3075 Initial Presentation of Advanced Colorectal Cancer in the Cecum Presenting With Mild Tenesmus

Abstract

INTRODUCTION: Colorectal cancer (CRC) is a lethal disease. 140,250 new cases of large bowel cancer are diagnosed annually in the USA including 97,220 colon and 43,030 rectal cancers. 50,630 Americans are expected to die of large bowel cancer each year. CRC is the third most common cause of cancer death in the USA in women, and the second leading cause of death in men. Common symptomology include change in bowel habits (74%), rectal bleeding with change in bowel habits (71%), iron deficiency anemia (21%). Appendicitis as the initial symptom of CRC is less than 1% for individuals over 40. CASE DESCRIPTION/METHODS: Patient is a 52 year old man who presents to our facility for general abdominal pain and tenesmus for three months. The patient has no family history of CRC nor colonoscopy. In the ED routine labs negative Imaging revealed acute appendicitis. Laparoscopic appendectomy was performed and the patient was discharged the following day. Patient returned two months later with complaints of tenesmus and abdominal pain. In the ED acute microcytic anemia was discovered. CT Abdomen and pelvis demonstrated diverticulosis without diverticulitis and FOBT positive. Colonoscopy performed and findings consisted of: large 6 cm cecal mass, biopsies taken, 8 mm polyp in transverse colon removed with cold snare, two 5-7 mm polyps in the ascending colon removed by cold snare, and 4 cm polyp removed via the hot snare in the descending colon. The patient then underwent colonic resection of the mass by general surgery. DISCUSSION: What is learned from this case is the importance of CRC screening and rare initial symptom of CRC of appendicitis in a male over the age of 40. The patient is 52 years old with without having CRC screening and acute appendicitis. Had the patient had his diagnostic colonoscopy at the age of 50 the cecal mass would have been discovered sooner and treatment could have been initiated. Another aspect of this case that makes it unusual was the patient did not have any of the more common symptoms of CRC. Our patient presented with general abdominal pain and tenesmus and the latter accounts for less than 1% of all symptomatology along with acute appendicitis. The patient did not have any of the “alarm” symptoms and if not for the appendicitis diagnosed in the hospital the patient “had no intentions” of doing CRC screening. The patient explains he had no family history of gastric or colon cancers, “So why bother?” The acute appendicitis from the cecal mass proved to be critical in the initiation of treatment.