Colorectal cancer differential diagnosis: Difference between revisions

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Revision as of 19:14, 23 January 2019

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

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

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

Colorectal cancer must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, inflammatory bowel disease, cystitis, and endometritis.^[1]^[2]^[3]^[4]^[5]^[6]

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

	Symptoms				Lab Findings		Imaging			Histopathology
Diseases	Clinical manifestations				Para-clinical findings						Gold standard	Comments
	Symptoms				Para-clinical findings
	Constipation/Diarrhea	Blood in stool	Abdominal pain	Other symptoms	Anemia	Tumor marker	Endoscopy	CT scan	Other diagnostic study	Histopathology
Adenocarcinoma
Arteriovenous malformation^[7]	-	+	-	-	+	-	Bright red, flat lesions Rarely, polypoid	-	-	Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa. Arteries directly connected to veins without capillary beds
Diverticular diseases^[8]	Constipation and/or Diarrhea^[9]	+/-	+	Fever, chills^[9] Nausea/vomiting(N/V)	-	-	Not recommended ^[9]	Outpouchings of the colonic wall (Diverticula)^[9] Inflamed diverticula Abscess formation Intraperitoneal free air (microperforation)	Barium enema: Circumferential narrowing^[10] Spiculated contour and tapered margins
Hemorrhoids^[11]	Constipation	+	-	Perianal Itching Pain with defecation Painful, hard lump in anus	+	-	Anoscopy: Protruding mass from the anus	-	DRE: Palpable mass, tender if thrombosed
Anal fissure^[12]	-	+	-	Painful defecation Itching Irritation	+/-	-	Anoscopy: Anal wall laceration	-	-
Infectious colitis^[13]	Diarrhea	+	+	Fever, chills N/V Bloating	-	-	Patchy or diffuse erythematous mucosa Edema, hemorrhage, with or without ulcers of mucosa	-	Stool cultures in adequate culture media Stool analysis: Leukocytosis
Peutz-Jeghers syndrome^[14]	+/-	+	+	Mucocutaneous hyperpigmentation (mouth, hands, and feet)^[15]^[16]^[17] Fatigue Weight loss Rectal prolapse	+	+/-	Multiple polyps ^[18] mucocutaneous pigmentation	Multiple polyps Intussusception Bowel obstruction^[19]	Barium enema PET-CT MRI	Multiple hamartomatous polyps on histological analysis^[20]^[21]	Genetic testing for STK11 Colonoscopy ^[22]
Carcinoids^[23]	Diarrhea	+/-	+	Flushing^[24] Wheezing Shortness of breath Palpitations Weight gain Hirsutism Weakness Leg edema	+	Urinary 5-hydroxyindoleacetic acid (5-HIAA)^[25] Chromogranin A (CgA) Other biochemical markers include: Substance P Neurotensin Bradykinin Human chorionic gonadotropin Neuropeptide L Pancreatic polypeptide	Infiltrating, ulcerating or fungating lesions in the wall of colon	Well-defined single or multiple lesions Round or ovoid in shape Variable in size ranges between 2-5 cm	PET scan MRI Ki-67 index^[26]	Solid or spongy nests of cells accentuated by neatly outlined luminal spaces ^[27] Peripheral nuclear palisading Granular eosinophilic cytoplasm.	Biopsy and histopathological analysis
Juvenile Polyposis Coli^[28]	Diarrhea	+	+	Prolapsing polyp^[29] Intussusception Macrocephalus Hypotonia	+	-	>5 juvenile polyps in the colon and rectum^[30] Multiple juvenile polyps in gastrointestinal tract	Will show multiple polyps in gastrointestinal tract	PET scan MRI	Hamartomatous polyps on histopathological analysis	Visualization of multiple polyps in gastrointestinal tract by endoscopy	Individuals who meet clinical criteria should get genetic testing germline mutation in the BMPR1A and SMAD4 genes.^[31] Increased risk of colorectal and gastric cancer^[32]
Gastrointestinal Stromal Tumors (GIST)^[33]^[34]	+/-	+/-	+/-	Mostly asymptomatic^[35] Are discovered incidentally Non-specific symptoms Early satiety and bloating	+/-	KIT protein CD 117 antigen	Subepithelial round masses Smooth margins Normal overlying mucosa may be intact or ulcerated Bulging into gastrointestinal lumen	Study of choice Evaluate extent and dimensions Evaluate metastatic disease	MRI Endoscopic ultrasonography PET scan^[36]	Spindle cell type are eosinophilic cells arranged in the form of whorls or fascicles.^[37]^[38] Epithelioid GISTs are rounded cells with oval nuclei and vesicular chromatin and appears nested^[39] On immunohistochemical staining they are positive for molecular markers CD117 antigen and KIT protein.	Biopsy and histopathological analysis	Cytologic analysis, and immunohistochemistry for KIT protein expression confirms the diagnosis of these lesions
