Colorectal cancer differential diagnosis: Difference between revisions

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* [[Leukocytosis]]
* [[Leukocytosis]]
|Ultrasound shows evidence of [[inflammation]]
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Ct scan shows acute gangrenous appendix with calcified appendicolith
* Ultrasound shows evidence of [[inflammation]]
 
* CT scan shows acute gangrenous appendix with calcified appendicolith
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
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* [[Pyuria]]  
* [[Pyuria]]  
* Presence of [[nitrites]] and leukocyte estrase
* Presence of [[nitrites]] and [[leukocyte esterase]]
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* X ray is done to probe the suspicion of emphysematous cystitis.
* X ray is done to probe the suspicion of emphysematous cystitis.
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* Purulent vaginal discharge
* [[Vaginal discharge|Purulent vaginal discharge]]
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* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
|[[Transvaginal ultrasound|Transvaginal utrasonography]]  
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* [[Transvaginal ultrasound|Transvaginal utrasonography]]
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* No specific tests
* No specific tests
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* Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses  
* Ultrasound is helpful to rule out other differential diagnosis such as [[pelvic abscess]], [[thrombosis]] and [[Tumor|masses]]
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* Vaginal discharge
* [[Vaginal discharge]]


* Vaginal bleeding  
* [[Vaginal bleeding]]
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|[[Salpingitis]]  
|[[Salpingitis]]  
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* Leukocytosis
* [[Leukocytosis]]
|Pelvic ultrasound
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* Vaginal discharge
* [[Pelvic ultrasound]]
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* [[Vaginal discharge]]
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*The table below summarizes the findings that differentiate colorectal from the most common other conditions that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue<ref><nowiki>{{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html<nowiki>}}</nowiki></ref>.
*The table below summarizes the findings that differentiate colorectal cancer from other common conditions that cause unexplained [[weight loss]], unexplained [[loss of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[anemia]], [[jaundice]], and <ref><nowiki>{{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html<nowiki>}}</nowiki></ref>.
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{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
| style="background:#f0f0f0;" align="center" |'''Condition'''
| style="background:#f0f0f0;" align="center" |'''Condition'''
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| '''Irritable Bowel Syndrome (IBS)'''||A clinical diagnosis is based on either Rome I, II, or III Criteria.<br> '''Rome I''' is continuous or recurrent symptoms for at least 3 months; abdominal pain or discomfort, relieved with defecation and/or associated with change in frequency and/or consistency of stool; and an irregular pattern of defecation with at least 25% of the time with two or more of the following: altered stool frequency, altered stool form, altered stool passage, passage of mucus, bloating or feeling of abdominal distention<br>'''Rome II''' is at least 12 weeks of abdominal discomfort or pain, which need not be consecutive, in the preceding 12 months with two or more of the following: relieved with defecation, onset associated with a change in frequency of stool, onset associated with a change in form of stool<br>'''Rome III''' is recurrent abdominal pain or discomfort 3 days per month in the last 3 months, associated with two or more of the following: improvement of abdominal pain with defecation, change in frequency of stool, change in appearance of stool; with onset at least 6 months prior to diagnosis||There is no specific diagnostic test for IBS; patients who fulfill the clinical criteria for IBS and have no alarm features have a very low probability of organic disease; colonoscopy or colonic imaging is recommended for patients older than 50 years of age due to higher pre-test probability of colorectal cancer
| '''[[Irritable Bowel Syndrome|Irritable Bowel Syndrome (IBS)]]'''||A clinical diagnosis is based on either Rome I, II, or III Criteria.
* '''Rome I''': is continuous or recurrent symptoms for at least 3 months; [[abdominal pain]] or [[discomfort]], relieved with [[defecation]] and/or associated with change in frequency and/or consistency of stool; and an irregular pattern of [[defecation]] with at least 25% of the time with two or more of the following: altered stool frequency, altered stool form, altered stool passage, passage of mucus, [[bloating]] or feeling of [[abdominal distention]]
* '''Rome II''' is at least 12 weeks of [[abdominal discomfort]] or [[Pain(patient information)|pain]], which need not be consecutive, in the preceding 12 months with two or more of the following: relieved with [[defecation]], onset associated with a change in frequency of stool, onset associated with a change in form of stool
* '''Rome III''' is recurrent [[abdominal pain]] or discomfort 3 days per month in the last 3 months, associated with two or more of the following: improvement of [[abdominal pain]] with [[defecation]], change in [[frequency]] of stool, change in appearance of stool; with onset at least 6 months prior to diagnosis
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* There is no specific diagnostic test for [[Irritable bowel syndrome|IBS]]; patients who fulfill the clinical criteria for [[IBS]] and have no alarm features have a very low probability of organic disease
* [[Colonoscopy]] or [[Colon (anatomy)|colonic imaging]] is recommended for patients older than 50 years of age due to higher pre-test probability of colorectal cancer


