Colorectal cancer differential diagnosis: Difference between revisions

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! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
![[Tenesmus]]
!Tenesmus
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
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*[[metastases]]
*[[metastases]]
| style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
| style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
*Detailed images and metastasis
*[[Metastasis]]
'''Barium enema'''
'''Barium enema'''
*Cancer or a precancerous polyp
*[[Cancer]] or [[Premalignant condition|precancerous]] [[polyp]]
'''Genetic testing'''
'''Genetic testing'''
*[[Hereditary nonpolyposis colorectal cancer case study one|Hereditary nonpolyposis colorectal cancer]] (HNPCC)
*[[Hereditary nonpolyposis colorectal cancer case study one|Hereditary nonpolyposis colorectal cancer]] (HNPCC)
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*[[Intussusception]]
*[[Intussusception]]
*[[Bowel obstruction]]
*[[Bowel obstruction]]
| style="background: #F5F5F5; padding: 5px;" |[[Barium enema|'''Barium enema''']]
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Multiple [[Polyp|polyps]].
* Multiple [[Polyp|polyps]].
[[MRI|'''MRI''']]
'''MRI'''
* Multiple [[Hamartoma|hamartomatous]] polyps
* Multiple [[Hamartoma|hamartomatous]] [[Polyp|polyps]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with central core of branching smooth muscle associated with mucosa
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with core of smooth muscle associated with mucosa
* Smaller [[Polyp|polyps]] may lack the prominent arborizing smooth muscle
* Smaller [[Polyp|polyps]] lack the prominent arborizing smooth muscle
| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for [[STK11]] and [[colonoscopy]]
| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for [[STK11]] and [[colonoscopy]]
|-
|-
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* Variable in size between 2-5 cm
* Variable in size between 2-5 cm
| style="background: #F5F5F5; padding: 5px;" |'''PET scan''' (11C-5-hydroxytryptophan, 11C-5-HTP)
| style="background: #F5F5F5; padding: 5px;" |'''PET scan''' (11C-5-hydroxytryptophan, 11C-5-HTP)
* Detects metastasis
* Detects [[metastasis]]
'''MRI'''
'''MRI'''
* Nodular mass originating from the bowel wall or regional uniform bowel wall thickening
* Nodular mass  
* Metastasis
* Wall thickening
* [[Metastasis]]
'''Ki-67 index'''
'''Ki-67 index'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* [[Polyp|Multiple polyps]] in [[gastrointestinal tract|GI tract]]
* [[Polyp|Multiple polyps]] in [[gastrointestinal tract|GI tract]]
| style="background: #F5F5F5; padding: 5px;" |'''Barium study'''
| style="background: #F5F5F5; padding: 5px;" |'''Barium study'''
* Multiple polyps in GI tract
* Multiple polyps in [[Gastrointestinal tract|GI tract]]
'''Stool DNA test'''
'''Stool DNA test'''
* ''SMAD4'' or ''BMPR1A''
* ''[[SMAD4]]'' or ''[[BMPR1A]]''
'''Diagnose if any of the following positive:'''
'''Diagnose if any of the following positive:'''
* More than five juvenile polyps of the colorectum
* More than five juvenile [[Polyp|polyps]] of the [[colorectum]]
* Multiple juvenile polyps throughout the GI tract
* Multiple juvenile [[Polyp|polyps]] throughout the [[Gastrointestinal tract|GI tract]]
* Any number of juvenile polyps and a family history of juvenile polyposis
* Any number of juvenile [[Polyp|polyps]] and a family history of juvenile [[polyposis]]
* Heterozygous pathogenic variant in ''SMAD4'' or ''BMPR1A''
* [[Heterozygous]] pathogenic variant in ''[[Mothers against decapentaplegic homolog 4|SMAD4]]'' or ''[[BMPR1A]]''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[asymptomatic]]
* [[asymptomatic]]
* Discovered incidentally
* [[Satiety|Early satiety]]
* [[Satiety|Early satiety]]
* [[Bloating]]
* [[Bloating]]
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* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
| style="background: #F5F5F5; padding: 5px;" |[[Benign]]
* Small, < 10 cms
* [[homogeneous]]
* Clear boundaries
* [[intraluminal]] or extraluminal growth
[[Malignant]] [[Gastrointestinal stromal tumor|GIST]] with [[metastasis]]:
* Size > 10 cm
* [[Calcification|Calcifications]]
* Irregular margins
* [[Heterogeneous]] and lobulated
* [[Lymphadenopathy]]
* [[Ulceration]]
* Extraluminal and [[mesenteric]] fat infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and[[intraluminal]] growth
'''Endoscopic ultrasonography'''
* Intermediate GIST (5-10 cms) [[heterogeneous]] with irregular borders and [[Intraluminal|intra]]/extra-luminal [[growth]].
* Large GISTs (>10 cms) [[heterogeneous]] with irregular borders and local/distant spread
* Malignant GIST with metastasis:
** Size > 10 cm
** [[Calcification|Calcifications]]
** Irregular margins
** [[Heterogeneous]] and lobulated
** [[Lymphadenopathy]]
** [[Ulceration]]
** Extraluminal and [[mesenteric]] fat infiltration
| style="background: #F5F5F5; padding: 5px;" |


