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Signs and Symptoms
The American Cancer society and other professional organizations
have long recognized that signs and symptoms can suggest colon and
rectal cancer. Patients are encouraged to seek evaluation if they
notice blood in the stool, change in bowel habits, (including change
in frequency, size, shape or urgency of bowel movements), or abdominal
or rectal pain. None of these symptoms are diagnostic of colon or
rectal cancer, but they need to be evaluated.
"What other conditions can cause symptoms similar to colon
and rectal cancer?"
The symptoms noted above are more often than not caused by conditions
other than cancer, including: polyps, diverticular disease, irritable
bowel syndrome, hemorrhoids, or fissures. Polyps are small growths
in the colon that many physicians believe precede colon cancer.
They are good to find and remove. They often look like a cherry
on a stalk. Diverticular disease is recognized by small sac like
projections through the muscle wall of the bowel. These small areas
of weakness can rupture and cause life threatening infections in
the abdomen. Hemorrhoids are enlarged veins around the anus. Veins
in this area are normal. It is only when they become enlarged and
protrude or bleed that we call them hemorrhoids. They are not precancerous.
Small injuries to the lining of the anal canal are call fissures
or ulcers. They can cause blood in the stool and be painful with
bowel movements.
"Do I have a sign or symptom of colon and rectal cancer?"
The answer should be a simple yes or no. If you wonder if you do,
then you should assume that you do. The risks of missing a colon
and rectal cancer are potentially devastating.
The signs of symptoms of colon and rectal cancer include unexplained
weight loss, blood in the stool, change of bowel habits (diarrhea
or constipation), and abdominal pain. The source of any of these
signs and symptoms needs to be determined. Looking for small amounts
of blood in the stool is not an adequate examination. There is no
test, physical examination, or x-ray, which will tell you whether
you have colon cancer. Only a biopsy of a lesion will tell you that.
However, some of these tests may be suspicious for an abnormality,
and then a biopsy can be ordered if necessary. The only security
you can have is that if an experienced clinician evaluates your
situation and orders the appropriate tests to put your mind at ease.
Any abnormality that is found needs to be pursued. As discussed
earlier, there are various ways to pursue these including barium
enema, colonoscopy, proctoscopy, and flexible sigmoidoscopy. If
such an abnormality exists, it demands explanation.
What Physicians are Looking For
All abnormalities of the colon take place in the bowel wall. They
generally start on the inside and grow into the lumen, or hollow
area of the bowel. Therefore, physicians are looking for abnormalities
that are protruding into the lumen of the bowel. These are called
polyps. All cancers are preceded by polyps.
Polyps and Biopsies
Not always. If the x-ray is so typical of a cancer or of a polyp,
then a biopsy is not necessary. In areas of question, then a confirmatory
examination and a biopsy is appropriate. Similarly, if the appearance
to the physician during colonoscopy is so typical of a cancer that
the diagnosis is clear, then a biopsy is not necessary. Furthermore,
if a biopsy is performed but fails to confirm the diagnosis of cancer,
yet the physician felt that cancer was the diagnosis, then it should
be treated as a cancer.
Biopsies are notorious for having sampling errors. By this we mean
that biopsies take a very, very small piece of the growth. The physician
will make an effort to get the biopsy that is felt to be representative
of the overall area of concern. If, however, the biopsy is inadequate
or fails to get a representative specimen, then an erroneous diagnosis
can be generated. Therefore, it is the combination of the appearance
of the lesion and the findings on the biopsy will be responsible
for the final recommendation that the physician will make.
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