Hamartoma^[40]	Diarrhea	+	Depending on location	Tenesmus	-	S100 (mucosal Schwann cell hamartoma (MSCH))	Large polypoid mass	Isodense or hypodense solid masses Heterogeneous mass Presence of fat in a well circumscribed nodule Calcification	Biopsy: Proliferation of bland spindle cells in the lamina propria (mucosal Schwann cell hamartoma (MSCH))	poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct Involvement of mucosa but never the submucosa	Biopsy
Colorectal Lymphoma^[41]^[42]	Normal	+/-	Depending on location	Weight loss	+	Non-Hodgkin’s lymphomas: CD-20	Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions	CT scan: polypoid mass, circumferential-cavitary lesions, focal mucosal nodularity, diffuse ulcerative or nodular lesions, regional lymph node involvement	Biopsy: Diffuse large B-cell lymphoma Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma Double-contrast enema: Subtle mucosal changes, gross tumor morphology	Diffuse large B-cell lymphoma: Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma	Biopsy
Kaposi's sarcoma^[43]	Diarrhea	+	Diffuse	Melena Hematochezia Abdominal pain N/V	+	CD34 CD31 D2-40 HHV-8 FHI-1 antibody LANA-1	Localized purpuric lesion	N/A	Electrophoresis: antibodies against Kaposi sarcoma herpes virus (HHV-8) Biopsy: Vascular proliferation, red blood cell and hemosiderin extravasation,lymphocytes and monocytes, neovascular lesion wrapped around a pre-existing space, intracytoplasmic PAS +ve hyaline globules	Vascular proliferation Red blood cell and hemosiderin extravasation Lymphocytes and monocytes Premonitory sign (a neovascular lesion wrapped around a pre-existing space) Intracytoplasmic PAS +ve hyaline globules	Biopsy
Ulcerative colitis^[44]	Diarrhea	+	LLQ^[44]		+		Continuous lesions^[44] Erythema (or redness of the mucosa) and friability of the mucosa Crypts, formation of residual mucosal tissue Pseudopolyps	-		Mucosal and submucosal inflammation^[44] Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria Distorted crypts Crypt abscess	Endoscopy and a mucosal biopsy^[45]
Crohn's disease^[44]	Diarrhea	+	LRQ^[44]	Tenesmus	+		Discontinuous lesions Strictures Linear ulcerations^[44]	-		Transmural pattern of inflammation^[44] Mucosal damage Focal infiltration of leukocytes into the epithelium Granulomas	Endoscopy and a mucosal biopsy^[45]
Irritable bowel syndrome	Constipation and/or diarrhea	+		Straining during defecation Urgency Sensation of incomplete evacuation Mucus passage Bloating Weight loss	-	-	Nor recommended	-	Diagnosis of exclusion with fulfilment of Rome criteria^[46]	-	Clinical diagnosis (Rome criteria)^[46]
Appendicitis^[47]	Diarrhea	-	RLQ	Pain starting periumbilical before localizing to the right iliac fossa N/V Fever, chills Loss of appetite	-	-	-	Appendiceal wall thickening (wall ≥ 3mm) Periappendiceal fat stranding Thickening of the lateral conal fascia and mesoappendix Extraluminal fluid Phlegmon Abscess	Tc-99m labeled anti-CD15 antibodies Ultrasound: Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter) Appendicolith Echogenic prominent pericaecal fat Periappeniceal fluid collection		CT scan
Strangulated hernia	Constipation	-	RLQ	N/V Heaviness or dull discomfort in the groin, with straining, lifting, coughing, or exercising Weakness, heaviness, burning, or aching in the groin Pain and swelling Fever	-	-	-	Defect in the abdominal wall muscles Appearance of bowel loops within the lesion Lateral crescent sign The hernia neck will be superolateral to the course of the inferior epigastric vessels.
Bowel endometriosis^[48]	Constipation and/or Diarrhea	+	Pelvic pain	Dyschezia Tenesmus	+	-	N/A	N/A	Transvaginal ultrasonography: heterogeneous, hypoechoic, spiculated mass Barium enema: Extrinsic mass compressing the bowel, fine crenulation of the mucosa, bowel strictures at the rectosigmoid junction T1-weighted or fat-suppression T1-weighted MRIs: Contrast enhanced mass or hyperintense foci, hemorrhagic foci or hyperintense cavities	N/A	Transvaginal ultrasonography