'''[[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]'''
[[Benign]]:
 
Benign:
* [[Mucosal]] [[ulceration]] or [[bleeding]]
* [[Mucosal]] [[ulceration]] or [[bleeding]]
* Smooth [[submucosal]] mass as hypoechoic mass
* Smooth [[submucosal]] mass as [[hypoechoic mass]]
[[Malignant]] GIST:
[[Malignant]] [[Gastrointestinal stromal tumor|GIST]]:
* [[Heterogeneous]] mass >4 cm in size
* [[Heterogeneous]] mass >4 cm in size
* Irregular borders
* Irregular borders
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular [[chromatin]] and appears nested
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and [[KIT|KIT protein.]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopic ultrasound
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopic ultrasound]]
[[biopsy]] and [[Histopathological|histopathological analysis]]
[[biopsy]] and [[Histopathological|histopathological analysis]]
|-
|-
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* [[Calcification]]
* [[Calcification]]
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy'''
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy'''
* Proliferation of bland spindle cells in the lamina propria  
* Proliferation of bland [[spindle cells]] in the [[lamina propria]]
* mucosal Schwann cell hamartoma (MSCH))
* mucosal [[Schwann cell tumor|Schwann cell hamartoma (]]MSCH))
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
* poorly circumscribed, short fascicles of uniform [[spindle cells]] replacing the [[Colon (anatomy)|colonic]] [[lamina propria]], separating and entrapping the [[Crypt (anatomy)|crypts]]
* The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct
* The [[Cell nucleus|nuclei]] are bland and mostly uniform, occasional larger [[Cell nucleus|nuclei]] are found. The [[Cytoplasm|cytoplasmic]] borders are indistinct
* Involvement of mucosa but never the submucosa
* Involvement of [[Mucous membrane|mucosa]] but never the [[submucosa]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
|-
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* [[Follicular lymphoma]]
* [[Follicular lymphoma]]
'''Double-contrast enema'''
'''Double-contrast enema'''
* Subtle mucosal changes
* Subtle [[Mucous membrane|mucosal]] changes
* Gross tumor morphology
* Gross [[tumor]] morphology
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
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* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''Serology'''
| style="background: #F5F5F5; padding: 5px;" |'''Serology'''
* [[Antibodies]] against Kaposi sarcoma herpes virus  (HHV-8)
* [[Antibodies]] against [[Kaposi's sarcoma|Kaposi sarcoma]] [[Kaposi's sarcoma-associated herpesvirus|herpes virus  (HHV-8)]]
'''Biopsy'''
'''Biopsy'''
* [[Vascular]] proliferation, red blood cell and [[hemosiderin]]
* [[Vascular]] proliferation, red blood cell and [[hemosiderin]]
* Extravasation,[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]]
* [[Extravasation]],[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]]
* Neovascular lesion wrapped around a pre-existing space
* [[Neovascularization|Neovascular]] lesion wrapped around a pre-existing space
* Intracytoplasmic PAS +ve [[hyaline]] globules
* Intracytoplasmic [[PAS stain|PAS]] +ve [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Vascular]] proliferation
* [[Vascular]] proliferation
* Red blood cell and [[hemosiderin]] extravasation
* [[Red blood cell|RBC]] and [[hemosiderin]] extravasation
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* Premonitory sign (a neovascular lesion wrapped around a pre-existing space)
* [[Premonitory sign]] [[Neovascularization|(neovascular]] lesion wrapped around a pre-existing space)
