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| style="background: #F5F5F5; padding: 5px;" |Physical examination with Ultrasound
| style="background: #F5F5F5; padding: 5px;" |Physical examination with Ultrasound
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Uterine cancer
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Uterine cancer<ref name="pmid16055605">{{cite journal |vauthors= |title=ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer |journal=Obstet Gynecol |volume=106 |issue=2 |pages=413–25 |date=August 2005 |pmid=16055605 |doi= |url=}}</ref><ref name="pmid195920792">{{cite journal |vauthors=Boruta DM, Gehrig PA, Fader AN, Olawaiye AB |title=Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review |journal=Gynecol. Oncol. |volume=115 |issue=1 |pages=142–153 |date=October 2009 |pmid=19592079 |doi=10.1016/j.ygyno.2009.06.011 |url=}}</ref><ref name="pmid6822361">{{cite journal |vauthors=Bokhman JV |title=Two pathogenetic types of endometrial carcinoma |journal=Gynecol. Oncol. |volume=15 |issue=1 |pages=10–7 |date=February 1983 |pmid=6822361 |doi= |url=}}</ref><ref name="pmid20628804">{{cite journal |vauthors=Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F |title=Factors associated with Type I and Type II endometrial cancer |journal=Cancer Causes Control |volume=21 |issue=11 |pages=1851–6 |date=November 2010 |pmid=20628804 |pmc=2962676 |doi=10.1007/s10552-010-9612-8 |url=}}</ref>
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* Menometorrhagia
* Menometorrhagia

Revision as of 18:12, 4 February 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]

Vaginal/Vulvar mass differential diagnosis

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Abnormal vaginal dyscharge Pelvic

pain

Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal

mass

HPV Pap smear STI Panel Ultrasound MRI CT Scan
Cervical cancer[1][2][3][4][5][6] + + + +

+

+ ± ±Chlamydia T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
 PET/CT scan:
Cervical polyp[7]
  • Postcoital
  • Intermenstrual
  • Postmenopausal
  • Bleeding after exam
 + − − − − −
  • Mass on exam
 − − − −
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
  • Epithelial cells with no nuclear atypia/mitoses
  • Hysteroscopy /Biopsy
Cervical leiomyoma[8][9][10][11][12][13][14][15]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
 + + −
  • Urinary retention
  • Constipation
  • Infertility
  • Bowel obstruction
  • Increase in pregnancy/labor complications
 − +
  • Large,irregular pelvic mass
 ±
− − −
  • Well circumscribed hyperechoic mass
 T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Spindle shaped smooth muscle cells
  • Mature adipocytes
  • Extracellular matrix consist of collagen,fibronectin.
  • Clinical diagnosis/ and
  • Ultrasound
Cervical lymphoma[16][17]
  • Postmenopausal bleeding
 − + −
  • Difficulty urinating
  • Post-coital pain
 + +
  • Larrge uterine/cervix mass
  • Irregularity
 + − − −
  • Well-defined, solid, concentric, hypoechoic mass
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
  • Biopsy
Cervical sarcoma[18]
  • Intermentrual
  • Postmenopausal
 ± + −
  • Post-coital pain
  • Fullness in pelvic
 ± +
  • Cervical mass
  • Lump protruding from vagina/vulva
 + − − −
  • Biopsy
Cervical erosion(Ectropion)[19][20][21]
  • Light bleeding after pelvic exam
  • Spotting
 + + ±
  • Post-coital pain
  • Painful cramps
  • Pain after sex
 − + − − − −
Cervicitis[22][23]
  • Intermenstrual bleeding
  • Postcoital
  • Bleeding after pelvic exam
 + +
  • Itching
  • Pain during urination
  • Pain during sex
  • Painful menstruation
  • May have fever only
  • Red,inflammed swollen cervix
  • Inflammation/irritation of vulva/vagina
 − − −
  • Chlamydia
  • Gonorrhea
  • Herpes simplex
  • Trichomonas vaginalis
IUD use[24]
  • Heavy bleeidng
 ± +
  • Itching
  • Painful menstruation
 − − − − ±
Pelvic inflammatory diseases[25]
  • Bleeding after sex
  • Intermenstrual bleeding
 + +
  • Itching/burning
  • Pain during sex
  • Painful menstruation
  • Burning sensation during urination
  • Pain during bowel movement
  • Fever
 ±Abdominal

