Clinical Features

• Weight loss

• Fever

• Night sweats

• Fatigue

• Abdominal discomfort (symptoms similar to diverticulitis, especially in carcinoma of the rectosigmoid or descending colon

• Definition: large bowel malignancies arising from the cecum, ascending colon, or transverse colon

• Clinical features

  • Occult bleeding or melena

  • Manifestations of iron deficiency anemia (due to chronic bleeding)

  • Diarrhea

• Definition: large bowel malignancies arising from the splenic flexure, descending colon, sigmoid colon, or the rectosigmoid junction

• Clinical features

  • Changes in bowel habits (size, consistency, frequency)

  • Blood-streaked stools

  • Colicky abdominal pain (due to obstruction)

• Definition: large bowel malignancies located ≤ 15 cm from the anal verge [9]

• Clinical features

  • Hematochezia

  • ↓ Stool caliber (pencil-shaped stool)

  • Rectal pain

  • Tenesmus

  • Flatulence

  • Fecal incontinence

CRC can metastasize through hematogenous, lymphatic, transperitoneal, and contiguous routes. Symptomatic metastases may be the first manifestation of CRC.

• Liver metastases (most common site of metastasis; 40–50%)

  • Ascites, abdominal distention

  • Hepatomegaly, RUQ pain

  • Jaundice

  • Anorexia, early satiety

• Lung metastases

  • Dyspnea

  • Cough

  • Hemoptysis

  • Pleural effusion

• Peritoneal metastases

  • Ascites, abdominal distension, diffuse abdominal pain

  • Bowel obstruction

• Evidence of distant lymphatic spread: Virchow node (rare)

• Melena, hematochezia

• Altered bowel habits

• Unexplained weight loss

• Unexplained iron deficiency anemia, especially in men older than 50 years of age and postmenopausal women

Because the distal colon has a smaller lumen than the proximal colon and contains solid fecal matter.

Typically, cancers of the colon and upper rectum initially metastasize to the liver via the portal vein, and cancers of the lower rectum initially metastasize to the lung via the inferior vena cava.