DR Medhat MRCP

• Clinical picture :
1) Change in bowel hapit (new onset constipation or spurious diarrhoea)
2) Fe deficiency anaemia.
Any patient >50 years old with newly onset
3) Rectal bleeding.
abdominal pain + weight loss + rectal bleeding =
4) Weight loss.
colonic cancer until proved otherwise by colonoscopy
5) Abdominal pain
6) Evidence of metastasis (hepatomegaly, ascitis).
• Investigations :
Colonoscopy & biopsy :
- It`s the 1 st investigation of choice in patient without co-morbid diseases.
- Biopsy shows most commonly adenocarcinoma.
- If it`s incomplete→ repeat colonoscopy or →CT colonography or barium enema.
- The most common site is sigmoid colon then rectum.
- Staging & grading (Duke staging):
1. Stage 0 : high grade dysplasia.
2. Stage I (A) : tumor limited to the bowel wall (mucosa & submucosa).
3. Stage II (B) : tumor through bowel wall (penetrating ms layer & serosa).
4. Stage III (C): tumor present in regional lymph nodes.
5. Stage IV (D) : distant metastasis (lung ,liver,bone,brain).
Flexible sigmoidoscopy : 1 st choice if the patient has co-morbid disease e.g IHD, CHF.
Barium enema :
- Considered in elderly or frail or when colonoscopy has been unsuccessful.
- It shows `apple-core` lesion (i.e circumferential narrowing of the lumen).
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