pain

  • Pelvic pain
  • Vaginal/vulvar tender lesion depending on microbial cause
 − − −
  • Chlamydia
  • Gonorrhea
Endometriosis[26][27][28][29]
  • Heavy mentrual bleeding
 ±
  • Pelvic pain
  • Back pain
 −
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
 − +
  • Tender uterosacral nodularity
  • Immobile uterus
  • Cervical motion tenderness
  • Retroverted uterus
 − − −
  • Visual inspection by laparascopy
Adenomyosis[30]
  • Abnormal uterine bleeding
 − + −
  • Painful menstruation
 −
  • Polypoid mass protruding into the endocervical canal.
 − − −
Cervical ectopic pregnancy[31]
  • Amennorhea
  • Bleeding after pelvic exam
 − − −
  • Pelvic pain
 − +
  • Soft and disporportionally enlarged uterus.
 − −
  • Empty uterine
  • Thickened endometrium
 T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
  • Necrotic hemorrhagic mass with chorionic villus
  • Hysterectomy and biopsy
DES exposure (Clear cell adenocarcinoma)[32]
  • Postcoital bleeding
 + − − −
Paget's disease of vulva to cervix[33][34][35]
  • Bleeding from lesion
  • Oozing
 ± −
  • Itching/burning
  • Pain in vulva
 − −
−
  • Scaly eczematoid lesion in vulva.
  • Erythematous plaques with white scaling.
  • Inguinal lymphadenopathy in case of metastases.
 − − − −
  • Intraepidermal adenocarcinoma which involves epidermis
  • Biopsy of lesion
Vaginal cancer[36]
  • Postcoital bleeding

+

  • Tenesmus
  • Dysuria
  • Urinary frequency
  • Constipation
  • Pelvic pain
  • Vaginal lump
  • Inguinal lymphadenopathy
 − − −
Nabothian cyst[37][38][39]
  • Postcoital bleeding
 + − −
  • Pain during sex
 −
  • Cystic mass on exam
 − − − −
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images
Rectal cancer[40][41][42][43][44] - - + -
  • Constipation/diarrhea
  • Absent bowel sounds
  • Rectal mass/bleeding
  • Abdominal tenderness
 Weight loss + LLQ + NL + - - +/- Endoscopic/transrectal US detects tumor extent Determine tumor stage Determine tumor stage
  • Sheets or cords of malignant cells
  • Cellular atypia & pleomorphism
  • High mitotic rate
  • Necrotic debris in glandular lumina
 Colonoscopy with biopsy
Submucous uterine leiomyoma[45][46][47] Menorrhagia - + -
  • Constipation
  • Urinary frequency/incontinence
  • Hydronephrosis
 - + Enlarged, irregular, firm, nontender uterus + - - -
  • Trans vaginal US: well defined hypoechoic
  • Saline US: for submucous fibroids/polypoi
 Provides information on no: of fibroids, size, vascularization, relationship with endometrial cavity & serosal surface Not required Not required Physical examination with Ultrasound
Uterine cancer[48][49][50][51]
  • Menometorrhagia
  • Intermenstrual bleeding
  • Postcoital bleeding
 + + -
  • Polyuria
  • Dysuria
  • Fatigue
  • Weight loss
 +
  • Enlarged uterus
  • Lymphadenpathy
  • Mesenteric nodules (metastases)
 + - - - Thickened endometrial lining >4cm
  • Endometrial thickening
  • Lymph node involvement
  • Pelvic metastases
  • Endometrial malignant cells
  • Low grade type 1
  • High grade type 2
 Histologic diagnosis
Vaginal lymphoma
Vaginal polyp
Vaginal adenosis

