Rectal Adenocarcinoma - Colonoscopy (5 of 8)

The presentation depends on the site of the cancer: Right colon cancers: weight loss, anemia, occult bleeding, mass in right iliac fossa, disease more likely to be advanced at presentation. Left colon cancers: often colicky pain, rectal bleeding, bowel obstruction, tenesmus, mass in left iliac fossa, early change in bowel habit, less advanced disease at presentation. The most common presenting symptoms and signs of cancer or large polyps are rectal bleeding, persisting change in bowel habit and anemia. All patients with symptoms suspicious of colorectal cancer must have a thorough abdominal and rectal examination. In some patients, symptoms do not become apparent until the cancer is far advanced. Approximately 55% of patients present with advanced colorectal cancer (spread to the lymph nodes, metastasised to other organs, or is so locally invasive that surgery to remove the primary tumour alone is unlikely to be sufficient for cure Jaundice and hepatomegaly indicate advanced disease with extensive liver metastases. Peritoneal metastases with ascites are often also present. 20-25% of patients have clinically detectable liver metastases at the time of the initial diagnosis and a further 40-50% of patients develop liver metastases within three years of primary surgery. Rarer clinical signs include: pneumaturia, gastro-colic fistula, ischiorectal or perineal abscesses, deep vein thrombosis.