the stool, even blood that cannot be seen by the naked eye (occult blood—see Stool Occult Blood Tests), can be a sign of cancer. Usually, the stool is tested every year. [merckmanuals.com]

  […] test (gFOBT) stool test Test to detect hidden blood in stool sample Annually No bowel preparation No direct risk to bowel Sample can be collected at home Dietary restrictions before testing Cannot detect precancerous changes Detects any blood, not just [labtestsonline.org]

• Bone Pain

  […] 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]

  The most common side effects of immunotherapy may include fatigue, rash, diarrhea, nausea, fever, muscle pain, bone pain, joint pain, abdominal pain, itching, vomiting, cough, decreased appetite, and shortness of breath. [cancer.net]

Screening is an important part of diagnosing colorectal carcinoma and has led to its decline in incidence over time [7]. The recommended mode of screening is colonoscopy every ten years from 50 years of age [8].

The mainstay of diagnosing colorectal carcinoma is colonoscopy followed by biopsy of the suspicious lesions.

Further testing is aimed at grading and staging the tumor that may have an implication on management.

Blood studies such as complete blood count, renal function tests, and hepatic function tests are important too as they serve as indicators of organ damage.

Serum carcinoembryonic antigen (CEA) levels give an insight into prognosis.

Other tests which must be considered are ultrasonography (US) and magnetic resonance imaging (MRI) to assess the spread of the disease.

A chest radiography and abdominal computed tomography (CT) may also help to assess metastatic spread. Positron emission tomography (PET) scans are gaining popularity as an effective imaging modality to detect metastatic lesions.

Molecular genetic testing to detect various genetic mutations is rapidly gaining evidence as a guide for the treatment of metastatic colorectal cancer.

• Polyps

  Sometimes abnormal growths, called polyps, form in the colon or rectum. Over time, some polyps may turn into cancer. Screening tests can find polyps so they can be removed before turning into cancer. [cdc.gov]

  At the same time the expression of cytoplasm VDR is weakest in normal colorectal mucosa and hyper plastic polyps while it grows during the adenoma stage and is most expressed during colorectal carcinoma. [ncbi.nlm.nih.gov]

  If not treated or removed, a polyp can become a potentially life-threatening cancer. Finding and removing precancerous polyps can prevent colorectal cancer. There are several forms of polyps. [cancer.net]

The concept of treatment for unresectable colorectal carcinoma consists of surgical treatment, chemotherapy, and radiotherapy. [ncbi.nlm.nih.gov]

Clinical trials Many colorectal cancer patients at Siteman receive treatment through clinical trials. These are studies investigating the newest drugs, therapies, and other approaches to treatment. [siteman.wustl.edu]

KEYWORDS: HIF1A-AS; Long chain noncoding RNA; clinicopathological features; colorectal carcinoma; diagnosis; prognosis [ncbi.nlm.nih.gov]

In the clinical setting, treatment of the underlying malignancy should be first considered in patients with a tumor presenting with kidney disease which is suspected to be paraneoplastic in etiology. [ncbi.nlm.nih.gov]

Etiology Predisposing factors Colorectal adenomas (see colonic polyps) Family history Hereditary syndromes Familial adenomatous polyposis: 100% risk by age 40 Hereditary nonpolyposis colorectal cancer (HNPCC): 80% progress to CRC. [amboss.com]

[…] versus non-etiological nature of the association is also not clearly defined. [romanianjournalcardiology.ro]

Several lines of evidence, including a 25-fold worldwide variation in CRC incidence rates and results from migration studies, implicate dietary and lifestyle factors as central to CRC etiology. [epic.iarc.fr]

Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5 Department of Epidemiology, Harvard T.H. [ncbi.nlm.nih.gov]

Public Health Sciences, Epidemiology Addressing research gaps in the molecular subtypes of breast cancer, researchers are taking a multidisciplinary approach to study the epidemiology and mutational landscapes of basal-like, luminal A, and luminal B tumors [fredhutch.org]

5][6] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

We report a case where nephrotic syndrome due to membranoproliferative glomerulonephritis developed in a patient with colorectal carcinoma and elucidate some of the pathophysiological mechanisms underpinning this presentation. [ncbi.nlm.nih.gov]

Differential diagnosis for a colorectal mass Other rare colonic cancers: lymphoma, carcinoid tumours, Kaposi’s sarcoma, invasive prostatecancer Benign polyps Pseudopolyps in colitis Endometriosis Lipoma Tuberculosis Video on colon cancer, focusing on pathophysiology [oxfordmedicaleducation.com]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. Lawler M, Johnston B, Van Schaeybroeck S, et al. Colorectal cancer. [medlineplus.gov]

Renehan AG, Roberts DL, Dive C: Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem 2008;114(1)71-83 72. [revista.spcir.com]

BACKGROUND: Chemo preventive and antitumor role of vitamin D is manifested through genetic and non genetic ways with a powerful antproliferatory and proapopoptic effect, which is proven by numerous epidemiologic studies. [ncbi.nlm.nih.gov]

Centers for Disease Control and Prevention (CDC). (2019) “What Are the Symptoms of Colorectal Cancer?” [preventcancer.org]

Colorectal Cancer Prevention: Diet Eating a nutritious diet, getting enough exercise, and controlling body fat could prevent 45% of colorectal cancers, according to researchers. [onhealth.com]

Public Health Sciences, Cancer Prevention Researchers are studying a subtype of colorectal cancer (CRC) that develops via the serrated pathway with a goal of determining future prevention strategies and advancing treatment for CRC. [fredhutch.org]

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