Colorectal Cancer CT Manifestations and Differential Diagnosis

Written by Shen Jiang Chao
Radiology
Updated on September 12, 2024
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Early-stage colon cancer is difficult to clearly detect on a CT scan. In the moderate to late stages, colon cancer has more typical manifestations on CT, mainly characterized by thickening of the colon wall, irregular narrowing of the intestinal lumen, and stiffness of the intestinal wall. After enhancement, significant enhancement can be observed. The pericolonic fat space may appear blurred, and in the late stages, small lymph nodes can be seen, and even distant metastasis, most commonly to the liver, can be detected. It is necessary to differentiate colon cancer from colonic inflammation. Inflammatory lesions are usually more widespread and have typical clinical features such as fever and abdominal pain. It is also necessary to differentiate from lymphoma, as lymphomas also cause narrowing of the intestinal lumen but the narrowing is not eccentric and the intestinal wall remains soft, generally not leading to obstruction, whereas in late-stage colon cancer, colonic obstruction can be observed.

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What should not be eaten with transverse colon cancer?

Transverse colon cancer is a type of colon cancer. Generally speaking, in terms of diet, one should not eat spicy, stimulating, or hard-to-digest foods, such as overly spicy food, hot pot, smoked, grilled, or pickled foods. It is best to avoid these, as well as alcohol and tobacco. Because transverse colon cancer can lead to intestinal blockage as the tumor grows, consuming spicy, stimulating, or indigestible foods, or overeating and causing indigestion, can lead to intestinal obstruction. This is a relatively high risk, and typically, once transverse colon cancer is diagnosed, consideration should begin for primarily curative surgery.

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What is the likelihood of metastasis for colon cancer with a certain Ki-67 index?

Currently, the Ki67 index in colon cancer cannot be used as a predictive factor for metastasis. Ki67 reflects the proliferation index of the tumor and is related to the malignancy level of the tumor, but it is not possible to judge the risk of subsequent metastasis based on the Ki67 value. The factors that can be used to assess the risk of postoperative metastasis in colon cancer mainly include the depth of local invasion of the colon cancer, whether there is lymph node metastasis, and the presence of certain specific gene mutations. The deeper the invasion, the higher the risk of metastasis. Patients with lymph node metastasis have a higher risk of distant recurrence and metastasis compared to those without detected lymph node metastasis.

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Is minimally invasive surgery suitable for transverse colon cancer?

Transverse colon cancer can also be considered for minimally invasive surgical treatment. The main procedure involves a complete resection of the transverse colon, and sometimes, it may require the resection of part of other organs. For instance, if the cancer has invaded the splenic region of the colon, a splenectomy may be necessary. If there is invasion into the liver area, partial liver resection may be needed. In cases where minimally invasive surgery is not suitable or inconvenient, it is also possible to switch to open surgery. The goal is to completely remove the tumor. Whether minimally invasive or traditional surgery is used, it is just a method of operation. Additionally, postoperative adjunct chemotherapy and other comprehensive treatments are necessary.

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What causes colon cancer?

Colorectal cancer is a malignant tumor of the digestive system, and its occurrence is related to the following factors: First, dietary factors. A high-fat content and a low fiber content in the diet both lead to an increased incidence of colorectal cancer. Furthermore, long-term consumption of pickled foods can also increase the incidence of colorectal cancer, presumably because these foods contain higher levels of nitrosamine carcinogens. Second, some benign chronic diseases of the colon, such as adenomatous polyps and certain chronic colitis, can also lead to an increased incidence of colorectal cancer. Third, environmental factors. Epidemiological studies have found that the occurrence of colorectal cancer is related to geographical distribution. In some environments with a high incidence of colorectal cancer, the content of some trace elements in the soil is too low, leading to a high incidence of colorectal cancer.

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Early symptoms of colon cancer

Colon cancer often does not have obvious symptoms in its early stages, and of course, the specific situation needs to be analyzed on a case-by-case basis, as it varies from person to person. As the disease progresses, some clinical symptoms may appear. The first one is changes in bowel habits and stool characteristics; there might be blood in the stool, changes such as an increased frequency of defecation, urgency followed by a feeling of incomplete evacuation, and a sensation of rectal fullness, along with possible changes in the shape or thinning of the stool. The second possible symptom is abdominal pain, which may also be accompanied by a feeling of bloating or abdominal discomfort. The third possibility is the symptoms of intestinal obstruction, which include cessation of bowel movements and passing gas. The fourth is that a mass may be felt in the abdomen. The fifth point is that some individuals, especially those in poor health, may experience symptoms of nutritional depletion from the tumor, such as anemia, weight loss, and fatigue. If there is early metastasis, symptoms corresponding to the metastasis may also appear.