Diagnosis for Colorectal Cancer

Once cancer is suspected through either screening or symptoms, it is imperative that a thorough evaluation be performed. A complete history and physical examination is necessary to assess comorbid conditions prior to treatment.

A detailed family history is important to determine the possibility of a familial or hereditary syndrome. Physical examination is most often unremarkable but can help determine the presence of advanced disease through findings such as hepatomegaly, adenopathy, or an abdominal mass. A complete colonoscopy should be performed, if possible, prior to definitive therapy to confirm the histologic diagnosis and to rule out synchronous polyps or cancers.

In addition, colonoscopic tattooing of the index lesion is important when the tumor is small or has been endoscopically excised to facilitate localization of these lesions at the time of operation.

In addition to routine laboratory blood studies, a preoperative serum carcinoembryonic antigen (CEA) measurement is useful in both prognosis and postoperative surveillance. An elevated preoperative CEA is more likely associated with advanced disease and is an independent predictor of poor outcome (Duffy et al, 2003). Although a preoperative CEA level is advocated as a guide to postoperative management, it is important to realize that a normal preoperative CEA should not influence the utility of CEA for postoperative surveillance.

Patients with normal levels at presentation, when the disease is clinically localized, often will develop CEA elevation with recurrence. Liver function tests can also be useful as a preoperative indicator of metastatic liver disease.

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Screening Guidelines for Colorectal Cancer
Colorectal Cancer Information
Colorectal Carcinoma Adjuvant and Chemotherapy
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Diagnosis for Colorectal Cancer

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