Colorectal cancer differential diagnosis
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To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
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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 may 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
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[1].
| 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
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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) |
| 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) |
| 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 |
| 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 |
| 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 |
Other conditions that can be mistaken for colorectal cancer including 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
References
- ↑ {{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html}}