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| '''Ulcerative Colitis'''||The average age of onset of inflammatory bowel disease (20 to 40 years) is younger than with colorectal cancer; patients with inflammatory bowel disease frequently have watery diarrhea; patients with colitis are at higher risk of colorectal cancer and may need reassessment if symptoms are atypical or do not respond to treatment||Colonoscopy will show rectal involvement, continuous uniform involvement, loss of vascular marking, diffuse erythema, mucosal granularity, and a normal terminal ileum (or mild 'backwash' ileitis in pancolitis)
| '''[[Ulcerative Colitis]]'''||
* The average age of onset of [[inflammatory bowel disease]] (20 to 40 years) is younger than with colorectal cancer
* Patients with [[inflammatory bowel disease]] frequently have [[watery diarrhea]]
* Patients with [[colitis]] are at higher risk of colorectal cancer and may need reassessment if symptoms are atypical or do not respond to treatment
|[[Colonoscopy]] shows:
* [[rectal]] involvement
* Continuous uniform involvement
* Loss of vascular marking
* Diffuse [[erythema]]
* Mucosal granularity
* Normal terminal ileum (or mild 'backwash' [[ileitis]] in [[pancolitis]])


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| '''Crohn's Disease'''||Patients with colitis are at higher risk of colorectal cancer and need reassessment if symptoms are atypical or do not respond to treatment||Colonoscopy with intubation of the ileum is the definitive test to diagnose Crohn's disease and will show mucosal inflammation and discrete deep superficial ulcers located transversely and longitudinally, creating a cobblestone appearance; the lesions are discontinuous, with intermittent areas of normal-appearing bowel (skip lesions)
| '''[[Crohn's disease|Crohn's Disease]]'''||
* Patients with [[colitis]] are at higher risk of colorectal cancer and need reassessment if symptoms are atypical or do not respond to treatment
|[[Colonoscopy]] with [[intubation]] of the [[ileum]] is the definitive test to diagnose [[Crohn's disease]] and will show:
* [[Mucosal|Mucosal inflammation]]
* Discrete deep or superficial [[ulcers]] located transversely and longitudinally, creating a cobblestone appearance  
* [[Lesions]] that are discontinuous, with intermittent areas of normal-appearing bowel (skip lesions)


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| '''Hemorrhoids'''||Bright red rectal bleeding that is separate from the stool; there is no abdominal discomfort or pain, altered bowel habits, or weight loss||Colonoscopy or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
| '''[[Hemorrhoids]]'''||
* Bright red [[rectal bleeding]] that is separate from the stool
* No [[abdominal discomfort]] or [[pain]]
* Altered bowel habits
* [[Weight loss]]
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* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to [[rectal bleeding]] and in those older than 50 years of age


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| '''Anal Fissure'''||Severe pain on defecation; blood is usually present on wiping, there is no abdominal discomfort or pain, altered bowel habits, or weight loss||Colonoscopy or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
| '''[[Anal Fissure]]'''||
* Severe pain on [[defecation]]
* Blood is usually present on wiping
* No [[abdominal discomfort]] or [[pain]]
* Altered bowel habits
* [[Weight loss]]
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* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age


