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To view the differential diagnosis of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis differential diagnosis|'''here''']]<br>
To view the differential diagnosis of familial adenomatous polyposis (FAP), click [[Familial adenomatous polyposis differential diagnosis|'''here''']]<br>
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer differential diagnosis|'''here''']]<br><br>
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click [[Hereditary nonpolyposis colorectal cancer differential diagnosis|'''here''']]<br><br>
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.
{{CMG}} {{AE}}  


==Overview==
==Overview==
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*Colorectal cancer must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[cystitis]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742  }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552  }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref>
*Colorectal cancer must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[cystitis]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742  }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552  }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref>


{| class="wikitable"
! colspan="2" rowspan="2" |Diseases
! colspan="2" |Symptoms
! colspan="3" |Signs
! colspan="2" |Diagnosis
! rowspan="2" |Comments
|-
!Abdominal pain
!Bowel habits
!Rebound tenderness
!Guarding
!Genitourinary signs
!Lab findings
!Imaging
|-
| rowspan="5" |GI diseases
|[[Colon carcinoma|Colorectal cancer]]
|LLQ
|[[Constipation]]
| -
| -
| -
|
* Serum [[carcino-embryogenic antigen]] 
* Low Vit b12
* [[Hypercalcemia]]
|CT scan, x-ray and MRI used to show [[metastasis]]
| -
|-
|[[Inflammatory bowel disease]]
|LLQ
|[[Bloody diarrhea]]
|<nowiki>-</nowiki>
| -
| -
|
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]]
|-
|[[Diverticulitis]]
|LLQ
|[[Constipation]]
Or
[[Diarrhea]]
| -
| +
|<nowiki>+ </nowiki>
|
* [[Leukocytosis]]
|CT scan shows evidence of [[inflammation]] and out-pouchings of the colonic wall
|
|-
|[[Appendicitis]]
|LLQ / RRQ
|[[Constipation]]
| +
| +
| -
|
* [[Leukocytosis]]
|
* Ultrasound shows evidence of [[inflammation]]
* CT scan shows acute gangrenous appendix with calcified appendicolith
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
|-
|[[Strangulated hernia]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* No specific tests
|
* CT scan used to detect the [[hernia]] and to show if it is single or multiple
|
|-
| rowspan="3" |Gentiourinary diseases
|[[Cystitis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Suprapubic tenderness
|
* [[Pyuria]]
* Presence of [[nitrites]] and [[leukocyte esterase]]
|
* X ray is done to probe the suspicion of emphysematous cystitis.
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous cystitis.
|
|-
|[[Prostatitis]]
|LLQ
Groin pain
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Tender and enlarged
|
* Serum [[Prostate specific antigen|PSA]] elevated
* [[Leukocytosis]]
* Elevated [[C-reactive protein|CRP]]
|
* CT scan shows [[edema]] and enlarged [[prostate]]
* [[Abscess]] may be observed
|
|-
|[[Pelvic inflammatory disease]]
|Bilateral
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| -
|
* [[Vaginal discharge|Purulent vaginal discharge]]
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
|
* [[Transvaginal ultrasound|Transvaginal utrasonography]]
|
|-
| rowspan="2" |Gynecological diseases
|[[Endometritis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* No specific tests
|
* Ultrasound is helpful to rule out other differential diagnosis such as [[pelvic abscess]], [[thrombosis]] and [[Tumor|masses]]
|
* [[Vaginal discharge]]
* [[Vaginal bleeding]]
|-
|[[Salpingitis]]
|LLQ/ RLQ
|
| +/-
| +/-
|
|
* [[Leukocytosis]]
|
* [[Pelvic ultrasound]]
|
* [[Vaginal discharge]]
|}
*The table below summarizes the findings that differentiate colorectal cancer from other common conditions that cause unexplained [[weight loss]], unexplained [[loss of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[anemia]], [[jaundice]], and  <ref><nowiki>{{Colorectal Cancer [Internet]. BMJ Publishing Group. 2011 [updated 2013 Feb 4]. Available from: </nowiki>http://bestpractice.bmj.com/best-practice/monograph/258/diagnosis/differential.html<nowiki>}}</nowiki></ref>.
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
| style="background:#f0f0f0;" align="center" |'''Condition'''