Differentiating [Disease name] from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Diagnosis Gold standard Additional findings Others
Symptoms Physical examination
Lab Findings Imaging
Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan
Rectal carcinoma[52][53][54][55][56] LLQ Constipation/diarrhea + + NL Anemia FOBT+ mass/polyp Apple core apearance Endoscopic/trnasrectal US detects tumor extent Determine tumor stage colonoscopy with biopsy DRE & proctoscopy detects tumor localization & extension
Rectal polyp[57][58][59] + Mucous diarrhea + + NL NL rectal mass/polyp NL NL/anemia NL FOBT+ Polyp N/A Polyp N/A colonoscopy with biopsy N/A
Anal cancer[60][61][62][63] +/- constipation/diarrhea + +/- NL NL lump/mass at anal opening NL NL/anemia N/A FOBT+ N/A N/A Determines anal cancer depth into sphincter Hypoattenuated necrotic mass on contrast CT Biopsy PET/CT detects localization of small anal tumors <2cm Sentinal lymph node biopsy detects lymph node metastases
Hemorrhoids[64][65][66][67] +/- fecal incontinence/mucous discharge + - NL/weakness,irritability NL NL iron deficiency anemia N/A blood on stool outer surface Done if colorectal cancer suspected N/A N/A N/A DRE + anoscopy anoscopy shows bulging purplish hue veins or dark, pink, glistening mass None
Rectal prolapse[68][69][70][71] Abdominal discomfort constipation/diarrhea +/- - NL NL Intermittent rectum protrusion seen NL NL/anemia N/A Mucous/blood in stool May be used for screening N/A Reveals asymmetry & any sphincter defect N/A History & physical examination DRE shows patulous anus, attenuated sphincter tone & mass Anal manometry to assess sphincter function
Foreign body[72][73][74][75] Anorectal pain and abdominal pain Constipation + - NL NL FOBT+ Foreign body Contraindicated Foreign body Foreign body Plain radiographs show presence of foreign body NL NL
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Prostatitis[76][77][78][79] LLQ/groin pain NL N/A - NL NL NL Tender/enlarged prostate leukocytosis NL/↑ PSA N/A N/A N/A
  • Focal hypoechoic regoin in peripheral prostate
  • Fluid collection suggests abscess
 Edematous/enlarged prostate N/A prostate biopsy & thermograms may also be done ↑ CRP
Fecal impaction[80][81][82][83] + constipation - +/- DRE shows fecal impaction NL Mild leukocytosis N/A N/A N/A Used in softening of stool & stimulation of evacuation N/A Presence of fecal matter in colon DRE to detect fecal impaction Abdominal radiograph to detect fecal loading
Anal stenosis[84][85][86] + constipation + +/- NL NL Visual inspection shows stenosis NL NL N/A NL Contraindicated N/A N/A N/A Visual inspection with DRE Incomplete evacuation None
Hypertrophied anal papillae[87][88][89][90] - NL +/- - NL NL Firm & palpable papillae on digital examination NL NL N/A Mixed with blood N/A Smooth polyp located inside anal verge N/A N/A Visual inspection with digital examination Associated with anal fissure & anal skin tag None
Endometriosis[91][92][93] +/- Constipation - - Fatigue Mild tenderness Nodules in posterior fornix Tenderness on vaginal exam Anemia - - N/A N/A Lesions can be detected on usg Not required N/A N/A N/A
Uterine malignancy[94][95][96] - NL - + Pallor NL Pelvic mass Vaginal bleeding Anemia Hcg - N/A N/A Increased thickness of uterine wall >4mm N/A Endometrial biopsy N/A N/A
Diseases Abdominal pain Bowel habits Blood in stool Weight loss General appearance Abdominal exam Rectal exam Genitourinary exam CBC Tumor markers Stool test Colonoscopy Barium enema Ultrasound CT scan Gold standard Additional findings Others
Cervical malignancy[97] - Normal - + Pallor

