Colorectal cancer
Background
- Colorectal cancer is extremely common
Clinical Features
- Asymptomatic, frequently grow slowly for long period of time before symptomatic
- Lower GI bleeding (occult or visible BRBPR/hematochezia
- Fatigue, generalized weakness due to anemia
- Change in bowel habits, constipation, tenesmus in rectal cancer
- Obstruction if mass large enough (left colon > right)
- Abdominal pain
- Focal pain or Peritonitis if perforation
- Abdominal pain
- Signs/symptoms of metastatic disease (e.g. hepatomegaly, ascites, lymphadenopathy) may be initial presentation
Differential Diagnosis
Lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fisulta
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic Pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal Hernia
- Mesenteric Ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Evaluation
- CBC, LFTs, coags if bleeding or signs of hepatic involvement
- CT abdomen- not definitive but may catch large mass or other alternative diagnoses
- Definitive diagnosis not likely to be made in ED, but suggestion of malignancy may be made on imaging if large mass seen
- Colonoscopy with biopsy
- Serum CEA
- Surgical pathology
Management
- Transfuse pRBCs prn for anemia
- Consult surgery for obstruction or perforation
- May also help coordinate outpatient diagnostic workup
Disposition
- Discharge if clinically stable
See Also
External Links
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