Colorectal cancer starts in the lining of the colon or rectum, usually from a polyp that grows and changes over many years. Screening finds it early, when surgery can often cure it.
Key symptoms
- Blood in the stool or dark stools
- Change in bowel habits or narrower stools
- Tiredness from iron deficiency anemia
- Abdominal pain, bloating and weight loss
What you find on exam
- Pale skin from anemia
- Abdominal mass or tenderness
- Rectal exam for a mass or blood
- Enlarged liver or ascites if the cancer has spread
Tests
- Colonoscopy with biopsy
- Blood count, iron studies and liver tests
- CEA level at baseline to follow treatment
- CT of chest, abdomen and pelvis for staging; MRI of the pelvis for rectal cancer
Treatment basics
- Surgery to remove the tumor and nearby lymph nodes
- Chemotherapy such as FOLFOX for node-positive colon cancer
- Chemotherapy and radiation for many rectal cancers
- Surveillance with CEA, CT and colonoscopy after treatment
Red flags
- Vomiting, belly swelling and no stool or gas, suggesting bowel obstruction
- Heavy rectal bleeding
- Severe sudden belly pain suggesting perforation
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.