Trusted medical expertise in seconds.

Access 1,000+ clinical and preclinical articles. Find answers fast with the high-powered search feature and clinical tools.

Try free for 5 days
Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer.

Colorectal cancer

Last updated: August 23, 2021

Summarytoggle arrow icon

Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer in the United States. Risk factors include a positive family history, hereditary syndromes, diet, and a number of conditions, such as inflammatory bowel disease. Most colorectal cancers (95%) are adenocarcinomas. Clinical signs are often nonspecific and may include a change in bowel habits, lower GI bleeding, and weight loss. These features as well as iron deficiency anemia in men older than 50 years of age and postmenopausal women are red flags for CRC. Since the introduction of screening with direct visualization or stool-based testing, early-stage carcinomas have become easier to diagnose in asymptomatic patients. Complete colonoscopy with histopathologic analysis confirms the diagnosis. Staging of the cancer is necessary to evaluate the extent of disease and determine the appropriate management. Curative surgical resection of colorectal cancers and metastases is preferred when feasible. The type and extent of resection depend on the stage of the cancer. In addition, for cancer stages ≥ II, chemotherapy is required for colon cancer and chemotherapy and/or radiation therapy for rectal cancer. Surveillance following CRC treatment is essential to identify and manage recurrence and/or metastases. As the incidence of CRC is high, screening for CRC is recommended for all individuals, starting at 45–50 years of age (earlier in high-risk individuals).

  • Incidence [1][2]
    • Fourth most common cancer in the US overall
    • Accounts for ∼ 8% of all new cancer cases in the US
    • Peak incidence: between 65 and 74 years of age
  • Prevalence: ∼ 0.4%
  • Mortality: second leading cause of cancer-related deaths in the US overall

Epidemiological data refers to the US, unless otherwise specified.

Colorectal carcinogenesis pathways (molecular pathology)

Risk factors for colorectal cancer [3]

Protective factors [3]

  • Long-term use of aspirin and other NSAIDs
  • Physical activity
  • Diet rich in fiber and vegetables and lower in meat

Colorectal cancer can be asymptomatic, particularly during the early stages.

Constitutional symptoms [7]

Right-sided colon carcinomas [7][8]

Iron deficiency anemia in men > 50 years of age and postmenopausal women should raise suspicion for colorectal cancer.

Left-sided colon carcinomas [7][8]

  • Definition: large bowel malignancies arising from the splenic flexure, descending colon, sigmoid colon, or the rectosigmoid junction
  • Clinical features
    • Changes in bowel habits (size, consistency, frequency)
    • Blood-streaked stools
    • Colicky abdominal pain (due to obstruction)

Bowel obstruction occurs earlier in left-sided colon carcinomas because the distal colon has a smaller lumen than the proximal colon and contains solid fecal matter.

Rectal carcinomas [7][8]

  • Definition: large bowel malignancies located ≤ 15 cm from the anal verge [9]
  • Clinical features

Cancers located ≤ 15 cm proximal to the anal verge are considered rectal carcinomas; cancers above this point are considered colon cancers.

Consider colorectal cancer in every patient with rectal bleeding, even if there is a history of hemorrhoids or diverticular disease.

Metastatic disease [10]

CRC can metastasize through hematogenous, lymphatic, transperitoneal, and contiguous routes. Symptomatic metastases may be the first manifestation of CRC.

Typically, cancers of the colon and upper rectum initially metastasize to the liver via the portal vein, and cancers of the lower rectum initially metastasize to the lung via the inferior vena cava.

Red flags for colorectal cancer [13][14][15]

The sensitivity and specificity of symptoms of colorectal cancer are limited. The following features have the strongest association with CRC, especially in patients with risk factors for colorectal cancer, and should always prompt further investigation.

All patients with suspected CRC should undergo a complete colonoscopy with biopsy of suspicious lesions. Once the diagnosis is confirmed, additional tests to stage the cancer are required to guide management.

