Cancer, colorectal

• 153.9 Malignant neoplasm of colon unspecified site

• 315.4 Developmental coordination disorder
• 718.45 Contracture of joint, pelvic region and thigh
• 719.70 Difficulty in walking
• 728.2 Muscular wasting and disuse atrophy
• 728.89 Disorders of muscle, ligament, and fascia
• 729.9 Other disorders of soft tissue
• 780.7 Malaise and fatigue
• 781.2 Abnormality of gait
• 782.3 Edema
• 786.0 Dyspnea and respiratory abnormalities
• 786.05 Shortness of breath

• C18.9 Malignant neoplasm of colon, unspecified

• As of March, 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated

Description

• Malignancy of the colon
• May metastasize and result in death if untreated, curable if caught in early stages
• Complaints often include changes in bowel habits: constipation, diarrhea, bowel urgency, incontinence, and cramping
• Pain frequently referred to low back

Essentials of Diagnosis

• Abdominal pain (constant or intermittent)
• Abdominal tenderness
• Nausea
• Vomiting
• Changes in bowel habits: diarrhea, constipation
• Bloating
• Rectal bleeding possible
• Rectal/anal irritation
• Acute drop in blood pressure may cause decrease blood flow to intestines
• Inability to swallow
• Lack of appetite
• Unexplained weight loss
• Abdominal pain upon ingesting food
• Joint pain possible
• Dark stool or bright red blood in stool
• Malaise, fatigue

General Considerations

• While PT may not manage GI disorders specifically, clients may receive care for secondary problems: weakness, gait abnormalities, limited aerobic endurance, musculoskeletal problems, neuromuscular problems, weight loss or weight gain
• Symptoms may include chronic or episodic diarrhea, incontinence or urgency of bowel movements, blood in stool
  • May be symptomatic of inflammatory disease, pre-cancerous condition, cancer
• Diagnosis for occult problems may take time and require intensive diagnostic testing
• GI disorders frequently refer pain to other body areas; individuals may be inappropriately referred to PT
• May be related to stress, constipation
• More serious problems include autoimmune conditions like Crohn’s
• Acute pain indicative of appendicitis
• GI complaints in females may indicate cancer/tumors in reproductive organs, or gynecological problems: endometriosis, uterine fibroids, ectopic pregnancies
• May indicate inguinal or umbilical hernia
• History of heartburn/indigestion may indicate GI or cardiac problems

Demographics

• GI disorders occur throughout lifespan (birth through geriatric)
• More common in people aged 50 years or older
  • Increased risk with older age
• More common if history of polyps or personal history of cancer
• Overall incidence of colon and rectal cancer 45.5 per 100,0001
  • Causasians 44.3 per 100,000
  • African Americans 53.1 per 100,00
  • Asians 34.9 per 100,000
  • American Indians 31.1 per 100,000

Signs and Symptoms

• Symptoms may be characteristic of multiple GI disorders, confounding medical diagnosis
• PT should recognize the possibility of GI pathology in differential diagnosis, especially when findings are not consistent with conditions commonly treated
• Pain
  • Abdominal/stomach pain, cramping (constant or intermittent, severe)
  • Pain upon ...