Colon Cancer Clinical Presentation

Updated: Jan 25, 2023
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Because of increased emphasis on screening practices, colon cancer is now often detected before it starts to cause symptoms. In more advanced cases, common clinical presentations include iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits, and intestinal obstruction or perforation. Right-sided lesions are associated with younger age, and common presenting signs include bleeding and/or diarrhea. Left-sided tumors are associated with older age, and patients commonly present with bowel obstruction. 

In patients younger than 50 years old—an age group that is experiencing rising rates of colorectal cancer (see Overview/Epidemiology)—a study that used data from England's Clinical Practice Research Datalink found that abdominal pain was the most common presenting symptom of colorectal cancer. Compared with other age groups, these younger patients had the lowest percentage of typical ‘red-flag’ signs and symptoms (ie, rectal bleeding, anemia, change in bowel habits, diarrhea, abdominal mass). Instead, these patients were more likely to have presented to their primary care provider, in the year before diagnosis, with nonspecific symptoms. [45]



Physical Examination

Physical examination findings can be very nonspecific (eg, fatigue, weight loss) or normal early in the course of colon cancer. In more advanced cases, any of the following may be present:

  • Abdominal tenderness
  • Macroscopic rectal bleeding
  • Palpable abdominal mass
  • Hepatomegaly
  • Ascites