Colorectal cancer can develop slowly and present with mild, non-specific symptoms such as changes in bowel habits, blood or mucus in stool, abdominal discomfort, and fatigue from anemia. Advanced disease may cause obstruction, weight loss, heavy bleeding, and symptoms from metastases (commonly liver or lungs). Physical exam (including digital rectal exam), blood tests, colonoscopy with biopsy, stool-based screening (FIT, stool DNA), and CT colonography are core tools for detection. Routine screening - generally recommended to begin at age 45 for average-risk adults - prevents cancer by finding and removing precancerous polyps and detects cancers early when treatment is most effective. People with a family history or other risk factors should discuss earlier or more frequent screening with their clinician.
Why early recognition matters
Colon (colorectal) cancer often develops slowly and can be easiest to treat when detected early. People with a first-degree relative (parent, sibling, or child) who had colorectal cancer should pay particular attention and discuss earlier screening with their clinician.Early signs to watch for
Early symptoms are often subtle and can be mistaken for routine digestive problems. Common early signs include:- Persistent change in bowel habits (diarrhea, constipation, or a change in stool caliber)
- Blood in the stool or on toilet paper (bright red or darker stool)
- Mucus in the stool
- Abdominal discomfort, cramps, or excessive gas
- Unexplained fatigue or weakness, which can reflect anemia from slow blood loss
Symptoms of more advanced disease
As tumors grow or spread, symptoms become more pronounced. Advanced signs include:- Obstructive symptoms: severe abdominal pain, bloating, and vomiting from bowel blockage
- Significant, unexplained weight loss
- Signs of anemia (pale skin, breathlessness on exertion)
- Visible or heavy rectal bleeding
- Symptoms from metastases, most commonly to the liver or lungs - for example, new jaundice or right upper-quadrant pain when the liver is affected
What clinicians look for: exam and tests
A focused physical exam may include a digital rectal exam to check for palpable masses or fresh blood. Routine blood tests can detect iron-deficiency anemia.Diagnostic tests commonly used:
- Colonoscopy with biopsy: the diagnostic gold standard. It lets clinicians visualize the entire colon and remove polyps.
- Stool-based tests: fecal immunochemical test (FIT) and multitarget stool DNA tests are noninvasive screening options; testing intervals vary by test.
- CT colonography (virtual colonoscopy) and other imaging when colonoscopy is incomplete or not possible.