Colorectal cancer history and symptoms
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
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Overview
History
The following history should be inquired when suspecting colorectal cancer in a patient:
- History of change in bowel habits
- History of bleeding per rectum
- History of excessive fatigue
- History of unexplained weight loss
- History of any abdominal pain
- History of tobacco use/smoking
- Any family history of colorectal cancer
Symptoms
Colon cancer often causes no symptoms until it has reached a relatively advanced stage. Thus, many organizations recommend periodic screening (see below). When symptoms do occur, they depend on the site of the lesion. Generally speaking, the nearer the lesion is to the anus, the more bowel symptoms there will be, such as:
- Change in bowel habits
- change in frequency (constipation and/or diarrhea),
- change in the quality of stools
- change in consistency of stools
- Bloody stools or rectal bleeding
- Stools with mucus
- Tarry stools (melena) (more likely related to upper gastrointestinal eg stomach or duodenal disease)
- Feeling of incomplete defecation (tenesmus) (usually associated with rectal cancer)
- Reduction in diameter of feces
- Bowel obstruction (rare)
Constitutional symptoms
Especially in the cases of cancer in the ascending colon, sometimes only the less specific constitutional symptoms will be found:
- Anemia, with symptoms such as dizziness, malaise and palpitations. Clinically there will be pallor and a complete blood picture will confirm the low hemoglobin level, often with low mean corpuscular volume.
- Anorexia
- Asthenia, weakness
- Unexplained weight loss.
Metastatic symptoms
There may also be symptoms attributed to distant metastasis:
- Shortness of breath as in lung metastasis
- Epigastric or right upper quadrant pain, as in liver metastasis. Rarely there can be jaundice if the outflow of bile is blocked. Clinically there might be liver enlargement.