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In 2006, more than 55,170 Americans will die of large bowel cancer.

Surgical resection is the primary treatment modality for CRC, and outcome is most closely related to the extent of disease at presentation..

Occult colonic bleeding is site, but not stage, dependent: cecal and ascending colon tumors have a fourfold higher mean daily blood loss (approximately 9 m L/day) than tumors at other colonic sites A change in bowel habits is a more common presenting symptom for left-sided cancers.

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The most common metastatic sites are the regional lymph nodes, liver, lungs, and peritoneum, and patients may present with signs or symptoms referable to any of these areas.

The presence of right upper quadrant pain, abdominal distention, early satiety, supraclavicular adenopathy, or periumbilical nodules usually signals advanced disease.

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Screening with fecal occult blood testing and flexible sigmoidoscopy can lead to diagnosis at an earlier stage of disease, and thereby reduce cause-specific mortality..

However, compliance with screening guidelines is poor; in two-thirds of patients, the initial diagnosis of CRC is established after the onset of symptoms The majority of patients with CRC have hematochezia or melena, abdominal pain, and/or a change in bowel habits Two reports evaluated the frequency of initial symptoms in patients presenting with potentially resectable colon cancer.

Some patients have more than one abnormality: Abdominal pain can be caused by a partial obstruction, peritoneal dissemination, or intestinal perforation leading to generalized peritonitis.

In addition, tenesmus caused by a rectal cancer may involve pelvic floor muscles, and a locally advanced lesion may involve the sciatic or obturator nerve, leading to a neuropathic pain syndrome.

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