Colorectal cancer physical examination: Difference between revisions

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__NOTOC__
{{Colon cancer}}
{{Colon cancer}}
'''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Elliot B. Tapper, M.D., Beth Israel Deaconess Medical Center
To view the physical examination of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis physical examination|'''here''']]<br>
To view the physical examination of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer physical examination|'''here''']]<br><br>
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D. {{USAMA}}


==Overview==
==Overview==
Any sort of suspicion of colorectal cancer requires regular follow-up appointments.
Generally, the most common signs of colorectal cancer are [[emaciation]], [[lethargy]], and [[pallor]]  Other signs include low-grade [[fever]], discomfort on [[palpation]], [[ascites]]  rectal bleeding, rectal mass, and [[jaundice]].


==Physical Examination==
==Colorectal Cancer Physical Examination==
===Appearance===
The physical examination of colorectal carcinoma may show:<ref>{{Cite journal
* The patient may appear pale (because of [[anemia]]) and emaciated (because of [[weight loss]]).
| author = [[Yasmine Samir Galal]], [[Tarek Tawfik Amin]], [[Abdulelah Khalid Alarfaj]], [[Abdulaziz Abdullah Almulhim]], [[Abdullah Abdulmohsen Aljughaiman]], [[Abdulrhaman Khaled Almulla]] & [[Rehab Ahmed Abdelhai]]
| title = Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening
| journal = [[Asian Pacific journal of cancer prevention : APJCP]]
| volume = 17
| issue = 4
| pages = 1837–1846
| year = 2016
| pmid = 27221862
}}</ref><ref>{{Cite journal
| author = [[Carmen Jochem]] & [[Michael Leitzmann]]
| title = Obesity and Colorectal Cancer
| journal = [[Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer]]
| volume = 208
| pages = 17–41
| year = 2016
| doi = 10.1007/978-3-319-42542-9_2
| pmid = 27909900
}}</ref><ref>{{Cite journal
| author = [[Hind Mrabti]], [[Mounia Amziren]], [[Ibrahim ElGhissassi]], [[Youssef Bensouda]], [[Narjiss Berrada]], [[Halima Abahssain]], [[Saber Boutayeb]], [[Samira El Fakir]], [[Chakib Nejjari]], [[Abdellatif Benider]], [[Nawfel Mellas]], [[Omar El Mesbahi]], [[Maria Bennani]], [[Rachid Bekkali]], [[Ahmed Zidouh]] & [[Hassan Errihani]]
| title = Quality of life of early stage colorectal cancer patients in Morocco
| journal = [[BMC gastroenterology]]
| volume = 16
| issue = 1
| pages = 131
| year = 2016
| doi = 10.1186/s12876-016-0538-9
| pmid = 27733117
}}</ref><ref>{{Cite journal
| author = [[Yasmine Samir Galal]], [[Tarek Tawfik Amin]], [[Abdulelah Khalid Alarfaj]], [[Abdulaziz Abdullah Almulhim]], [[Abdullah Abdulmohsen Aljughaiman]], [[Abdulrhaman Khaled Almulla]] & [[Rehab Ahmed Abdelhai]]
| title = Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening
| journal = [[Asian Pacific journal of cancer prevention : APJCP]]
| volume = 17
| issue = 4
| pages = 1837–1846
| year = 2016
| pmid = 27221862
}}</ref><ref>{{Cite journal
| author = [[Samir Pathak]], [[Sanjay Pandanaboyana]], [[Ian Daniels]], [[Neil Smart]] & [[K. R. Prasad]]
| title = Obesity and colorectal liver metastases: Mechanisms and management
| journal = [[Surgical oncology]]
| volume = 25
| issue = 3
| pages = 246–251
| year = 2016
| doi = 10.1016/j.suronc.2016.05.021
| pmid = 27566030
}}</ref><ref>{{Cite journal
| author = [[Masato Watanabe]], [[Masanori Tada]], [[Takafumi Satomi]], [[Daichi Chikazu]], [[Masashi Mizumoto]] & [[Hideyuki Sakurai]]
| title = Metastatic rectal adenocarcinoma in the mandibular gingiva: a case report
| journal = [[World journal of surgical oncology]]
| volume = 14
| issue = 1
| pages = 199
| year = 2016
| doi = 10.1186/s12957-016-0958-6
| pmid = 27473859
}}</ref><ref>{{Cite journal
| author = [[Vivek Subbiah]] & [[Howard Jack West]]
| title = Jaundice (Hyperbilirubinemia) in Cancer
| journal = [[JAMA oncology]]
| volume = 2
| issue = 8
| pages = 1103
| year = 2016
| doi = 10.1001/jamaoncol.2016.1236
| pmid = 27416009
}}</ref>


