A Review of Relationship Between Presenting Symptoms and Tumour Location in Colorectal Carcinoma in Tertiary Centre Hospital

Last reviewed: March 2026

Background and Context

Colorectal cancer (CRC) is one of the most commonly diagnosed malignancies worldwide and a leading cause of cancer-related death. In Malaysia, CRC ranks among the top three cancers in both males and females, with the Malaysia National Cancer Registry documenting rising incidence rates over recent decades. This increase has been attributed to urbanisation, dietary changes towards processed and red meat-heavy diets, rising obesity prevalence, and an ageing population.

The clinical presentation of CRC varies significantly depending on the location of the primary tumour within the colon and rectum. The right-sided colon (caecum, ascending colon, and proximal transverse colon) derives from the embryological midgut, while the left-sided colon (distal transverse, descending, sigmoid colon, and rectum) derives from the hindgut. These anatomical and embryological differences translate into distinct clinical presentations, molecular profiles, and prognostic outcomes.

Understanding the relationship between presenting symptoms and tumour location is crucial for primary care physicians and emergency department clinicians, who are often the first point of contact for patients with undiagnosed CRC. Symptom recognition can guide appropriate investigation — particularly colonoscopy — and potentially reduce diagnostic delays that contribute to late-stage presentation.

Study Design and Methodology

The study was conducted at a Malaysian tertiary care hospital and involved a retrospective review of patients diagnosed with histologically confirmed colorectal carcinoma. Medical records were examined for presenting symptoms, tumour location as determined by colonoscopy and surgical findings, histopathological characteristics, and tumour staging using the TNM classification system.

Tumour locations were classified as right-sided colon (caecum through proximal transverse colon), left-sided colon (distal transverse through sigmoid colon), and rectal. Presenting symptoms assessed included rectal bleeding, change in bowel habits (diarrhoea, constipation, or alternating), abdominal pain, anaemia, weight loss, palpable abdominal mass, and intestinal obstruction. Statistical analysis examined associations between symptom patterns and tumour location.

Key Results

The study confirmed patterns consistent with international literature while providing valuable Malaysian data. Right-sided tumours were more commonly associated with occult blood loss leading to iron-deficiency anaemia, vague abdominal discomfort, and nonspecific constitutional symptoms such as fatigue and weight loss. The often subtle nature of right-sided symptoms contributes to delayed diagnosis, with many patients presenting at more advanced stages.

Left-sided and rectal tumours, by contrast, more frequently presented with overt rectal bleeding, changes in stool calibre, alternating bowel habits, and a sensation of incomplete evacuation. These symptoms — while more alarming and thus more likely to prompt medical consultation — may still be attributed to benign conditions such as haemorrhoids, potentially leading to diagnostic delays.

Implications for Malaysian Healthcare

The findings underscore the importance of a low threshold for investigation in patients presenting with persistent gastrointestinal symptoms, particularly in the Malaysian context where CRC incidence is rising. For primary care practitioners, the key clinical message is that the absence of overt rectal bleeding should not provide false reassurance — right-sided cancers frequently present with nonspecific symptoms and anaemia alone.

Malaysia has implemented a national colorectal cancer screening programme, and the immunochemical faecal occult blood test (iFOBT) is recommended as a screening tool for asymptomatic individuals aged 50 and above. However, uptake remains suboptimal, and the findings of this study reinforce the need for both population-level screening expansion and improved clinical awareness of symptom patterns that should trigger urgent investigation.

Limitations

The study’s retrospective design and single-centre setting limit the generalisability of findings. Symptom data derived from medical records may not fully capture patients’ complete symptom histories. The sample size and ethnic composition of the study population were not detailed in the available abstract, preventing assessment of potential ethnic variations in presentation. Furthermore, the study did not assess molecular subtypes or microsatellite instability status, which may influence both presentation and prognosis.