Fatigue

NL Pelvic mass Anemia N/A FOBT - N/A N/A Cervical thickening Detects metastasis Cone biopsy N/A N/A
Pelvic abscess[98][99] + Nil - +/- Fluctuating mass Vaginal discharge in females leucocytosis - FOBT - N/A N/A Location and consistency of abscess Location and consistency of abscess N/A N/A N/A
Pelvic sarcoma[100][101][102] + NL/constipation +/- +/- NL/cachetic with fever presence of mass NL N/A Lleukocytosis NL N/A N/A N/A Well circusmscribed, multinodular/infiltrating mass of soft tissue attenuation CT/MRI/Biopsy PET with FDG used for staging None

References

  1. ↑ Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
  2. ↑ Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.
  3. ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
  4. ↑ . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)
  5. ↑ Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
  6. ↑ Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.
  7. ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
  8. ↑ Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
  9. ↑ Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
  10. ↑ Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.
  11. ↑ Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.
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  13. ↑ Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
  14. ↑ El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.
  15. ↑ Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.
  16. ↑ Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.
  17. ↑ Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.
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  19. ↑ Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.
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  21. ↑ Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.
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  23. ↑ Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
  24. ↑ Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.
  25. ↑ Hoenderboom BM, van Benthem B, van Bergen J, Dukers-Muijrers N, Götz HM, Hoebe C, Hogewoning AA, Land JA, van der Sande M, Morré SA, van den Broek I (January 2019). "Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial". Sex Transm Infect. doi:10.1136/sextrans-2018-053778. PMID 30606817. Vancouver style error: initials (help)
  26. ↑ Hsu AL, Khachikyan I, Stratton P (June 2010). "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol. 53 (2): 413–9. doi:10.1097/GRF.0b013e3181db7ce8. PMC 2880548. PMID 20436318.
  27. ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
  28. ↑ Datta S, Kunde K (July 2008). "From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy". J Obstet Gynaecol. 28 (5): 552–3. doi:10.1080/01443610802247352. PMID 18850447.
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  34. ↑ Lloyd J, Evans DJ, Flanagan AM (July 1999). "Extension of extramammary Paget disease of the vulva to the cervix". J. Clin. Pathol. 52 (7): 538–40. PMC 501500. PMID 10605411.
  35. ↑ Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ (January 2010). "Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course". Int. J. Gynecol. Pathol. 29 (1): 69–78. doi:10.1097/PGP.0b013e3181b1cc5e. PMID 19952933.
  36. ↑ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
  37. ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
  38. ↑ Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.
  39. ↑ Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.
  40. ↑ Chiara Molinari, Federica Matteucci, Paola Caroli & Alessandro Passardi (2015). "Biomarkers and Molecular Imaging as Predictors of Response to Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer". Clinical colorectal cancer. 14 (4): 227–238. doi:10.1016/j.clcc.2015.05.014. PMID 26170142. Unknown parameter |month= ignored (help)
  41. ↑ William Hamilton & Deborah Sharp (2004). "Diagnosis of colorectal cancer in primary care: the evidence base for guidelines". Family practice. 21 (1): 99–106. PMID 14760054. Unknown parameter |month= ignored (help)
  42. ↑ Wolfgang B. Gaertner, Mary R. Kwaan, Robert D. Madoff & Genevieve B. Melton (2015). "Rectal cancer: An evidence-based update for primary care providers". World journal of gastroenterology. 21 (25): 7659–7671. doi:10.3748/wjg.v21.i25.7659. PMID 26167068. Unknown parameter |month= ignored (help)
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  44. ↑ Mohammad Sadegh Fazeli & Mohammad Reza Keramati (2015). "Rectal cancer: a review". Medical journal of the Islamic Republic of Iran. 29: 171. PMID 26034724.
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