Summary
Definition
History and exam
Key diagnostic factors
- family history
Other diagnostic factors
- rectal bleeding
- mucus discharge
- weight loss
- tenesmus
- change in bowel habit
- symptoms and signs of anemia
Risk factors
- increasing age
- family history of colorectal cancer or colorectal polyps
- previous history of polyps
- male sex
- acromegaly
Diagnostic tests
1st tests to order
- colonoscopy
- CT colonography
- chromoendoscopy
- histology
Tests to consider
- flexible sigmoidoscopy
Emerging tests
- virtual chromoendoscopy techniques
- artificial intelligence-assisted colonoscopy
- capsule endoscopy
Treatment algorithm
suitable for endoscopic resection
unsuitable for endoscopic resection
Contributors
Authors
Edward T. Pring, FRCS, PhD
Post CCT Fellow
St Mark’s the National Bowel Hospital
London
UK
Disclosures
ETP declares that he has no competing interests.
Jason Rai, MRCS, MMedEd
General Surgery Specialty Registrar
Oxford Deanery
Clinical Research Fellow
St Mark’s the National Bowel Hospital
London
UK
Disclosures
JR declares that he has no competing interests.
Allison Wallace, MRCS, MSc
General Surgery Specialty Registrar
Oxford Deanery
Clinical Research Fellow
St Mark’s the National Bowel Hospital
London
UK
Disclosures
AW declares that she has no competing interests.
Laura E. Gould, MRCS
General Surgery Specialty Registrar
North East and Central London Deanery
Clinical Research Fellow
St Mark’s the National Bowel Hospital
London
UK
Disclosures
LG declares that she has no competing interests.
Dinh V. C. Mai, MRCS
General Surgery Specialty Registrar
Oxford Deanery
Clinical Research Fellow at St Mark’s the National Bowel Hospital
London
UK
Disclosures
DM declares that she has no competing interests.
Ioanna Drami, MRCS, MSc, BSc
General Surgery Specialty Registrar
North East and Central London Deanery
Clinical Research Fellow at St Mark’s the National Bowel Hospital
London
UK
Disclosures
ID declares that she has no competing interests.
John T. Jenkins, MD
Consultant Colorectal Surgeon
St Mark’s the National Bowel Hopital
London
UK
Disclosures
JTJ declares that he has no competing interests.
Acknowledgements
Mr Edward T. Pring, Mr Jason Rai, Miss Alison Wallace, Miss Laura E. Gould, Mr Dinh V. C. Mai, Miss Ioanna Drami and Mr John T. Jenkins would like to gratefully acknowledge Mr Phil Tozer and Mr George Malietzis previous contributors to this topic.
Disclosures
PT and GM declares that they have no competing interests.
Peer reviewers
John Anderson, FRCS
Consultant Colorectal Surgeon
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
JA declares that he has no competing interests.
Sharon Stein, MD
Assistant Professor of Surgery
Division of Colon and Rectal Surgery
University Hospital Case Medical Center
Cleveland
OH
Disclosures
SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.
References
Key articles
Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force On Colorectal Cancer. Am J Gastroenterol. 2017 Jul;112(7):1016-30.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [internet publication].Full text
Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-57.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Colorectal cancer
- Hemorrhoids
- Anal fissure
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: colorectal cancer screening
- ACR appropriateness criteria: colorectal cancer screening
More GuidelinesPatient information
Bowel cancer
Colonoscopy
More Patient information
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