Clinical presentation

Local recurrence of a tumour is more common in rectal than colon primaries. It may be identified early in the asymptomatic phase by follow up monitoring or may present with similar symptoms to the primary lesion. Blood loss through the rectum, mucous discharge, altered bowel habit, and straining are common features of recurrent rectal cancer. Pain and urinary symptoms are features of localised pelvic recurrence. Recurrent intra-abdominal disease can present as small or large bowel obstruction, and recurrence at other sites may be indicated by focal features such as hepatic capsular pain, jaundice, dyspnoea, localised bone pain, or neurological symptoms. Systemic features of weight loss, anorexia, nausea, and asthenia are symptoms commonly associated with advanced colorectal cancer. The tumour is often palpable on rectal or abdominal examination, and malignant ascites may also be evident.