Colorectal Carcinoma Diagnosis | Colorectal Examination
Diagnosis of Colorectal Cancer
- Clinical diagnosis can be attained by signs and symptoms.
- Diagnosis of colorectal carcinoma can be done through physical examination-
- Abdominal examination may be negative.
- Only in case of intestinal obstruction due to stenosing lesion at the recto-sigmoid junction one may palpate distended large bowel filled with stools.
- In late cases one may get enlarged liver fro metastasis, ascites and secondary deposits in the peritoneum.
Rectal examination of colorectal carcinoma
- It is very important and 90% of colorectal carcinoma can be felt digitally.
- All cases of slight rectal problem should be examined by digital examination to exclude carcinoma.
- Typical indurated feel is noticed in case of carcinoma. Even in case of higher growths, bimanual palpation may feel the carcinoma even at the recto-sigmoid junction.
- One finger in the rectum another on the lower part of the abdomen can feel such carcinoma.
- In case of females, one finger in the rectum another in the vagina will give a good idea about the degree of infiltration.
- After rectal examination one must look at the gloved finger whether it is smeared with mucus and blood. If present, the diagnosis is almost certain of cancer.
Special investigations for colorectal cancer -
Proctosigmoidoscopy
It will reveal the growth and may help in taking biopsy.
Biopsy
Whenever a growth is detected through proctoscope or sigmoidoscope a biopsy must be taken from the edge of the tumor and also from the central part of the tumor.
Histological diagnosis is more important and it will also detect the histological grading which is essential to know the prognosis.
Barium enema
It should always be performed even when a carcinoma is detected in the lower part of the rectum.
When sigmoidoscope fails to visualize the growth because of the spasm of the bowel below it, barium enema X-ray is the only easily available diagnostic tool in the hand of surgeon.
When carcinoma has been diagnosed by digital examination or by sigmoidoscopy, even then barium examination should be performed to exclude multiple adenomatous polyposis and other synchronous carcinomas higher up in the colon.
Endorectal ultrasonography (ERUS)
ERUS has revolutionized the management of rectal cancer. The accuracy of digital examination is highly subjective and varies from 60-80%. CT and MRI are not as accurate as this technique in assessing depth of local invasion and involvement of mesorectal lymph nodes.
Colonoscopy
This is only available in a few specialized units, is definitely the best method to exclude any lesion higher up in the colon.
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