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AIM: To study the diagnostic significance of K-ras gene mutations in fecal samples from elderly patients with large intestinal cancer.METHODS: DNA was extracted in the fecal and tissue samples from 23 large intestinal cancer patients, 20 colonic adenomatoid polypus patients and 20 healthy subjects. The K-ras gene mutations at the first and second bases of codon 12 were detected by the allele specific mismatch method.RESULTS: The K-ras gene mutation was 56.52%(13/23) in the large intestinal cancer patients, which was notably higherthan that in the normal subjects whose K-ras gene mutationwas 5%(1/20) (χ2=12.93, P＜0.001). There was no significantdifference in comparison with that of colonic adenomatoidpolypus patients whose K-ras gene mutation was 30%(6/12)(χ2=3.05, P＞0.05). The K-ras gene mutation at the secondbase of codon 12 was 92.13%(12/13) in the large intestinalcancer patients. There was no significant difference betweenthe detection rate of K-ras gene mutation in the fecal andtissue samples (χ2=9.35, P＜0.01).CONCLUSION: Our results indicate that detection of theK-ras gene mutations in fecal samples provides a non-invasive diagnostic method for the elderly large intestinal cancer patients. Its significance in the early diagnosis of large intestinal cancer awaits further studies.