* Intracytoplasmic PAS +ve [[hyaline]] globules
* Intracytoplasmic [[Periodic acid-Schiff stain|PAS +ve]] [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |Biopsy
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation]]<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation]]<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
* Aberrant [[Blood vessel|vessels]] with thickened, hypertrophic walls in the [[Mucous membrane|mucosa]] and the [[submucosa]]
* Arteries directly connected to veins without capillary beds
* [[Artery|Arteries]] directly connected to [[Vein|veins]] without [[capillary beds]]
| style="background: #F5F5F5; padding: 5px;" |Accidental finding
| style="background: #F5F5F5; padding: 5px;" |Accidental finding
|-
|-
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* Not recommended  
* Not recommended  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Outpouchings of the colonic wall (Diverticula)
* Outpouchings of the [[Colon (anatomy)|colonic wall]] [[Diverticular|(diverticula)]]
* Inflamed diverticula
* [[Diverticulitis|Inflamed diverticula]]
* Abscess formation
* [[Abscess|Abscess formation]]
* Intraperitoneal free air (microperforation)
* Intraperitoneal free air (microperforation)
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |CT scan
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhoids]]<ref name="JacobsSolomon2014">{{cite journal|last1=Jacobs|first1=Danny|last2=Solomon|first2=Caren G.|title=Hemorrhoids|journal=New England Journal of Medicine|volume=371|issue=10|year=2014|pages=944–951|issn=0028-4793|doi=10.1056/NEJMcp1204188}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhoids]]<ref name="JacobsSolomon2014">{{cite journal|last1=Jacobs|first1=Danny|last2=Solomon|first2=Caren G.|title=Hemorrhoids|journal=New England Journal of Medicine|volume=371|issue=10|year=2014|pages=944–951|issn=0028-4793|doi=10.1056/NEJMcp1204188}}</ref>
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* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
* Palpable mass, tender if [[Thrombosis|thrombosed]]
* [[Palpation|Palpable]] mass, tender if [[Thrombosis|thrombosed]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patchy or diffuse [[Erythematous|erythematous mucosa]]
* Patchy or diffuse [[Erythematous|erythematous mucosa]]
* Edema, [[hemorrhage]], with or without [[ulcers]] of mucosa
* [[Edema]], [[hemorrhage]], with or without [[ulcers]] of [[Mucous membrane|mucosa]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Stool culture
| style="background: #F5F5F5; padding: 5px;" |[[Stool culture]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>V
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>V
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +


LLQ
[[Left lower quadrant abdominal pain resident survival guide|LLQ]]
| +
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Weight loss|Weight loss]]
* [[Weight loss|Weight loss]]
* Diarrhea with[[mucus]]  
* [[Diarrhea]] with[[mucus]]  
* Urgency
* Urgency
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Mucosal and submucosal inflammation
* [[Mucous membrane|Mucosal]] and [[Submucosa|submucosal]] [[inflammation]]
* Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
* [[Hemorrhages|Hemorrhage]] or [[Inflammation|inflammatory]] [[Neutrophil|polymorphonuclear cells]] aggregate in the [[lamina propria]]
* Distorted crypts
* Distorted [[Crypt (anatomy)|crypts]]
* Crypt abscess
* [[Crypt abscess]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopic biopsy
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy|Endoscopic biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +


