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Clinical presentation, diagnosis, and staging of colorectal cancer

Finlay A Macrae, MD
Johanna Bendell, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editors
Diane MF Savarese, MD
Shilpa Grover, MD, MPH, AGAF


Colorectal cancer (CRC) is a common and lethal disease. It is estimated that approximately 135,430 new cases of large bowel cancer are diagnosed annually in the United States [1], including approximately 95,520 colon and 39,910 rectal cancers. Approximately 50,260 Americans are expected to die of large bowel cancer each year. Although CRC mortality has been progressively declining since 1990 at a rate of approximately 2.5 to 3 percent per year [2], it still remains the third most common cause of cancer death in the United States in women, and the second leading cause of death in men. Global, country-specific incidence and mortality rates are available from the World Health Organization Globocan database.

In contrast to these declines, the incidence of CRC in men and women under the age of 50 has been steadily increasing at a rate of 2.1 percent per year from 1992 through 2012 [3]. These increases are driven predominantly by left-sided cancers in general and rectal cancer in particular (3.9 percent per year) [4]. Current literature suggests that over 86 percent of those diagnosed under the age of 50 are symptomatic at diagnosis, and this is associated with more advanced stage at diagnosis and poorer outcomes [5]. At present, screening is not recommended for individuals under the age of 50 unless they have a positive family history or a predisposing inherited syndrome. (See "Screening for colorectal cancer: Strategies in patients at average risk" and "Screening for colorectal cancer in patients with a family history of colorectal cancer" and "Colorectal cancer: Epidemiology, risk factors, and protective factors", section on 'Incidence'.)

CRC is diagnosed after the onset of symptoms, or through screening colonoscopy or fecal occult blood testing in the majority of patients. Screening of asymptomatic individuals for CRC is advocated by major societies and preventive care organizations. Screening has been shown to detect asymptomatic early-stage malignancy and improve mortality. However, while compliance with CRC screening guidelines is steadily improving, it is still relatively low. (See "Screening for colorectal cancer: Strategies in patients at average risk".)

The clinical presentation, diagnosis, and staging of CRC will be reviewed here. The pathology, prognostic determinants, and treatment of colon and rectal cancer are discussed elsewhere.

(See "Pathology and prognostic determinants of colorectal cancer".)


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