ELDER TIP Older patients may ignore bowel symptoms, believing that they result from constipation, poor diet, or hemorrhoids. Evaluate your older patient's responses to your questions carefully.
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stools; anemia; and abdominal aching, pressure, or dull cramps. As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs or symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
On the left side, a tumor causes signs of an obstruction even in early stages because in this area stools are of a formed consistency. It commonly causes rectal bleeding (in many cases ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure. As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stools. Typically, he notices that passage of stools or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the feces and mucus in or on the stools.
With a rectal tumor, the first symptom is a change in bowel habits, in many cases beginning with an urgent need to defecate on arising (morning diarrhea) or obstipation alternating with diarrhea. Other signs are blood or mucus in stools and a sense of incomplete evacuation. Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull, and sometimes constant, ache confined to the rectum or sacral region.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Extramedullary tumors produce symptoms by pressing on nerve roots, the spinal cord, and spinal vessels; intramedullary tumors, by destroying the parenchyma and compressing adjacent areas. Because intramedullary tumors may extend over several spinal cord segments, their symptoms are more variable than those of extramedullary tumors.
The following clinical effects are likely with all malignant spinal cord neoplasms:
❑Pain — Most severe directly over the tumor, radiates around the trunk or down the limb on the affected side and is unrelieved by bed rest. It may worsen when lying down or with straining, coughing, or sneezing. Pain can be diffuse, occurring over all extremities. Generally, it progressively worsens and isn't relieved by medication.
❑ Motor symptoms — Asymmetric spastic muscle weakness, decreased muscle tone, exaggerated reflexes, and a positive Babinski's sign. If the tumor is at the level of the cauda equina, muscle flaccidity, muscle wasting, weakness, and progressive diminution in tendon reflexes are characteristic.
❑ Sensory deficits — Contralateral loss of pain, temperature, and touch sensation (Brown-Séquard's syndrome). These losses are less obvious to the patient than functional motor changes. Caudal lesions invariably produce paresthesias in the nerve distribution pathway of the involved roots.
❑Bowel and bladder symptoms — Urine retention is an inevitable late sign with cord compression. Early signs include incomplete emptying or difficulty with the urine stream, which is usually unnoticed or ignored. Cauda equina tumors cause bladder and bowel incontinence due to flaccid paralysis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Inactive colon:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
The primary symptom of inactive colon is chronic constipation. The patient commonly strains to produce hard, dry stools accompanied by mild abdominal discomfort. Straining can aggravate other rectal conditions such as hemorrhoids.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Rectal polyps:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Because rectal polyps don’t generally cause symptoms, they’re usually discovered incidentally during a digital examination or rectosigmoidoscopy. Rectal bleeding is a common sign; high rectal polyps leave a streak of blood on the stool, whereas low rectal polyps bleed freely.
Rectal polyps vary in appearance. Common polypoid adenomas are small, multiple lesions that are redder than normal mucosa. They’re commonly pedunculated (attached to rectal mucosa by a long, thin stalk) and granular, with a red, lobular, or eroded surface.
Villous adenomas are usually sessile (attached to the mucosa by a wide base) and vary in size from 0.5 to 12 cm. They are soft, friable, and finely lobulated. They may grow large and cause painful defecation; however, because adenomas are soft, they rarely cause bowel obstruction. Sometimes adenomas prolapse outside the anus, expelling parts of the adenoma with feces. These polyps may cause diarrhea, bloody stools, and subsequent fluid and electrolyte depletion, with hypotension and oliguria.
In hereditary polyposis, rectal polyps resemble benign adenomas but occur as hundreds of small (0.5 cm) lesions carpeting the entire mucosal surface. Associated signs include diarrhea, bloody stools, and secondary anemia. In patients with hereditary polyposis, changes in bowel habits with abdominal pain usually signal rectosigmoid cancer.
Juvenile polyps are large, inflammatory lesions, commonly without an epithelial covering. Mucus-filled cysts cover their usually smooth surface.
Focal polypoid hyperplasia produces small (less than 3 mm), granular, sessile lesions, similar to the colon in color, or gray or translucent. They usually occur at the rectosigmoid junction.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Colorectal cancer:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms of colorectal cancer result from local obstruction and, in later stages, from direct extension to adjacent organs (bladder, prostate, ureters, vagina, sacrum) and distant metastasis (usually to the liver).
In the early stages, signs and symptoms are typically vague and depend on the anatomical location and function of the bowel segment containing the tumor. Later, they generally include pallor, cachexia, ascites, hepatomegaly, and lymphangiectasis.
Cancer on the right side
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stool; anemia; and abdominal aching, pressure, or dull cramps.
As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
Cancer on the left side
On the left side, a tumor causes signs and symptoms of an obstruction even in early stages because in this area, stool is of a formed consistency. It commonly causes rectal bleeding (typically ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure.
As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stool. Typically, he notices that passage of stool or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the stool and mucus in or on the stool.
Rectal tumor signs
With a rectal tumor, the first indication is a change in bowel habits, often beginning with an urgent need to defecate on arising (“morning diarrhea”) or obstipation alternating with diarrhea. Other indications include blood or mucus in stool and a sense of incomplete evacuation.
Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull and sometimes constant ache confined to the rectum or sacral region.
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Source: Handbook of Diseases, 2003
Article Excerpts About Symptoms of Colorectal cancer:
Colorectal Cancer: NWHIC (Excerpt)
Colorectal cancer is sometimes called a silent killer. This is because
a person can have no symptoms at all at the start of the illness. As the
cancer worsens, symptoms start to appear. The good news is that this
cancer, if caught early, can be treated and often cured. The even better
news is that it can be prevented with screening tests and a healthy
lifestyle. (Source: excerpt from Colorectal Cancer: NWHIC)
Colorectal Cancer: NWHIC (Excerpt)
There are often no symptoms for colorectal cancer in its early stages,
which is why screening tests are important. People who do have symptoms
can have:
-
A change in bowel habits
-
Diarrhea, constipation, or feeling that the bowel doesn't
empty completely
-
Bright red or very dark blood in the stool
-
Stools that are narrower than normal
-
Discomfort in the abdomen - frequent gas pains, bloating,
fullness, and/or cramps
-
Weight loss with no known reason
-
Constant and extreme tiredness
-
Vomiting
-
Anemia (low iron in the blood) with no known reason
Some of these symptoms can be caused by other conditions. Talk with
your health care provider right away if you think you are having any of
these symptoms. (Source: excerpt from Colorectal Cancer: NWHIC)
What You Need To Know About Cancer of the Colon and Rectum: NCI (Excerpt)
Common signs and symptoms of colorectal cancer include:
-
A change in bowel habits
-
Diarrhea, constipation, or feeling that the bowel does
not empty completely
-
Blood (either bright red or very dark) in the stool
-
Stools that are narrower than usual
-
General abdominal discomfort (frequent gas pains,
bloating, fullness, and/or cramps)
-
Weight loss with no known reason
-
Constant tiredness
-
Vomiting
(Source: excerpt from What You Need To Know About Cancer of the Colon and Rectum: NCI)
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