LRQ
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| +
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Discontinuous lesions
* Discontinuous lesions
* Strictures
* [[Strictures]]
* Linear ulcerations
* Linear [[Ulcer|ulcerations]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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* Transmural pattern of [[inflammation]]
* Transmural pattern of [[inflammation]]
* [[Mucous membrane|Mucosal]] damage
* [[Mucous membrane|Mucosal]] damage
* Focal infiltration of leukocytes into the epithelium
* Focal [[Infiltration (medical)|infiltration]] of [[White blood cells|leukocytes]] into the [[epithelium]]
* Granulomas
* [[Granuloma|Granulomas]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopic biopsy
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy|Endoscopic biopsy]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
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* [[Abscess]]
* [[Abscess]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
'''Ultrasound'''
'''Ultrasound'''
* Aperistaltic, noncompressible, dilated [[Appendicitis ultrasound|appendix]] (>6 mm)
* Aperistaltic, noncompressible, dilated [[Appendicitis ultrasound|appendix]] (>6 mm)
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising
* Heaviness/dull discomfort in the groin, with straining, lifting, [[Cough|coughing]], or [[Physical exercise|exercising]]
* Weakness, heaviness, burning, or aching in the groin
* [[Weakness]], heaviness, burning, or aching in the groin
* [[swelling]]
* [[swelling]]
* [[Fever]]
* [[Fever]]
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*
*
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Hypoechoic mass suggesting dilated and edematous intestinal segment
* Hypoechoic mass suggesting dilated and edematous [[Intestine|intestinal segment]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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'''T1-weighted or fat-suppression T1-weighted MRIs'''
'''T1-weighted or fat-suppression T1-weighted MRIs'''
* Contrast enhanced mass  
* Contrast enhanced mass  
* Hyperintense hemorrhagic  
* Hyperintense [[hemorrhagic]]
* Hyperintense cavities  
* Hyperintense [[Cavity|cavities]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A

Revision as of 19:09, 25 January 2019

Colorectal cancer Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Qurrat-ul-ain Abid, M.D.[3]

Overview

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

Colorectal Cancer Differential Diagnosis

Other conditions that can be mistaken for colorectal cancer include the following:

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study
Adenocarcinoma[7] ↑ or ↓ + +/- + + PET scans

Barium enema

Genetic testing

  • Different grades of differentiation of glandular structures
    • Sheets or cords of malignant cells,
    • Cellular atypia, pleomorphism
    • High mitotic rate
  • Necrotic debris in glandular lumina
  • Desmoplastic reaction (sign of invasion)
 Biopsy and histopathological analysis
Peutz-Jeghers syndrome
[8][9][10][11][12] 		↑ or ↓ + + - + Barium enema

MRI

Genetic testing for STK11 and colonoscopy
Carcinoids
[13][14][15][16][17] 		↑ +/- + - +
  • Infiltrating, ulcerating or fungating lesions in the wall of colon
  • Well-defined single/multiple lesions
  • Round/ovoid in shape
  • Variable in size between 2-5 cm
 PET scan (11C-5-hydroxytryptophan, 11C-5-HTP)

MRI

Ki-67 index

  • Solid/spongy nests of cells accentuated by neatly outlined luminal spaces
  • Peripheral nuclear palisading
  • Granular eosinophilic cytoplasm
 Biopsy and histopathological analysis
Juvenile Polyposis Coli[18][19][20][21][22] ↑ + + - + Barium study

Stool DNA test

Diagnose if any of the following positive:

  • Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
  • Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils and neutrophils
  • Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
  • Areas of conventional dysplasia
 Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)[23][24][25][26][27] - +/- - - +/- Benign

Malignant GIST with metastasis:

Endoscopic ultrasonography

Benign:

Malignant GIST:

Endoscopic ultrasound

biopsy and histopathological analysis

Hamartoma[30] ↑ + + +
  • N/A
 -
  • Large polypoid mass
 Biopsy Biopsy
Colorectal Lymphoma[31][32] - +/- + - +
  • Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
  • Polypoid mass
  • Circumferential-cavitary lesions
  • Focal mucosal nodularity
  • Diffuse ulcerative or nodular lesions
  • Lymphadenopathy
 Biopsy:

Double-contrast enema

Biopsy
Kaposi's sarcoma[33] ↑ + + - +
  • Localized purpuric lesion
  • N/A
 Serology

