Question: I am a student FNP coming up with diff diagnosis for a senerio. I have come up with rectal cancer or acute appendicites for the following :Right lower quad belly pain radiating to mid-abdominal area, 54 yrs old, periods of constipation interspersed with bouts of diarrhea which she attributes to her use of stool softners. She had been seen prior by 4 other docs who said to changd diet and loose wt. She lost 20 lbs in three mths ,and has changed eating habits, symptoms getting progressively worse. Has no S.O.B, chest pain, palpitations, dysuria, back pain or diff urinating. Has not traveled out of the country w//I past yr. Smokes 1/2 pack of cigarettes/day for 30yrs, no alcohol usage,. Med. history significant for hypertension & partial hysterectomy. Family history heart disease, hypertension, colon cancer, diabetes, gout and hypothyroidism. On exam pt pale, t=100.5, cardiac and respiratory system are fine, has oral aphthous ulcers and abd soft, nondistended, diffuse abd. tenderness, Auscultation detected borborygmi but no organmegaly, rectal exam reveals tenderness and guiac= positive for stools. No hemmrrhoids pr palpable masses noted. So, am I missing another prominent differential diagosis ???