===Skin===
===General appearance===
* [[Pallor]]
*[[Lethargy]]
* [[Jaundice]] (liver metastasis)
*Palor
*[[Emaciation]]
*[[Confusion]]


===Head===
===Vital Signs===
* [[Lymphadenopathy]] ([[metastasis]])
Vital signs are generally within normal limit, but patients with severe disease may have the following vital signs:
*Low-grade [[fever]]
*Decreased SPO2
*[[Tachypnea]]
*[[Tachycardia]]
*[[Hypotension]]


===Abdomen===
===Abdomen===
* Discomfort on palpation
*Discomfort on palpation
* [[Hepatomegaly]]
*[[Hepatomegaly]]
* Per-rectal exam may reveal [[bleeding]] and mass per rectum
*Absent bowel sounds - may be suggestive of [[intestinal obstruction]]
*[[Ascites]]
 
===Rectal exam===
*[[Rectal bleeding]]
*Rectal mass
 
===Chest===
*Decreased/absent breath sounds


==Follow-ups==
===Skin===
The aims of follow-up are to diagnose in the earliest possible stage any metastasis or tumors that develop later but did not originate from the original cancer (metachronous lesions).
*[[Pallor]]
*[[Jaundice]]


The U.S. [[National Comprehensive Cancer Network]] and [[American Society of Clinical Oncology]] provide guidelines for the follow-up of colon cancer.<ref name="NCCNguidelines">[http://www.nccn.org/professionals/physician_gls/PDF/colon.pdf NCCN Clinical Practice Guidelines in Oncology - Colon Cancer (version 1, 2008: September 19, 2007).]</ref><ref name="ASCOguidelines">{{cite journal |last=Desch CE, Benson AB 3rd, Somerfield MR, ''et al''; American Society of Clinical Oncology |first= |authorlink= |coauthors= |year=2005 |month= |title=Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline |journal=J Clin Oncol |volume=23 |issue=33 |pages=8512-9 |id= |url=http://jco.ascopubs.org/cgi/reprint/JCO.2005.04.0063v1.pdf |accessdate= |quote= }}</ref> A [[medical history]] and [[physical examination]] are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years. [[Carcinoembryonic antigen]] blood level measurements follow the same timing, but are only advised for patients with T2 or greater lesions who are candidates for intervention. A [[Computed tomography|CT-scan]] of the chest, abdomen and pelvis can be considered annually for the first 3 years for patients who are at high risk of recurrence (for example, patients who had poorly differentiated tumors or venous or lymphatic invasion) and are candidates for curative surgery (with the aim to cure). A [[colonoscopy]] can be done after 1 year, except if it could not be done during the initial staging because of an obstructing mass, in which case it should be performed after 3 to 6 months. If a villous polyp, polyp >1 centimeter or high grade dysplasia is found, it can be repeated after 3 years, then every 5 years. For other abnormalities, the colonoscopy can be repeated after 1 year.
===HEENT===
*[[Jaundice]]
*[[Lymphadenopathy]]  