References

↑ 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.
↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
↑ 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.
↑ 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.
↑ ^9.0 ^9.1 ^9.2 ^9.3 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.
↑ 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.
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↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
↑ 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.
↑ 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.
↑ 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.
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↑ 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.
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Template:WikiDoc Sources

[pmid17573742-1] 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

[pmid8596552-3] Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.

[hhh-4] Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016

[nlm-5] Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016

[pmid27107781-6] Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.

[pmid28139503-7] 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.

[pmid16187597-8] 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.

[ShenChen2005-9] 9.0 ^9.1 ^9.2 ^9.3 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.

[SheimanLevine20082-10] 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.

[JacobsSolomon2014-11] Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.

[pmid27041801-12] Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.

[pmid22080825-13] 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.

[pmid27298573-14] 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.

[KopacovaTacheci20092-15] 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.

[GiardielloTrimbath2006-16] 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.

[urlPeutz-Jeghers_syndrome_|_Genetic_and_Rare_Diseases_Information_Center_(GARD)_–_an_NCATS_Program-17] "Peutz-Jeghers syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".

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[BeggsLatchford2010-21] 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.

[KopacovaTacheci20093-22] 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.

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@@ Line 11: / Line 11: @@
 *Colorectal cancer must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[cystitis]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742  }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552  }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref>
+'''Other conditions that can be mistaken for colorectal cancer include the following:'''
+*Benign colon polyps
+*[[Ischemic colitis]]
+*[[Infectious colitis]]
+*[[Arteriovenous malformation]] ([[AVM]])
+*[[Carcinoid]]/[[neuroendocrine]] tumors
+*[[Small intestine]] carcinomas
+*Gastrointestinal lymphoma
+*[[Ileus]]
+*[[Pregnancy]]
+*[[Appendicitis]]
+*[[Hernia]]
+*[[Lactose intolerance]]
+*[[Flatulence]]
+*[[Ulcer]]
+*[[Cholecystitis]]
 {| class="wikitable"
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
 | colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
-! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
+! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
 | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Comments
@@ Line 21: / Line 37: @@
 | colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
 |-
-! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
 ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
@@ Line 30: / Line 46: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
-! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor marker
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor marker
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Endoscopy
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
@@ Line 44: / Line 60: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-| colspan="2" style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 58: / Line 74: @@
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
 * Bright red, flat lesions
@@ Line 81: / Line 97: @@
 * [[Nausea and vomiting|Nausea/vomiting(N/V)]]
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |Not recommended <ref name="ShenChen2005">{{cite journal|last1=Shen|first1=Shu-Huei|last2=Chen|first2=Jen-Dar|last3=Tiu|first3=Chui-Mei|last4=Chou|first4=Yi-Hong|last5=Chiang|first5=Jen-Huei|last6=Chang|first6=Cheng-Yen|last7=Lee|first7=Chen-Hsen|title=Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting|journal=Journal of the Chinese Medical Association|volume=68|issue=9|year=2005|pages=411–418|issn=17264901|doi=10.1016/S1726-4901(09)70156-X}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 105: / Line 121: @@
 * Painful, hard lump in anus
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Anoscopy]]: Protruding mass from the [[anus]]
@@ Line 124: / Line 140: @@
 * [[Irritation]]
 | style="background: #F5F5F5; padding: 5px;" | +/-
-| colspan="2" | -
+| -
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Anoscopy]]: Anal wall laceration
@@ Line 143: / Line 159: @@
 * [[Bloating]]
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
 * Patchy or diffuse [[Erythematous|erythematous mucosa]]
@@ Line 155: / Line 171: @@
 | style="background: #F5F5F5; padding: 5px;" |
 |-