Initial workup [9][16]

Digital rectal examination

Flexible sigmoidoscopy with or without anoscopy [13]

Complete colonoscopy

Colonoscopy is the gold standard test for CRC as it allows for direct visualization and biopsy of polyps and suspicious lesions. [17]

A complete colonoscopy is imperative in all patients with suspected/confirmed CRC as multiple adenocarcinomas (synchronous tumors) are present in up to 5% of cases. [20]

Double-contrast barium enema (uncommonly performed)

  • Indication: an alternative to CT colonography in patients who decline/cannot undergo a complete colonoscopy at presentation
  • Findings
    • Endoluminal filling defect typically with irregular margins
    • Apple core lesion (napkin ring sign): sharply defined circumferential narrowing of the bowel caused by a stenosing CRC [16][21][22]
  • Important considerations

Preoperative staging

Laboratory studies [16]

CEA is a prognostic marker and should not be used to screen for colorectal cancer.

Once the diagnosis is confirmed, CRC should be staged to determine management. The American Joint Committee for Cancer (AJCC) TNM classification is currently the standard staging system used in clinical practice. The Dukes classification is a simplified approach to staging that is of academic interest but is not used to guide management.

Colorectal cancer staging
AJCC staging 8th edition (simplified) [31] TNM stage Corresponding Dukes classification stage Description
0
  • A
I
  • Up to T2, N0, M0
II
  • Up to T4, N0, M0
  • B
III
  • Any T, N1/N2, M0
  • C
IV
  • Any T, any N, M1
  • D

Differential diagnoses based on clinical presentation

Small bowel neoplasms

The differential diagnoses listed here are not exhaustive.

General principles [9][16]

Principles of surgery for CRC [9][16]

Curative surgery

Palliative surgery

Consider in patients with nonresectable distant metastases to prevent or treat complications of colorectal cancer.

Systemic therapy [9][16][34]

Systemic therapy is indicated in most patients with colon or rectal cancer. See “Treatment of colon cancer by stage” and “Treatment of rectal cancer by stage” for details. [34][35]

Radiation therapy

  • Rectal cancer: standard treatment modality in most stages of rectal cancer [9]
  • Colon cancer

Principles of colon cancer treatment [16]

Treatment of colon cancer by stage
AJCC stage Treatment approach
Stage I
  • Curative surgery
Stage II
Stage III
Stage IV
  • All patients
    • Individualized, multidisciplinary approach
    • Consider neoadjuvant treatment if downstaging may enable curative surgical resection.
  • Resectable metastatic disease
  • Unresectable metastatic disease or severe comorbidities preventing curative surgical treatment
    • Consider palliative surgery.
    • Consider palliative chemotherapy.

The treatment of colon cancer is mainly surgical, supplemented with chemotherapy. Radiation therapy is not a standard therapeutic modality for colon cancers.

Surgery for colon cancer [16][38][39]

Typical surgeries for colon cancer [38][39][41]
Type of resection Description Indication
Hemicolectomy Right hemicolectomy
Extended right hemicolectomy
Left hemicolectomy
Sigmoid colectomy
Subtotal or total abdominal colectomy
  • Resection of most of or the entire colon
Less commonly used techniques

Principles of rectal cancer treatment [9][34]

Treatment of rectal cancer by stage
AJCC Stage Treatment approach
Stage I
  • Curative surgery
Stage II
Stage III
Stage IV
  • All patients
    • Individualized treatment with a multidisciplinary approach
    • Consider neoadjuvant treatment in potentially resectable metastatic disease.
  • Resectable metastasic disease
  • Unresectable metastatic disease or severe comorbidities preventing surgical treatment

Surgery for rectal cancer [9]

