What are the symptoms of colon cancer?
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Symptoms of Colon Cancer
Common Symptoms of Colon Cancer
Rectal Bleeding
Rectal bleeding is one of the most specific symptoms of colon cancer, with a high specificity of 99.4% and a positive predictive value (PPV) of 4.0%1. It is frequently reported among patients, with studies indicating that up to 58% of colorectal cancer patients experience this symptom2. Rectal bleeding is more commonly associated with left-sided colon cancers4.
Abdominal Pain
Abdominal pain is another prevalent symptom, reported by approximately 52% of patients with colorectal cancer2. The pain can vary in location and nature, sometimes mimicking upper gastrointestinal issues3. It is more commonly associated with right-sided colon cancers4.
Change in Bowel Habits
Changes in bowel habits, including constipation, diarrhea, and changes in stool consistency, are reported by about 51% of colorectal cancer patients2. These symptoms are less specific but still significant indicators of potential colorectal cancer1.
Anemia and Occult Bleeding
Anemia and occult bleeding are common systemic symptoms, with anemia present in 57% of patients and occult bleeding in 77%2. These symptoms often lead to the initial suspicion of colorectal cancer, especially in asymptomatic patients identified through screening5.
Bloating and Distended Abdomen
Symptoms such as bloating and a distended abdomen are less specific but still reported among colorectal cancer patients1. These symptoms can be indicative of gastrointestinal issues and warrant further investigation.
Less Common Symptoms
Weight Loss
Unexplained weight loss is another symptom associated with colorectal cancer, although it is less common than the symptoms mentioned above6. Weight loss, along with rectal bleeding, has been shown to have a significant association with colorectal cancer6.
Systemic Symptoms
Systemic symptoms such as fatigue, nausea, and vomiting are also reported among colorectal cancer patients3. These symptoms are often indicative of more advanced disease and can complicate the clinical picture.
Pain in Unusual Locations
In rare cases, colon cancer can present with pain in unusual locations such as the thigh, waist, and back, often due to complications like retroperitoneal abscesses9. These cases are easily misdiagnosed and require careful clinical evaluation.
Diagnostic Challenges
Variability in Symptom Presentation
The presentation of symptoms can vary significantly depending on the location of the cancer within the colon. For instance, rectal bleeding is more common in distal colon cancers, while abdominal pain is more frequently associated with proximal colon cancers1 4. This variability can complicate the diagnostic process.
Importance of Clinical Vigilance
Given the wide range of symptoms and their varying specificity, it is crucial for healthcare professionals to maintain a high level of clinical suspicion when evaluating patients with gastrointestinal symptoms. Early referral for diagnostic tests such as colonoscopy is recommended, especially when symptoms persist or are accompanied by systemic signs like anemia4 7.
Conclusion
Colon cancer presents with a variety of symptoms, the most common being rectal bleeding, abdominal pain, and changes in bowel habits. While some symptoms like rectal bleeding are highly specific, others such as bloating and systemic symptoms are less so. The variability in symptom presentation underscores the importance of thorough clinical evaluation and early diagnostic testing to improve outcomes for patients with suspected colorectal cancer.
Sources and full results
Most relevant research papers on this topic
Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care
Almost all abdominal symptoms could indicate colorectal cancer, but rectal bleeding is the most specific and sensitive, with supplementary information like a positive FOBT or persistent symptoms potentially revising the PPV upwards.
Observational Study
Rigorous JournalHow does colorectal cancer present? symptoms, duration, and clues to location
Colorectal cancer presents with common symptoms, and our decision rule may prompt earlier colonoscopy investigation for patients with "chronic" gastrointestinal symptoms.
Observational Study
Highly CitedSymptoms of carcinoma of the colon and rectum.
Classic symptoms of colon and rectum carcinoma are uncommon, and abdominal pain in these diseases may not indicate advanced disease.
Case ReportSymptoms and Initial Diagnostic Test in Colorectal Cancer Patients
Early colonoscopy is recommended for colorectal cancer patients with abdominal pain or bleeding as their main gastrointestinal symptoms, as fecal occult blood test has limitations.
Observational StudyMost bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review
Colonoscopies are warranted for rectal bleeding and weight loss only, not for other bowel cancer symptoms.
Systematic ReviewRigorous JournalHighly CitedSymptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study
Patients with relevant symptoms and mental health or gastro-intestinal comorbidities may have longer time to diagnosis for colorectal cancer.
Observational StudyRigorous JournalHighly CitedDISTANT MANIFESTATIONS OF COLONIC CARCINOMA
Distant symptoms of colon cancer may be caused by local effects of the tumor in the bowel, or by distant or "paraneoplastic" symptoms resulting from the tumor's spread.
Retroperitoneal abscess as a presentation of colon cancer: The largest case set analysis to date, which extracted from our unit and the literature
Colon cancer with retroperitoneal abscess is a rare and easily misdiagnosed subtype, with pain as the main symptom and CT imaging as the preferred diagnostic method.
Observational StudyDiet and bowel symptoms among colon cancer survivors
One-third of colon cancer survivors perceive that food items, particularly fat and spices, negatively impact their bowel function, with a discrepancy between healthcare professionals providing advice and patients remembering it.
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