-'''Other conditions that can be mistaken for colorectal cancer include the following:'''
-*Benign colon polyps
-*[[Ischemic colitis]]
-*[[Infectious colitis]]
-*[[Arteriovenous malformation]] ([[AVM]])
-*[[Carcinoid]]/[[neuroendocrine]] tumors
-*[[Small intestine]] carcinomas
-*Gastrointestinal lymphoma
-*[[Ileus]]
-*[[Pregnancy]]
-*[[Appendicitis]]
-*[[Hernia]]
-*[[Lactose intolerance]]
-*[[Flatulence]]
-*[[Ulcer]]
-*[[Cholecystitis]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome]]<ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" | +/-
@@ Line 198: / Line 196: @@
 * Multiple [[hamartomatous]] [[polyps]] on [[Histological|histological analysis]]<ref name="urlPeutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1266/#pjs.Diagnosis |title=Peutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Genetic testing]] for [[STK11]]
 *[[Colonoscopy]] <ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+|
-|-
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
-| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
-! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
-| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
-! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Comments
 |-
-| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
-|-
-! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
-! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
-! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
-|-
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constipation/Diarrhea
-! 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;" |Other symptoms
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor Markers
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other imaging
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoid|Carcinoids]]<ref name="pmid20011309">{{cite journal |vauthors=Chung TP, Hunt SR |title=Carcinoid and neuroendocrine tumors of the colon and rectum |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=45–8 |date=May 2006 |pmid=20011309 |pmc=2780103 |doi=10.1055/s-2006-942343 |url=}}</ref>
@@ Line 267: / Line 242: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Biopsy]] and [[Histopathology|histopathological analysis]]
-| style="background: #F5F5F5; padding: 5px;" |
+|
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Juvenile polyposis syndrome|Juvenile Polyposis Coli]]<ref name="pmid7054044">{{cite journal |vauthors=Grotsky HW, Rickert RR, Smith WD, Newsome JF |title=Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred |journal=Gastroenterology |volume=82 |issue=3 |pages=494–501 |date=March 1982 |pmid=7054044 |doi= |url=}}</ref>
@@ Line 292: / Line 267: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Visualization of multiple [[polyps]] in [[gastrointestinal tract]] by [[endoscopy]]
-| style="background: #F5F5F5; padding: 5px;" |
+|
 * Individuals who meet clinical criteria  should get genetic testing  germline mutation in the ''BMPR1A'' and ''SMAD4'' genes.<ref name="pmid229654022">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>
@@ Line 298: / Line 273: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |+/-
+| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |+/-
+| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |+/-
+| style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" |
 * Mostly [[asymptomatic]]<ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
@@ Line 306: / Line 281: @@
 * Non-specific symptoms
 * Early satiety and bloating
-| style="background: #F5F5F5; padding: 5px;" |+/-
+| style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" |
 * KIT protein
@@ Line 329: / Line 304: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Biopsy]] and [[Histopathological|histopathological analysis]]
-| style="background: #F5F5F5; padding: 5px;" |
+|
 * [[Cytological|Cytologic analysis]], and [[immunohistochemistry]] for KIT protein expression confirms the [[diagnosis]] of these [[Lesion|lesions]]
 |-
@@ Line 340: / Line 315: @@
 * [[Tenesmus]]
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 * S100 (mucosal Schwann cell hamartoma (MSCH))
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 367: / Line 342: @@
 * Weight loss
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 * Non-Hodgkin’s lymphomas: CD-20
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 404: / Line 379: @@
 * [[Nausea and vomiting|N/V]]
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 * [[CD34]]
 * [[CD31]]
@@ Line 435: / Line 410: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 * Continuous lesions<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>
@@ Line 461: / Line 436: @@
 *
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 493: / Line 467: @@
 * Weight loss
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |Nor recommended
 | style="background: #F5F5F5; padding: 5px;" | -
@@ Line 514: / Line 488: @@
 * [[Anorexia|Loss of appetite]]
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 551: / Line 525: @@
 | style="background: #F5F5F5; padding: 5px;" | -
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 576: / Line 550: @@
 * Tenesmus
 | style="background: #F5F5F5; padding: 5px;" | +
-| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A

Colorectal cancer differential diagnosis: Difference between revisions

Revision as of 19:14, 23 January 2019

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Colorectal Cancer Differential Diagnosis

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