Last reviewed: March 2020
Last updated: March  2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • increasing age
  • rectal bleeding
  • change in bowel habit
  • rectal mass
  • positive family history
  • abdominal mass

Other diagnostic factors

  • anaemia
  • male sex
  • abdominal pain
  • weight loss and anorexia
  • abdominal distension
  • palpable lymph nodes

Risk factors

  • increasing age
  • adenomatous polyposis coli mutation
  • Lynch syndrome (hereditary non-polyposis colorectal cancer)
  • MYH-associated polyposis
  • hamartomatous polyposis syndromes
  • inflammatory bowel disease
  • obesity
  • acromegaly
  • limited physical activity
  • lack of dietary fibre

Diagnostic investigations

1st investigations to order

  • FBC
  • liver biochemistry
  • renal function
  • colonoscopy
  • double-contrast barium enema
  • CT colonography
  • CT scan of thorax, abdomen, and pelvis
More 1st investigations to order

Investigations to consider

  • pelvic MRI
  • transrectal endoscopic ultrasound (TRUS)
  • biopsy
  • carcinoembryonic antigen (CEA)
  • PET scan
More investigations to consider

Emerging tests

  • advanced optical imaging techniques
More emerging tests

Treatment algorithm

Contributors

Associate Dean Clinical Operations

Chair

Department of Surgery

Drexel University College of Medicine

Philadelphia

PA

Disclosures

DES declares that he has no competing interests.

Chief

Division of Colorectal Surgery

Department of Surgery

Drexel University

Philadelphia

PA

Disclosures

JLP declares that he has no competing interests.

Assistant Professor of Medicine

Department of Surgery

Drexel University

Philadelphia

PA

Disclosures

JR declares that he has no competing interests.

Dr David E. Stein, Dr Juan L. Poggio, and Dr Jascha Rubin would like to gratefully acknowledge Dr Najjia Mahmoud, Dr Emily Carter Paulson, Dr Gary Atkin, Dr Anne Ballinger, Dr Mark O'Hara, Dr Mark Harrison, and Dr Robert Glynne-Jones, previous contributors to this topic.

Peer reviewersVIEW ALL

Consultant Colorectal Surgeon

St Mark's Hospital and Academic Institute

Northwick Park

Middlesex

UK

Disclosures

SC declares that she has no competing interests.

Chief of Staff

Chairman

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

SW declares that he has no competing interests.

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