Summary
Definition
History and exam
Key diagnostic factors
- increasing age
- rectal bleeding
- change in bowel habit
- rectal mass
- positive family history
- abdominal mass
Other diagnostic factors
- anemia
- male sex
- abdominal pain
- weight loss and anorexia
- abdominal distension
- palpable lymph nodes
Risk factors
- increasing age
- family history
- adenomatous polyposis coli mutation
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- MUTYH/MYH-associated polyposis
- hamartomatous polyposis syndromes
- inflammatory bowel disease
- obesity
- acromegaly
- limited physical activity
- lack of dietary fiber
- smoking
- moderate to heavy alcohol consumption
- low vitamin D
- consumption of red and processed meats
Diagnostic tests
1st tests to order
- complete blood count
- liver biochemistry
- renal function
- quantitative fecal immunochemical test
- colonoscopy
- CT colonography
- double-contrast barium enema
- CT scan of chest, abdomen, and pelvis
- genetic testing
Tests to consider
- MRI pelvis: rectal cancer protocol
- transrectal endoscopic ultrasound
- biopsy
- carcinoembryonic antigen
- PET scan
Emerging tests
- advanced optical imaging techniques
Treatment algorithm
rectal cancer, suitable for surgery
rectal cancer, not suitable for surgery
colon cancer, suitable for surgery
colon cancer, not suitable for surgery
Contributors
Authors
David E. Stein, MD, FACS, FASCRS
Professor of Surgery
Georgetown University School of Medicine
Georgetown
DC
Regional Chief of Surgery
MedStar Health
Baltimore
MD
Disclosures
DES declares that he has no competing interests.
Kamila A. Nowak-Choi, MD
Assistant Professor
Department of Radiation Oncology
University of Maryland Upper Chesapeake Medical Center KCC Radiation Oncology
Bel Air
MD
Disclosures
KANC declares that she has no competing interests.
Acknowledgements
Dr David E. Stein and Dr Kamila A. Nowak-Choi would like to gratefully acknowledge Dr Pallavi P. Kumar, Dr David M. Lisle, Dr Juan L. Poggio, Dr Jascha Rubin, 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.
Disclosures
PKP, DML, JLP, JR, NM, ECP, MOH, GA, and AB declare that they have no competing interests. MH is the chair of the Mount Vernon Upper GI Tumor Site Specific Group and a member of the National Cancer Research Institute anal, rectal, and advanced colorectal groups. He has also received honoraria for speaking and has been supported to attend international meetings on gastrointestinal cancer from Roche. He has also received research funding from Pfizer for a trial in rectal cancer. RGJ is the chief medical adviser to the charity Bowel Cancer UK. He has received honoraria for lectures from Roche, Sanofi, and Pfizer. He has received funding for the EXTRA study, involving capecitabine and radiotherapy in anal cancer, published in the International Journal of Radiation Biology Physics. RGJ has also received funding and free cetuximab for an ongoing phase 1/2 study integrating cetuximab into chemoradiation in rectal cancer, and has an agreement from Roche to supply bevacizumab for 3 months to 60 patients in one randomized phase 2 study as neoadjuvant chemotherapy in rectal cancer (BACCHUS). He has also been supported by Roche to attend international meetings in gastrointestinal cancer.
Peer reviewers
Susan Clark, BChir, MB
Consultant Colorectal Surgeon
St Mark's Hospital and Academic Institute
Northwick Park
Middlesex
UK
Disclosures
SC declares that she has no competing interests.
Steven Wexner, MD, FACS, FRCS, FRCS Ed, FASCRS, FAC
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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