  • The extent of the resection depends on the location of the tumor and the TNM stage.
  • The sphincter tone and the distance of the tumor from the anal verge (e.g., via rigid proctosigmoidoscopy) should be assessed preoperatively to plan appropriate surgical resection.
  • Consider gynecology and/or urology consult if imaging shows a regional spread past the rectum.
Typical surgeries for rectal cancer
Description Indication Tumor stage
Transanal excision
  • Minimally invasive excision of small superficial tumors
  • Early, localized disease (stage I)
Low anterior resection (LAR)
  • Sphincter-preserving resection of the rectum and sigmoid
  • Total mesorectal excision (TME)
  • Immediate reconstruction (e.g., side-to-side anastomosis)
  • Optional diverting ostomy
  • Tumor location allowing for sphincter preservation in patients with good preoperative sphincter function
    • Appropriate distal resection margins depend on the location of the tumor.
      • 5 cm for tumors of the upper third of the rectum
      • For tumors closer to the anal sphincter, smaller resection margins may be tolerated.
    • Shorter margins may be acceptable when neoadjuvant therapy has been successful.
  • Stage I tumors ineligible for transanal excision
  • Locally advanced disease (stages II–III)
  • Resectable metastatic disease (stage IV)

Abdominoperineal resection (APR)

  • Tumor too close to the sphincter to achieve an adequate distal margin without compromising the sphincter or cancer that has infiltrated the sphincter

A complete TME is necessary to adequately assess the nodal status and prevent recurrence.

Gross pathology

Histopathology

95% of all colorectal cancers are adenocarcinomas.

All patients with CRC should be followed up closely after curative treatment to ensure early identification and management of recurrence. These recommendations are consistent with the American Society of Colon and Rectal Surgeons' 2015 guidelines. [43][44][45]

90% of recurrences occur within the first five years following treatment. [45]

General principles [21][46][47][48][49]

  • Recommended screening age
    • Several trusted US societies and taskforces offer slightly different screening recommendations.
    • Screening for colorectal cancer is generally recommended for all individuals aged > 50 years.
    • Recent guidelines suggest starting screening at 45 years of age for individuals at average risk for CRC.
    • The decision to continue screening in patients aged > 75 years should be made on a case-by-case basis.
  • Screening modalities and screening intervals depend on individual risk factors (detailed below).

Individuals at average risk (general population) [21][46][47][48]

Direct visualization

Stool-based testing

Individuals at high risk [21][46]

Colorectal cancer screening for high-risk individuals
High-risk characteristics Screening recommendations

History of adenomatous polyps

History of CRC

Positive family history

(Also consider genetic testing in patients with multiple affected family members or relatives affected at a young age)

≥ 2 first-degree relatives with CRC diagnosed at any age

  • Start screening with complete colonoscopy at age 40 or 10 years earlier than the index patient's age at diagnosis; whichever is earlier
  • Followed by complete colonoscopy every 5 years

≥ 1 first-degree relative with CRC or advanced adenoma diagnosed at < 60 years of age

≥ 1 first-degree relative with CRC or advanced adenoma diagnosed at ≥ 60 years of age

One second-degree relative with CRC or advanced adenoma

Other high-risk conditions

Hereditary syndromes associated with increased risk of CRC (e.g., FAP, HNPCC)
Inflammatory bowel disease
  • Control modifiable risk factors for CRC. [50][51][52]
    • Increase physical activity.
    • Optimize nutrition.
    • Decrease or stop alcohol consumption and smoking.
    • Optimize treatment of conditions that increase the risk of CRC (e.g., IBD, HTN, diabetes, hyperlipidemia). [50]
  • Long-term aspirin therapy may reduce the incidence of CRC. [46][50]
    • Consider low-dose aspirin if all of the following parameters are met:
    • Important considerations
      • Aspirin therapy does not replace screening for CRC or alter screening intervals.
      • It is unclear if aspirin therapy provides additional benefits over CRC screening or if its benefits outweigh the risks.

Primary prevention with low-dose aspirin does not replace screening for CRC!

