Colorectal cancer develops with few, if any, symptoms at first.
It depends a little on the location of the colon cancer. If the cancer is closer to the anus (left side), symptoms may include blood in or on the stool, a change in bowel habits, stools that are narrower than usual and general weakness and weight loss. These symptoms are more typical for colon cancer and physicians would easily recommend a colonoscopy for further work up. However if the tumor is on the right side, almost a foot away from the anus, the symptoms may be more general such as unexplained stomach discomfort, frequent gas, pains, or indigestion, unexplained weight loss and chronic fatigue.
These symptoms can also be seen with other health conditions and many of my patients are seen by their doctors who often prescribe medications for upset stomach or treat for stomach flu. However, if you have any of these symptoms, discuss them with your doctor. Only your doctor, through testing, can determine why you’re having these symptoms. Last week I saw a 32 year old woman who had blood in her stool for over a year, but otherwise was very healthy. She saw her doctor three times for her symptoms but was told she has hemorrhoids. She was not the first young patient who was told: she is too young for colon cancer and it must be hemorrhoids causing the bleeding. If anyone has ongoing blood per rectum, you should undergo a colonoscopy, even when you are young and have no family history. A significant delay in diagnosis can make difference between a cure and dying of cancer.
The symptoms of colon cancer may be very vague, particular when the tumor in on the right (ascending site) of the colon. It was recently reported that colonoscopies can miss the tumors on the right side since it is more difficult to reach it with the colonoscopy. In the literature 10-15 percent of polyps have been missed by colonoscopy. It is critical that experienced colorectal surgeons and gastroenterologist do the colonoscopies. They need to take the time to go all the way to the right side to the end of the colon. As mentioned, the location of the tumor is associated with different symptoms but also may look different. On the right side, we have more flat tumors and on the left more the polyps and cauliflower growing tumors. We also know not only it is more difficult to reach the right side it is also more difficult to recognize the flat tumors.
In addition, right sided cancers are more characteristic in patients who have a genetic predisposition and are also usually younger. If there is any family history of colon cancer, endometrium or ovarian is present and some of the symptoms above exist, please contact your doctor and get a diagnostic work up which should include colonoscopy and laboratory tests. It is important to know that in families with a genetic predisposition, which is known as HNPCC (hereditary non polyposis colorectal cancer), not only colon cancer can develop but you can also develop endometrium, ovarian and gastric cancers. It is very important to get to know your family history of cancer which can help to identify a cancer predisposition and may change the way you are being treated and followed up.