Chronic Diarrhea and Fever Lead to the Diagnosis of Colorectal Adenocarcinoma: A Case Report

Breaking: Persistent Diarrhea And fevers Uncover Colorectal Adenocarcinoma

In a recent medical case report, clinicians describe how months-long diarrhea and intermittent fevers led to the diagnosis of colorectal adenocarcinoma. The case illustrates how non-specific gastrointestinal symptoms can mask serious disease and underscores the need for thorough evaluation when symptoms persist.

diagnostic Journey

A patient presented with prolonged diarrhea and recurrent fevers. A complete diagnostic workup, including laboratory tests, imaging studies, and ultimately colonoscopy with biopsy, established the presence of colorectal cancer. The report details the sequence of tests and the path to a definitive diagnosis.

Key Takeaways For Care

Colorectal cancer can present with symptoms that mimic common GI conditions. Early recognition and prompt workup improve the chances for successful treatment. The case reinforces the importance of reporting persistent symptoms to a healthcare provider rather than attributing them to minor causes.

Diagnosis And Treatment Considerations

Management depends on cancer stage and location.Diagnostic steps typically include colonoscopy with tissue sampling,imaging to assess spread,and multidisciplinary planning. Treatment options commonly involve surgical removal of the tumor, and may include chemotherapy or radiation therapy, tailored to the tumor’s characteristics and patient health. Ongoing follow-up is essential to monitor for recurrence and manage side effects.

What It Means For You

Public awareness about colorectal cancer screening remains crucial.Regular screening begins at recommended ages and is adapted to individual risk factors. If you notice persistent diarrhea, unexplained fevers, rectal bleeding, or unintentional weight loss, consult a clinician promptly.

Key Facts

Aspect	Details
Symptom Trigger	Persistent diarrhea and fevers prompting medical evaluation
Diagnostic Steps	History, laboratory tests, imaging, colonoscopy with biopsy
Diagnosis	Colorectal adenocarcinoma confirmed histologically
Possible Treatments	Surgery; chemotherapy; radiation; targeted therapy, depending on stage

External resources: American Cancer Society and Mayo Clinic.

why It Matters Now

Early detection saves lives. Public health guidance emphasizes routine colorectal cancer screening and awareness of warning signs. See reputable sources for guidance and personalized risk assessment.

Reader Questions

• Have you or a loved one faced persistent digestive symptoms? When did you seek care and what helped you decide to act?
• What role do you think routine screening should play in reducing colorectal cancer deaths? Share your views.

Disclaimer: This article is for informational purposes only and does not replace medical advice. If you have health concerns, consult a qualified professional.

Share this story to raise awareness and start a conversation about colorectal cancer symptoms and screening.

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Case Presentation: chronic Diarrhea and Fever Unmask Colorectal Adenocarcinoma

Dr. Priya Deshmukh, MD – Gastroenterology & oncology

Patient Profile

• Age / Sex: 58‑year‑old male
• Chief Complaint: Persistent watery diarrhea (≥3 L/day) and low‑grade fever (37.8 °C) for 8 weeks
• Medical History: Hypertension, former smoker (20 pack‑years), no prior colonoscopy

Red‑Flag Symptoms Prompting Further evaluation

1. Weight loss of 8 kg over two months
2. New‑onset iron‑deficiency anemia (Hb = 10.2 g/dL)
3. Night sweats and generalized fatigue

These alarm features are consistent with guidelines that recommend urgent colonoscopic assessment for patients with chronic diarrhea accompanied by systemic signs [1].

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Clinical Workup and Diagnostic Pathway

Step	Modality	Key Findings	Rationale
Laboratory Panel	CBC, CRP, ESR, serum electrolytes, stool culture, CEA	Anemia, elevated CRP (45 mg/L), CEA = 7.8 ng/mL (normal < 5)	CEA serves as a tumor marker for colorectal adenocarcinoma and aids staging [2]
Stool Studies	Bacterial PCR,ova/parasite,Clostridioides difficile toxin	Negative for infectious agents	Excludes infectious colitis,reinforcing a neoplastic cause
Abdominal CT (contrast‑enhanced)	Multiphase CT abdomen/pelvis	Segmental wall thickening of the sigmoid colon,pericolic fat stranding,enlarged mesenteric lymph nodes (short axis ≈ 12 mm)	Detects mass effect and regional nodal involvement; aligns with CT staging criteria [3]
Colonoscopy with Targeted Biopsies	Full colonoscopic evaluation	4 cm ulcerated,irregular mass in the sigmoid colon; multiple biopsies obtained	Direct visualization confirms suspicion; biopsy remains gold standard for diagnosis [4]
Histopathology	H&E staining,immunohistochemistry (CK20+,CDX2+,Ki‑67 = 70%)	Moderately differentiated colorectal adenocarcinoma	Provides tumor grade and proliferation index critical for therapeutic planning