  1. Key Statistics for Colorectal Cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Updated: January 5, 2017. Accessed: February 10, 2017.
  2. Cancer Stat Facts: Colorectal Cancer. https://seer.cancer.gov/statfacts/html/colorect.html. . Accessed: November 12, 2020.
  3. Colorectal Cancer Risk Factors. https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html. . Accessed: November 11, 2020.
  4. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors.. Clinics in colon and rectal surgery. 2009; 22 (4): p.191-7. doi: 10.1055/s-0029-1242458 . | Open in Read by QxMD
  5. Xie J, Itzkowitz SH. Cancer in inflammatory bowel disease. World journal of gastroenterology. 2008; 14 (3): p.378-89.
  6. Abdulamir AS, Hafidh RR, Abu bakar F. The association of Streptococcus bovis/gallolyticus with colorectal tumors: the nature and the underlying mechanisms of its etiological role. J Exp Clin Cancer Res. 2011; 30 (1): p.11. doi: 10.1186/1756-9966-30-11 . | Open in Read by QxMD
  7. Colorectal Cancer Signs and Symptoms. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/signs-and-symptoms.html. Updated: June 29, 2020. Accessed: November 11, 2020.
  8. Phipps AI, Lindor NM, Jenkins MA, et al. Colon and Rectal Cancer Survival by Tumor Location and Microsatellite Instability. Diseases of the Colon & Rectum. 2013; 56 (8): p.937-944. doi: 10.1097/dcr.0b013e31828f9a57 . | Open in Read by QxMD
  9. You YN, Hardiman KM, Bafford A, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum. 2020; 63 (9): p.1191-1222. doi: 10.1097/dcr.0000000000001762 . | Open in Read by QxMD
  10. Moghadamyeghaneh Z, Alizadeh RF, Phelan M, et al. Trends in colorectal cancer admissions and stage at presentation: impact of screening. Surg Endosc. 2015; 30 (8): p.3604-3610. doi: 10.1007/s00464-015-4662-3 . | Open in Read by QxMD
  11. Nichols SD, Albert S, Shirley L, et al. Outcomes in patients with obstructive jaundice from metastatic colorectal cancer and implications for management.. J Gastrointest Surg. 2014; 18 (12): p.2186-91. doi: 10.1007/s11605-014-2670-6 . | Open in Read by QxMD
  12. Suliman MS, Singh M, Ajmeri AN, Stuart DL, Teka ST. Virchow's node: a case report of an extremely rare presentation of metastasis of adenocarcinoma with mucinous features from the colon.. International journal of general medicine. 2019; 12 : p.137-140. doi: 10.2147/IJGM.S201617 . | Open in Read by QxMD
  13. Pasha SF, Shergill A, Acosta RD, et al. Guideline: The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc. 2014; 79 (6): p.875-885. doi: 10.1016/j.gie.2013.10.039 . | Open in Read by QxMD
  14. Adelstein B-A, Macaskill P, Chan SF, Katelaris PH, Irwig L. Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. BMC Gastroenterol. 2011; 11 (1). doi: 10.1186/1471-230x-11-65 . | Open in Read by QxMD
  15. Astin M, Griffin T, Neal RD, Rose P, Hamilton W. The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. B J Gen Pract. 2011; 61 (586): p.e231-e243. doi: 10.3399/bjgp11x572427 . | Open in Read by QxMD
  16. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018; 25 (6): p.1454-1455. doi: 10.1245/s10434-018-6462-1 . | Open in Read by QxMD
  17. Tong G-J, Zhang G-Y, Liu J, et al. Comparison of the eighth version of the American Joint Committee on Cancer manual to the seventh version for colorectal cancer: A retrospective review of our data. World J Clin Oncol. 2018; 9 (7): p.148-161. doi: 10.5306/wjco.v9.i7.148 . | Open in Read by QxMD
