COLORECTAL CANCER

History:
     TRIAD: Anemia, weakness, LRQ mass
     Blood streaked stools, tenesmus (straining) Anorexia, fatigue, wt loss, 
     Dull & persistent abd. Pain
     Chg. In bowel habits = obstipation, constipation, diarrhea, small caliber stool

Physical:
     Ascites = abd. Wall involvement
     Virchow's Nodes = Spread thru lymphatics = supraclavicular nodes 
     Jaundice, hepatomegaly, masses
     Rectal Exam = palpable mass

Labs:
     Liver Function, CEA baseline, stool occult blood, microcytic anemia

Metastatic Workup: 
     
     Colonoscopy, SMA-20, CBC, chest x-ray, abdominal CT, liver function, IVP

Sites Of Involvement:
     Cecum & Ascending Colon:
          Persistent RLQ pain, Anemia, Rarely an Obstructive pattern
          Left Colon:
          Obstructive symptoms
          Scirrhous and annular lesions most common (Apple Core)
          Blood & Mucous in stool
          Invasion of adjacent structures
     Rectal Lesions:
          Bright Red blood from rectum
          Tenesmus and feeling of incomplete evacuation
          Obstructive Sx uncommon
          Mild abd. Cramping to severe rectal pain

Preoperative Procedures:
     1. Preoperative Radiation = Helps to reduce size of tumor, easier resection
     2. Preop Bowel Prep = Cathartics, liquid diet, daily enemas, nonabsorbable antibiotics
          ** No Cathartics in partial obstruction
          ** No oral fluid in complete obstruction (possible perforation)
     3. Surgical Resection = Resect tumor with a margin of 3-5 cm    
                             Resect mesentery at arterial origin
                      Resect primary lymphatic drainage
     4. Adjuvant chemotherapy or radiotherapy
     5. Follow-up = Liver Function, serial CEA, colonoscopy yearly    