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.

• Virchow's Node

  Other physical findings, although rare, should be systematically searched for, including peripheral lymphadenopathy, especially a Virchow’s node in the left supraclavicular space; hepatomegaly from hepatic metastases; and temporal or intercostal muscle [intechopen.com]

• 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]

  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]

  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]

  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]

• Fatigue

  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]

  Many times aggressive medical treatment is needed and the patient's independence, strength, range of motion, and fatigue levels are negatively impacted. [physio-pedia.com]

• 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]

  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]

  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]

  “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]

  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]

• 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]

  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]

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

  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]

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

• Abdominal Pain

  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]

  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]

  Right Sided Tumors Left Sided Tumors Anemia Change in Bowel Habits Abdominal Pain Rectal Blood Loss Weight Loss Abdominal Pain Change in Bowel Habits * Associated with chronic occult bleeding linked to iron deficiency & anemia Early Stage Advanced Stage [physio-pedia.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]

  The most common presenting symptoms and signs of cancer or large polyps are rectal bleeding, persisting change in bowel habit and anaemia. [patient.info]

• 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]

  Stool or fecal occult blood testing (FOBT) Tumors of the colon and rectum tend to bleed slowly into the stool. The small amount of blood mixed into the stool usually is not visible to the naked eye. [medicinenet.com]

• Cheilitis

  Iron deficiency anemia can cause koilonychia manifested by brittle, longitudinally furrowed, and spooned nails; glossitis manifested by lingual erythema and papillae loss; and cheilitis manifested by scaling or fissuring of the lips. [intechopen.com]

• Swelling of Hand

  […] in hands or feet breathing difficulties chronic headaches blurry vision bone fractures While colorectal cancer sounds clear-cut, there’s actually more than one type of cancer. [healthline.com]

• Night Sweats

  sweats), fatigue, abdominal discomfort In general, right-sided tumors chronically bleed, and left sided tumors cause obstruction Symptoms according to location Rectosigmoid > ascending colon > descending colon Right-sided carcinomas (10%): cecum and [amboss.com]

• Cutaneous Manifestation

  Cutaneous manifestations of visceral carcinomas are scarce, occurring in around 0.7-12% of internal malignancies. Lung cancer is one of the most common sources of skin metastasis, particularly in male patients. [ncbi.nlm.nih.gov]

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.

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]

Pause or ‘holidays’ in treatment The discussion about temporary suspension of treatment may be assessed with the patient within the context of indolent or asymptomatic disease. 44–48 Second-line treatment The second line of treatment depends on the initial [esmoopen.bmj.com]

Colorectal cancer treatment If you have colorectal cancer, your doctor will talk to you about treatment options. These include: Surgery. This is usually the main treatment for colon and rectal cancer. It removes the tumor. Chemotherapy. [familydoctor.org]

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

BRAF mutations: usually associated with a V600E mutation; can be predictive of prognosis after colorectal cancer diagnosis. [oncolink.org]

[…] of GNRI in determining postoperative complication risk and long-term prognosis in elderly patients with colorectal cancer, as well as support for nutrition interventions. [oncologynurseadvisor.com]

High microsatellite instability, due to mutated mismatch repair genes, occurs in 15-20% of cancers and is associated with a better prognosis, if the cancer is localised Mutations in RAS or NRAS confer resistance to anti-EGFR therapy Initial surgical [oxfordmedicaleducation.com]

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]

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]

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

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]

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]

We assessed the overall and age-specific risks of colorectal SPTs within the national Surveillance, Epidemiology, and End Results (SEER) 1 Program database population. [academic.oup.com]

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]

Removing these polyps is the most effective way to prevent the development of colorectal cancer. [ucsfhealth.org]

Finding and removing polyps can prevent colorectal cancer. Explore the links on this page to learn more about colorectal cancer prevention, screening, treatment, statistics, research, clinical trials, and more. [cancer.gov]

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

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]

1. Guidice MED, Vella ET, Hey A, et al. Systematic review of clinical features of suspected colorectal cancer in primary care. Can Fam Physician. 2014;60(8):405-415.
2. Barwick TW, Scott SB, Ambrose NS. The two week referral for colorectal cancer: a retrospective analysis. Colorectal Dis. 2004;6(2):85–91.
3. Panzuto F, Chiriatti A, Bevilacqua S, et al. Symptom-based approach to colorectal cancer: survey of primary care physicians in Italy. Dig Liver Dis. 2003;35(12):869–875.
4. Robertson R, Campbell C, Weller DP, et al. Predicting colorectal cancer risk in patients with rectal bleeding. Br J Gen Pract. 2006;56(531):763–767.
5. Ellis BG, Thompson MR. Factors identifying higher risk rectal bleeding in general practice. Br J Gen Pract. 2005;55(521):949–955.
6. Hamilton W, Lancashire R, Sharp D, Peters TJ, Cheng KK, Marshall T. The importance of anaemia in diagnosing colorectal cancer: a case-control study using electronic primary care records. Br J Cancer. 2008;98(2):323–327.
7. American Cancer Society. Cancer Facts & Figures 2016. American Cancer Society. Available at https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2016.html
8. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104 (3):739-750.