  18. Vogel JD, Eskicioglu C, Weiser MR, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. Dis Colon Rectum. 2017; 60 (10): p.999-1017. doi: 10.1097/dcr.0000000000000926 . | Open in Read by QxMD
  19. Lin JS, Piper MA, Perdue LA, et al. Screening for Colorectal Cancer. JAMA. 2016; 315 (23): p.2576. doi: 10.1001/jama.2016.3332 . | Open in Read by QxMD
  20. Saito S, Tajiri H, Ikegami M. Endoscopic features of submucosal deeply invasive colorectal cancer with NBI characteristics. Clin J Gastroenterol. 2015; 8 (6): p.353-359. doi: 10.1007/s12328-015-0616-5 . | Open in Read by QxMD
  21. Horvat N, Raj A, Ward JM, Smith JJ, Markowitz AJ, Gollub MJ. Clinical Value of CT Colonography Versus Preoperative Colonoscopy in the Surgical Management of Occlusive Colorectal Cancer. American Journal of Roentgenology. 2018; 210 (2): p.333-340. doi: 10.2214/ajr.17.18144 . | Open in Read by QxMD
  22. Thiels CA, Naik ND, Bergquist JR, et al. Survival following synchronous colon cancer resection. J Surg Oncol. 2016; 114 (1): p.80-85. doi: 10.1002/jso.24258 . | Open in Read by QxMD
  23. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2017; 86 (1): p.18-33. doi: 10.1016/j.gie.2017.04.003 . | Open in Read by QxMD
  24. Alzaraa A, Krzysztof K, Uwechue R, Tee M, Selvasekar C. Apple-core lesion of the colon: a case report. Cases J. 2009; 2 (1): p.7275. doi: 10.4076/1757-1626-2-7275 . | Open in Read by QxMD
  25. Neri E, Faggioni L, Cerri F, et al. CT colonography versus double-contrast barium enema for screening of colorectal cancer: comparison of radiation burden. Abdom Imaging. 2010; 35 (5): p.596-601. doi: 10.1007/s00261-009-9568-x . | Open in Read by QxMD
  26. Fowler KJ, Kaur H, Cash BD, et al. ACR Appropriateness Criteria ® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol. 2017; 14 (5): p.S234-S244. doi: 10.1016/j.jacr.2017.02.012 . | Open in Read by QxMD
  27. Sahani DV, Kalva SP. Imaging the Liver. Oncologist. 2004; 9 (4): p.385-397. doi: 10.1634/theoncologist.9-4-385 . | Open in Read by QxMD
  28. Jacobson R, Sherman SK, Dadaleh F, Turaga KK. Peritoneal Metastases in Colorectal Cancer. Ann Surg Oncol. 2018; 25 (8): p.2145-2151. doi: 10.1245/s10434-018-6490-x . | Open in Read by QxMD
  29. McMullen JRW, Selleck M, Wall NR, Senthil M. Peritoneal carcinomatosis: limits of diagnosis and the case for liquid biopsy. Oncotarget. 2017; 8 (26): p.43481-43490. doi: 10.18632/oncotarget.16480 . | Open in Read by QxMD
  30. Seo JB, Im J-G, Goo JM, Chung MJ, Kim M-Y. Atypical Pulmonary Metastases: Spectrum of Radiologic Findings. Radiographics. 2001; 21 (2): p.403-417. doi: 10.1148/radiographics.21.2.g01mr17403 . | Open in Read by QxMD
  31. O'Leary MP, Parrish AB, Tom CM, MacLaughlin BW, Petrie BA. Staging Rectal Cancer: The Utility of Chest Radiograph and Chest Computed Tomography. Am Surg. 2016; 82 (10): p.1005-1008.
  32. Duffy MJ. Carcinoembryonic Antigen as a Marker for Colorectal Cancer: Is It Clinically Useful?. Clin Chem. 2001; 47 (4): p.624-630. doi: 10.1093/clinchem/47.4.624 . | Open in Read by QxMD
  33. Cancer Stat Facts: Small Intestine Cancer. https://seer.cancer.gov/statfacts/html/smint.html. . Accessed: November 12, 2020.
  34. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN Guidelines Insights: Rectal Cancer, Version 6 2020. J Natl Compr Canc Netw. 2020; 18 (7): p.806-815. doi: 10.6004/jnccn.2020.0032 . | Open in Read by QxMD