| style="background:#f0f0f0;" align="center" |'''Differentiating Signs/Symptoms'''
| style="background:#f0f0f0;" align="center" |'''Differentiating Tests'''
|-
| '''[[Irritable Bowel Syndrome|Irritable Bowel Syndrome (IBS)]]'''||A clinical diagnosis is based on either Rome I, II, or III Criteria.
* '''Rome I''': is continuous or recurrent symptoms for at least 3 months; [[abdominal pain]] or [[discomfort]], relieved with [[defecation]] and/or associated with change in frequency and/or consistency of stool; and an irregular pattern of [[defecation]] with at least 25% of the time with two or more of the following: altered stool frequency, altered stool form, altered stool passage, passage of mucus, [[bloating]] or feeling of [[abdominal distention]]
* '''Rome II''' is at least 12 weeks of [[abdominal discomfort]] or [[Pain(patient information)|pain]], which need not be consecutive, in the preceding 12 months with two or more of the following: relieved with [[defecation]], onset associated with a change in frequency of stool, onset associated with a change in form of stool
* '''Rome III''' is recurrent [[abdominal pain]] or discomfort 3 days per month in the last 3 months, associated with two or more of the following: improvement of [[abdominal pain]] with [[defecation]], change in [[frequency]] of stool, change in appearance of stool; with onset at least 6 months prior to diagnosis
|
* There is no specific diagnostic test for [[Irritable bowel syndrome|IBS]]; patients who fulfill the clinical criteria for [[IBS]] and have no alarm features have a very low probability of organic disease
* [[Colonoscopy]] or [[Colon (anatomy)|colonic imaging]] is recommended for patients older than 50 years of age due to higher pre-test probability of colorectal cancer
|-
| '''[[Ulcerative Colitis]]'''||
* The average age of onset of [[inflammatory bowel disease]] (20 to 40 years) is younger than with colorectal cancer
* Patients with [[inflammatory bowel disease]] frequently have [[watery diarrhea]]
* Patients with [[colitis]] are at higher risk of colorectal cancer and may need reassessment if symptoms are atypical or do not respond to treatment
|[[Colonoscopy]] shows:
* [[rectal]] involvement
* Continuous uniform involvement
* Loss of vascular marking
* Diffuse [[erythema]]
* Mucosal granularity
* Normal terminal ileum (or mild 'backwash' [[ileitis]] in [[pancolitis]])
|-
| '''[[Crohn's disease|Crohn's Disease]]'''||
* Patients with [[colitis]] are at higher risk of colorectal cancer and need reassessment if symptoms are atypical or do not respond to treatment
|[[Colonoscopy]] with [[intubation]] of the [[ileum]] is the definitive test to diagnose [[Crohn's disease]] and will show:
* [[Mucosal|Mucosal inflammation]]
* Discrete deep or superficial [[ulcers]] located transversely and longitudinally, creating a cobblestone appearance
* [[Lesions]] that are discontinuous, with intermittent areas of normal-appearing bowel (skip lesions)
|-
| '''[[Hemorrhoids]]'''||
* Bright red [[rectal bleeding]] that is separate from the stool
* No [[abdominal discomfort]] or [[pain]]
* Altered bowel habits
* [[Weight loss]]
|
* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to [[rectal bleeding]] and in those older than 50 years of age
|-
| '''[[Anal Fissure]]'''||
* Severe pain on [[defecation]]
* Blood is usually present on wiping
* No [[abdominal discomfort]] or [[pain]]
* Altered bowel habits
* [[Weight loss]]
|
* [[Colonoscopy]] or colonic imaging is recommended in patients with abdominal symptoms in addition to rectal bleeding and in those older than 50 years of age
|-
| '''[[Diverticular disease]]'''||
* [[Diverticular disease|Diverticular stricture]] or [[Inflammatory|inflammatory mass]] may be clinically indistinguishable from colorectal cancer
|
* [[Colonoscopy]] with [[biopsies]] and [[Computed tomography|CT imaging]] will usually differentiate [[diverticular disease]] from colorectal cancer
|}


'''Other conditions that can be mistaken for colorectal cancer include the following:'''
'''Other conditions that can be mistaken for colorectal cancer include the following:'''

Revision as of 18:09, 23 January 2019

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To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

Colorectal Cancer Differential Diagnosis


Other conditions that can be mistaken for colorectal cancer include the following:

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.


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