Colorectal cancer physical examination: Difference between revisions
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===Abdomen=== | ===Abdomen=== | ||
* Discomfort on palpation | * Discomfort on palpation | ||
* [[Hepatomegaly]] | |||
* Per-rectal exam may reveal [[bleeding]] and mass per rectum | * Per-rectal exam may reveal [[bleeding]] and mass per rectum | ||
Revision as of 14:39, 9 August 2012
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Elliot B. Tapper, M.D., Beth Israel Deaconess Medical Center
Overview
Any sort of suspicion of colorectal cancer requires regular follow-up appointments.
Physical Examination
Appearance
- The patient may appear pale (because of anemia) and emaciated (because of weight loss).
Skin
Head
Abdomen
- Discomfort on palpation
- Hepatomegaly
- Per-rectal exam may reveal bleeding and mass per rectum
Follow-ups
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).
The U.S. National Comprehensive Cancer Network and American Society of Clinical Oncology provide guidelines for the follow-up of colon cancer.[1][2] 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 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.
Routine PET or ultrasound scanning, chest X-rays, complete blood count or liver function tests are not recommended.[1][2] 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%.[3][4][5]
References
- ↑ 1.0 1.1 NCCN Clinical Practice Guidelines in Oncology - Colon Cancer (version 1, 2008: September 19, 2007).
- ↑ 2.0 2.1 Desch CE, Benson AB 3rd, Somerfield MR, et al; American Society of Clinical Oncology (2005). "Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline" (PDF). J Clin Oncol. 23 (33): 8512–9.
- ↑ Jeffery M, Hickey BE, Hider PN (2002). "Follow-up strategies for patients treated for non-metastatic colorectal cancer". Cochrane Database Syst Rev. CD002200.
- ↑ Renehan AG, Egger M, Saunders MP, O'Dwyer ST (2002). "Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials". BMJ. 324 (7341): 831–8.
- ↑ Figueredo A, Rumble RB, Maroun J, et al; Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. (2003). "Follow-up of patients with curatively resected colorectal cancer: a practice guideline". BMC Cancer. 3: 26.