CLINICAL PRESENTATION

ANGANA BHATTACHARJEE 10.03.2017

Malda Medical College

CLINICAL PRESENTATION Patients with COLON CANCER

present in three ways-

VAGUE ABDOMINAL SYMPTOMS AND PALLOR

ASYMPTOMATIC INDIVIDUALS DISCOVERED BY ROUTINE SCREENING

EMERGENCY CONDITION WITH INTESTINAL OBSTRUCTION,PERITONITIS OR RARELY ACUTE GI BLEDDING

CLINICAL PRESENTATION ACCORDING TO ANATOMICAL SITE

RIGHT SIDED COLONIC CANCER

FATIGUE ASSOCIATED WITH ANAEMIA

ALTERED BOWEL HABIT

ABDOMINAL PAIN IN ADVANCED TUMORS

MELENA-DARK TARRY STOOL

RIGHT SIDED ABDOMINAL

MASS

DESCENDING / SIGMOID COLON:

CONSTIPATION ALTERNATING WITH DIARRHOEA,ABDOMINAL

PAIN AND OBSTRUCTIVE SYMPTOMS,MELENA,

PERFORATION

TRANSVERSE: ALTERED BOWEL HABITS,BOWEL

OBSTRUCTION,MELENA

RECTAL:CHANGES IN BOWEL MOVEMENT,RECTAL

FULLNESS,URGENCY,BLEEDING,TENESMUS

ANAL:BLEEDING,DISCHARGE,MASS,

TENDERNESS ON PALPATION,PAIN ON DEFECATION

ADVANCED CANCER PAIN ABDOMEN-COLICKY AND RECURRENT DISTENSION,VOMITTING CONSTIPATION REDUCED BOWEL SOUNDS ON AUSCULTATION DEHYDRATION,TACHYCARDIA, HYPOTENSION PALPABLE LEFT SUPRACLAVICULAR LYMPH

NODES(VIRCHOW’S NODE) METASTATIC FEATURES

COMPLICATIONS STERCORAL ULCER OBSTRUCTION PERFORATION PERITONITIS PERICOLIC ABSCESS

MODE OF SPREAD

LOCAL SPREAD

HEMATOLOGICAL SPREAD

LYMPHATIC SPREAD

LOCAL SPREAD

INVADE THE BLADDER,OBSTRUCT

URETER CAUSING HYDRONEPHROSIS

PERFORATION CAUSING

PERITONITIS,PERICOLIC ABSCESS,FAECAL

FISTULA

ADHERENCE TO PSOAS MUSCLE

POSTERIORLY

INVADE UTERUS,OVARY

ABSCESS IN LATERAL

ABDOMINAL WALL

METASTASIS

LIVER METASTASIS• COMMONEST SITE-SPREADS VIA PORTAL VEINS• ENLARGED LIVER WITH HARD UMBILICATED

NODULES• JAUNDICE• DARK COLOURED URINE• LOSS OF APETITE,WEIGHTLOSS• NAUSEA VOMITTING• CONFUSION• ASCITES

LUNG METASTASIS• COUGH WITH OR WITHOUT

BLOOD • RECURRENT RESPIRATORY

INFECTIONS• HOARSENESS• WHEEZING• SHORTNESS OF BREATH

BONE METASTASIS• BONE PAIN• MUSCLE WEAKNESS AND NUMBNESS• WEAK BONES WITH INCREASED

SUSCEPTIBILITY TO FRACTURE• INCREASED SERUM CALCIUM LEVEL• BONE MARROW SUPPRESSION

MODIFIED DUKE’S CLASSIFICATION

A : GROWTH LIMITED TO BOWEL WALL B : INVADES INTO EXTRABOWEL TISSUES

BUT NO LYMPH NODES ARE INVOLVED B1 : INVADING MUSCULARIS PROPRIA B2 : INVADING INTO OR THROUGH

SEROSA C : LYMPH NODE SECONDARIES D : DISTANT SPREAD