Biopsy

Biopsy
Arteriovenous malformation[34] - + - -
  • N/A
 +
  • Bright red, flat lesions
  • Rarely, polypoid
  • N/A
 N/A Accidental finding
Diverticular diseases[35][36][37] ↑ or ↓ +/- +

RLQ

- -
  • Not recommended
 Barium enema
  • Circumferential narrowing
  • Spiculated contour
  • Tapered margins
  • N/A
 CT scan
Hemorrhoids[38] ↓ + + -
  • Perianal Itching
  • Pain with defecation
  • Painful-hard lump in anus
 +
  • N/A
 DRE
  • N/A
 Clinical
Anal fissure[39] - + + - +/-
  • N/A
 N/A
  • N/A
 Clinical
Infectious colitis[40] ↑ + + - -
  • N/A
 Stool cultures

Stool analysis

  • N/A
 Stool culture
Ulcerative colitis[41]V ↑ + +

LLQ

+ +
  • N/A
 N/A Endoscopic biopsy
Crohn's disease[41] ↑ + +

RLQ

+ +
  • N/A
 N/A Endoscopic biopsy
Irritable bowel syndrome[42] ↑ ↓ + + + -
  • Not recommended
  • N/A
 Diagnosis of exclusion
  • N/A
 Clinical diagnosis (Rome criteria)
Appendicitis[43] ↑ - +

RLQ

- -
  • N/A

Ultrasound

  • Aperistaltic, noncompressible, dilated appendix (>6 mm)
  • Appendicolith
  • Echogenic prominent pericaecal fat
  • Periappendiceal fluid collection
  • N/A
 CT scan
Strangulated hernia ↓ - +

RLQ

- -
  • N/A
  • Defect in the abdominal wall muscles
  • Bowel loops within the lesion
  • Lateral crescent sign
  • The hernia neck superolateral to the course of the inferior epigastric vessels
 Ultrasound:
  • N/A
 Ultrasound
Bowel endometriosis[44] ↑ or ↓ + Pelvic + +
  • N/A
  • N/A
 Transvaginal ultrasound
  • Heterogeneous, hypoechoic, spiculated mass

T1-weighted or fat-suppression T1-weighted MRIs

  • N/A
 Transvaginal ultrasound

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  7. ↑ Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
  8. ↑ Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
  9. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  10. ↑ Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
  11. ↑ Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
  12. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  13. ↑ Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
  14. ↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
  15. ↑ Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B (May 2012). "TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study". J. Natl. Cancer Inst. 104 (10): 764–77. doi:10.1093/jnci/djs208. PMID 22525418.
  16. ↑ Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
  17. ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  18. ↑ Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
  19. ↑ Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
  20. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  21. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  22. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  23. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  24. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  25. ↑ Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD (July 2004). "KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications". Am. J. Surg. Pathol. 28 (7): 889–94. PMID 15223958.
  26. ↑ Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K (November 2005). "18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors". World J Surg. 29 (11): 1429–35. doi:10.1007/s00268-005-0045-6. PMID 16222452.
  27. ↑ Miettinen M, Sobin LH, Lasota J (January 2005). "Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up". Am. J. Surg. Pathol. 29 (1): 52–68. PMID 15613856.
  28. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  29. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  30. ↑ Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
  31. ↑ Quayle FJ, Lowney JK (May 2006). "Colorectal lymphoma". Clin Colon Rectal Surg. 19 (2): 49–53. doi:10.1055/s-2006-942344. PMC 2780105. PMID 20011310.
  32. ↑ Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
  33. ↑ Arora M, Goldberg EM (July 2010). "Kaposi sarcoma involving the gastrointestinal tract". Gastroenterol Hepatol (N Y). 6 (7): 459–62. PMC 2933764. PMID 20827371.
  34. ↑ Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
  35. ↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
  36. ↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
  37. ↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
  38. ↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
  39. ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
  40. ↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
  41. ↑ 41.0 41.1 Fakhoury M, Negrulj R, Mooranian A, Al-Salami H (2014). "Inflammatory bowel disease: clinical aspects and treatments". J Inflamm Res. 7: 113–20. doi:10.2147/JIR.S65979. PMC 4106026. PMID 25075198.
  42. ↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
  43. ↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.
  44. ↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.


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