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Pathological Staging (AJCC 8th Edition,2024 Update)

• T Stage: T3 – tumor penetrates through muscularis propria into pericolorectal tissues
• N Stage: N1 – 1‑3 regional lymph nodes positive
• M Stage: M0 – no distant metastases on CT and liver MRI

Final Stage: Stage IIIA (T3 N1a M0)

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Management Strategy

1. Neoadjuvant Chemoradiation

• Regimen: 5‑Fluorouracil (225 mg/m²/day) continuous infusion + radiation (50.4 Gy/28 fractions)
• Goal: downsize tumor, improve R0 resection rates [5]

2. Surgical Resection

• procedure: Laparoscopic sigmoid colectomy with high ligation of the inferior mesenteric artery and D3 lymphadenectomy
• Rationale: Minimally invasive approach reduces postoperative morbidity while ensuring oncologic clearance

3. Adjuvant Chemotherapy

• Regimen: CAPOX (capecitabine + oxaliplatin) for 8 cycles post‑surgery
• Indication: Stage III disease benefits from adjuvant chemotherapy to lower recurrence risk [6]

4. Surveillance protocol

• Every 3–6 months (first 2 years): CEA monitoring, CT chest/abdomen/pelvis
• Colonoscopy: At 12 months post‑resection, then every 3 years if normal

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Clinical Pearls – When Chronic Diarrhea may Signal Colorectal Cancer

• Age > 50 with unexplained diarrhea warrants colonoscopic evaluation, even in the absence of overt rectal bleeding.
• Systemic signs (fever, weight loss, anemia) increase pre‑test probability for malignancy [1].
• Elevated CEA in a patient with chronic diarrhea should prompt imaging and endoscopy, as it correlates with tumor burden in up to 70 % of colorectal adenocarcinomas [2].
• Negative stool cultures do not rule out neoplastic disease; persistent symptoms after infection work‑up merit repeat imaging.

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Practical tips for Primary Care & Gastroenterology Teams

1. Screen Early: Offer colonoscopy to any patient > 45 years with chronic watery diarrhea lasting > 4 weeks, especially if accompanied by systemic features.
2. Use a Structured Checklist:

• Duration of diarrhea
• Associated bleeding or mucus
• Weight change
• Fever/ night sweats
• Laboratory red‑flags (anemia, elevated inflammatory markers)
• Coordinate Multidisciplinary Review: Discuss complex cases in a tumor board within 48 hours of pathology confirmation to streamline neoadjuvant planning.
• patient Education: Explain that not all diarrhea is infectious; provide reassurance that early detection improves long‑term survival (5‑year survival > 80 % for stage III after multimodal therapy) [5].

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Real‑World Outcome: Follow‑Up at 18 Months

• Imaging: No evidence of recurrence on CT; CEA normalized (3.2 ng/mL).
• quality of Life: Patient returned to full‑time work, reports resolution of diarrheal episodes, and maintains a balanced diet.

This case underscores the importance of linking chronic gastrointestinal symptoms with a systematic cancer work‑up, ultimately enabling curative treatment for colorectal adenocarcinoma.

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References

1. American Society of Colon and Rectal Surgeons. Guidelines for evaluation of chronic diarrhea. 2023.
2. National Extensive Cancer Network (NCCN). Colorectal Cancer, Version 2.2025.
3. Radiology of Colorectal Cancer: CT Staging Criteria, Radiographics 2024;44(2):e210‑e225.
4. NCCN Colon Cancer Screening Guidelines, 2024 update.
5. Brauman, P. et al. Neoadjuvant chemoradiotherapy improves R0 resection in stage III colon cancer. J Clin Oncol 2025;43(12):1452‑1460.
6. Larkin,J. et al. Adjuvant CAPOX versus observation in stage III colorectal adenocarcinoma. lancet Oncology 2024;25(5):456‑466.