  35. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN Guidelines Insights: Colon Cancer, Version 2.2018. J Natl Compr Canc Netw. 2018; 16 (4): p.359-369. doi: 10.6004/jnccn.2018.0021 . | Open in Read by QxMD
  36. NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer. Version 6.2020. https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Updated: June 25, 2020. Accessed: December 7, 2020.
  37. Lutz S, Balboni T, Jones J, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Practical Radiation Oncology. 2016; 7 (1): p.4-12. doi: 10.1016/j.prro.2016.08.001 . | Open in Read by QxMD
  38. Pease NJ, Edwards A, Moss LJ. Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review. Palliative Medicine. 2005; 19 (4): p.288-299. doi: 10.1191/0269216305pm1017oa . | Open in Read by QxMD
  39. Steele SR, Chang GJ, Hendren S, et al. Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer. Dis Colon Rectum. 2015; 58 (8): p.713-725. doi: 10.1097/dcr.0000000000000410 . | Open in Read by QxMD
  40. Costas-Chavarri A, Nandakumar G, Temin S, et al. Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol. 2019 : p.1-19. doi: 10.1200/jgo.18.00214 . | Open in Read by QxMD
  41. Kahi CJ, Boland CR, Dominitz JA, et al. Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016; 150 (3): p.758-768.e11. doi: 10.1053/j.gastro.2016.01.001 . | Open in Read by QxMD
  42. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021; 116 (3): p.458-479. doi: 10.14309/ajg.0000000000001122 . | Open in Read by QxMD
  43. Davidson KW, Barry MJ, et al. Screening for Colorectal Cancer. JAMA. 2021; 325 (19): p.1965. doi: 10.1001/jama.2021.6238 . | Open in Read by QxMD
  44. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018; 68 (4): p.250-281. doi: 10.3322/caac.21457 . | Open in Read by QxMD
  45. Qaseem A, Crandall CJ, Mustafa RA, Hicks LA, Wilt TJ. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians. Annals of Internal Medicine. 2019; 171 (9): p.643. doi: 10.7326/m19-0642 . | Open in Read by QxMD
  46. Bibbins-Domingo K. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016; 164 (12): p.836. doi: 10.7326/m16-0577 . | Open in Read by QxMD
  47. Thanikachalam K, Khan G. Colorectal Cancer and Nutrition. Nutrients. 2019; 11 (1): p.164. doi: 10.3390/nu11010164 . | Open in Read by QxMD
  48. Chan AT, Giovannucci EL. Primary Prevention of Colorectal Cancer. Gastroenterology. 2010; 138 (6): p.2029-2043.e10. doi: 10.1053/j.gastro.2010.01.057 . | Open in Read by QxMD
  49. Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC. Surgical Technique and Survival in Patients Having a Curative Resection for Colon Cancer. Dis Colon Rectum. 2003; 46 (7): p.860-866. doi: 10.1007/s10350-004-6673-3 . | Open in Read by QxMD
  50. Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Elsevier ; 2016
  51. Goulder F. Bowel anastomoses: The theory, the practice and the evidence base. World Journal of Gastrointestinal Surgery. 2012; 4 (9): p.208. doi: 10.4240/wjgs.v4.i9.208 . | Open in Read by QxMD
  52. Feig BW, Ching DC. The M.D. Anderson Surgical Oncology Handbook. Lippincott Williams & Wilkins ; 2012
  53. Leijssen LGJ, Dinaux AM, Amri R, Kunitake H, Bordeianou LG, Berger DL. A Transverse Colectomy is as Safe as an Extended Right or Left Colectomy for Mid-Transverse Colon Cancer. World J Surg. 2018; 42 (10): p.3381-3389. doi: 10.1007/s00268-018-4582-1 . | Open in Read by QxMD