A sudden change in bowel habits or blood in the feces (often detectable only in a laboratory) may be the first symptoms of colon cancer. In the early stages of the disease there may be no obvious symptoms. Diagnosis is made by physical examination of the rectum and a laboratory examination of blood for carcinoembryonic antigen (CEA), a tumor marker produced by colon cancers. These may be followed by an endoscopic examination of the colon with a sigmoidoscope (to examine the rectum and the adjoining sigmoid colon) or colonoscope (to examine the entire colon). A biopsy of any suspicious tissue, such as a polyp or a flat or depressed lesion, is then examined in a laboratory to determine if cancerous changes are present. If cancer is found, the patient is evaluated to determine the extent of the primary tumor and whether the disease has spread throughout the body.