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| '''Diverticular disease'''||Diverticular stricture or inflammatory mass may be clinically indistinguishable from colorectal cancer||Colonoscopy with biopsies and CT imaging will usually differentiate diverticular disease from colorectal cancer
| '''[[Diverticular disease]]'''||
* [[Diverticular disease|Diverticular stricture]] or [[Inflammatory|inflammatory mass]] may be clinically indistinguishable from colorectal cancer
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* [[Colonoscopy]] with [[biopsies]] and [[Computed tomography|CT imaging]] will usually differentiate [[diverticular disease]] from colorectal cancer


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'''Other conditions that can be mistaken for colorectal cancer including the following:'''
'''Other conditions that can be mistaken for colorectal cancer include the following:'''
*Benign colon polyps
*Benign colon polyps
*[[Ischemic colitis]]
*[[Ischemic colitis]]

Revision as of 15:43, 15 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

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

Diseases Symptoms Signs Diagnosis Comments
Abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Colorectal cancer LLQ Constipation - - - CT scan, x-ray and MRI used to show metastasis -
Inflammatory bowel disease LLQ Bloody diarrhea - - - - Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis
Diverticulitis LLQ Constipation

Or

Diarrhea

- + + CT scan shows evidence of inflammation and out-pouchings of the colonic wall
Appendicitis LLQ / RRQ Constipation + + -
  • CT scan shows acute gangrenous appendix with calcified appendicolith
 Nausea & vomiting,decreased appetite
Strangulated hernia LLQ - - - -
  • No specific tests
  • CT scan used to detect the hernia and to show if it is single or multiple
Gentiourinary diseases Cystitis LLQ - + -
  • Suprapubic tenderness
  • X ray is done to probe the suspicion of emphysematous cystitis.
  • CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis LLQ

Groin pain

- - -
  • Tender and enlarged
Pelvic inflammatory disease Bilateral - + -
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
Salpingitis LLQ/ RLQ +/- +/-
Condition Differentiating Signs/Symptoms Differentiating Tests
Irritable Bowel Syndrome (IBS) A clinical diagnosis is based on either Rome I, II, or III Criteria.
  • Rome I: is continuous or recurrent symptoms for at least 3 months; abdominal pain or discomfort, relieved with defecation and/or associated with change in frequency and/or consistency of stool; and an irregular pattern of defecation with at least 25% of the time with two or more of the following: altered stool frequency, altered stool form, altered stool passage, passage of mucus, bloating or feeling of abdominal distention
  • Rome II is at least 12 weeks of abdominal discomfort or pain, which need not be consecutive, in the preceding 12 months with two or more of the following: relieved with defecation, onset associated with a change in frequency of stool, onset associated with a change in form of stool
  • Rome III is recurrent abdominal pain or discomfort 3 days per month in the last 3 months, associated with two or more of the following: improvement of abdominal pain with defecation, change in frequency of stool, change in appearance of stool; with onset at least 6 months prior to diagnosis
  • There is no specific diagnostic test for IBS; patients who fulfill the clinical criteria for IBS and have no alarm features have a very low probability of organic disease
  • Colonoscopy or colonic imaging is recommended for patients older than 50 years of age due to higher pre-test probability of colorectal cancer
Ulcerative Colitis Colonoscopy shows:
  • rectal involvement
  • Continuous uniform involvement
  • Loss of vascular marking
  • Diffuse erythema
  • Mucosal granularity
  • Normal terminal ileum (or mild 'backwash' ileitis in pancolitis)
Crohn's Disease
  • Patients with colitis are at higher risk of colorectal cancer and need reassessment if symptoms are atypical or do not respond to treatment
 Colonoscopy with intubation of the ileum is the definitive test to diagnose Crohn's disease and will show:
  • Mucosal inflammation
  • Discrete deep or superficial ulcers located transversely and longitudinally, creating a cobblestone appearance
  • Lesions that are discontinuous, with intermittent areas of normal-appearing bowel (skip lesions)
Hemorrhoids
  • Colonoscopy or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
Anal Fissure
  • Colonoscopy or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
Diverticular disease

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

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. ↑ {{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html}}


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