Routine [[Positron emission tomography|PET]] or [[Medical ultrasonography|ultrasound scanning]], [[chest X-ray]]s, [[complete blood count]] or [[liver function tests]] are not recommended.<ref name="NCCNguidelines"/><ref name="ASCOguidelines"/> These guidelines are based on recent meta-analyses showing that intensive surveillance and close follow-up can reduce the 5-year mortality rate from 37% to 30%.<ref name="Cochrane2002">{{cite journal |last=Jeffery M, Hickey BE, Hider PN|first=|authorlink= |coauthors=|year=2002 |month= |title=Follow-up strategies for patients treated for non-metastatic colorectal cancer |journal=Cochrane Database Syst Rev |volume= |issue= |pages= |id=CD002200 |url=http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002200/frame.html |accessdate= |quote= }}</ref><ref name="BMJfollowup">{{cite journal |last=Renehan AG, Egger M, Saunders MP, O'Dwyer ST|first= |authorlink= |coauthors= |year=2002 |month= |title=Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials |journal=BMJ |volume=324 |issue=7341 |pages=831-8 |id= |url=http://www.bmj.com/cgi/reprint/324/7341/813 |accessdate= |quote= }}</ref><ref name="BMCCancerFollowup">{{cite journal |last=Figueredo A, Rumble RB, Maroun J, ''et al''; Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. |first= |authorlink= |coauthors= |year=2003 |month= |title=Follow-up of patients with curatively resected colorectal cancer: a practice guideline. |journal=BMC Cancer |volume=3 |issue= |pages=26 |id= |url=http://www.biomedcentral.com/1471-2407/3/26 |accessdate= |quote= }}</ref>
===Extremities===
*[[Swelling of the legs|Swelling of hands and feet]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Conditions diagnosed by stool test]]
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Latest revision as of 16:12, 18 December 2017

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To view the physical examination of familial adenomatous polyposis (FAP), click here
To view the physical examination of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D. Usama Talib, BSc, MD [2]

Overview

Generally, the most common signs of colorectal cancer are emaciation, lethargy, and pallor Other signs include low-grade fever, discomfort on palpation, ascites rectal bleeding, rectal mass, and jaundice.

Colorectal Cancer Physical Examination

The physical examination of colorectal carcinoma may show:[1][2][3][4][5][6][7]

General appearance

Vital Signs

Vital signs are generally within normal limit, but patients with severe disease may have the following vital signs:

Abdomen

Rectal exam

Chest

  • Decreased/absent breath sounds

Skin

HEENT

Extremities

References

  1. ↑ Yasmine Samir Galal, Tarek Tawfik Amin, Abdulelah Khalid Alarfaj, Abdulaziz Abdullah Almulhim, Abdullah Abdulmohsen Aljughaiman, Abdulrhaman Khaled Almulla & Rehab Ahmed Abdelhai (2016). "Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening". Asian Pacific journal of cancer prevention : APJCP. 17 (4): 1837–1846. PMID 27221862.
  2. ↑ Carmen Jochem & Michael Leitzmann (2016). "Obesity and Colorectal Cancer". Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer. 208: 17–41. doi:10.1007/978-3-319-42542-9_2. PMID 27909900.
  3. ↑ Hind Mrabti, Mounia Amziren, Ibrahim ElGhissassi, Youssef Bensouda, Narjiss Berrada, Halima Abahssain, Saber Boutayeb, Samira El Fakir, Chakib Nejjari, Abdellatif Benider, Nawfel Mellas, Omar El Mesbahi, Maria Bennani, Rachid Bekkali, Ahmed Zidouh & Hassan Errihani (2016). "Quality of life of early stage colorectal cancer patients in Morocco". BMC gastroenterology. 16 (1): 131. doi:10.1186/s12876-016-0538-9. PMID 27733117.
  4. ↑ Yasmine Samir Galal, Tarek Tawfik Amin, Abdulelah Khalid Alarfaj, Abdulaziz Abdullah Almulhim, Abdullah Abdulmohsen Aljughaiman, Abdulrhaman Khaled Almulla & Rehab Ahmed Abdelhai (2016). "Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening". Asian Pacific journal of cancer prevention : APJCP. 17 (4): 1837–1846. PMID 27221862.
  5. ↑ Samir Pathak, Sanjay Pandanaboyana, Ian Daniels, Neil Smart & K. R. Prasad (2016). "Obesity and colorectal liver metastases: Mechanisms and management". Surgical oncology. 25 (3): 246–251. doi:10.1016/j.suronc.2016.05.021. PMID 27566030.
  6. ↑ Masato Watanabe, Masanori Tada, Takafumi Satomi, Daichi Chikazu, Masashi Mizumoto & Hideyuki Sakurai (2016). "Metastatic rectal adenocarcinoma in the mandibular gingiva: a case report". World journal of surgical oncology. 14 (1): 199. doi:10.1186/s12957-016-0958-6. PMID 27473859.
  7. ↑ Vivek Subbiah & Howard Jack West (2016). "Jaundice (Hyperbilirubinemia) in Cancer". JAMA oncology. 2 (8): 1103. doi:10.1001/jamaoncol.2016.1236. PMID 27416009.


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