I always feel fatigued and tired

Causes of fatigue
1. Post viral infection
2. Endocrine
  1. Hypothroidism
  2. Addisons
3. Organ failure
  1. Heart failure
4. Neoplastic
5. Chronic infecetion
  1. TB
6. Chronic inflammatory diseases
  1. Crohn's disease
Physiology of defecation
1. Several steps
Types of colorectal cancer
1. Squamous cell carcinoma
2. Cloacogenic carcinoma
3. Adenocarcinoma
4. Rare
  1. Basal cell carcinoma
  2. Melanoma
5. Risk factors
  1. Age
  2. Male gender
  3. Smoking
  4. Obesity
  5. Heriditary polyposis syndromes
  6. First degree relatives with colon cancer
  7. Diet factors
6. Pathogenesis
  1. Two pathways
    1. Adenoma-carcinoma sequence
      1. Mutation of both copies of APC
        K-ras mutation
        P53 mutation and increased COX 2
        Carcinoma
        Polyp formation
        Increased risk for polyp
    2. MSI
      1. Mutations of mismatch repair enzyme
        Accumalation of several mutation
7. Signs and symptoms
  1. Change in bowel habits
  2. Difficulty in relieving oneself
  3. Rectal bleeding
  4. Cramping
  5. Fatigue
  6. Unintentional weight loss
8. Investigations
  1. Colonscopy
  2. CT scan
  3. Laboratory tests
    1. CBC
    2. Tumor markers
      1. CEA
9. Staging and grading
10. Mangement
  1. FOLFOX
    1. 5-Flurouracil
    2. Leucoverin
    3. Oxaloplatin
  2. CAPOX
    1. Capcitabeine
  3. Surgical
    1. Excision of the mass
      1. Local
      2. Total
11. Screening
  1. Age 45 and above
  2. Relatives with colorectal cancer
12. Epidemiology
Anatomy of large intestine

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I always feel fatigued and tired

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