Patient will present as → a 69 year old male who complains of rectal pruritus, bleeding with defecation and a sensation of incomplete evacuation. A palpable mass is noted on digital rectal examination.
This is a rare form of cancer there are about 7,000 cases per year of anorectal cancer and approximately 900 deaths.
- Hematochezia—most common symptom, tenesmus, rectal mass; a feeling of incomplete evacuation of stool (due to mass)
- Primarily adenocarcinomas.
- Risk factors include infection with human papillomavirus (HPV), chronic fistulas, irradiated anal skin, leukoplakia, lymphogranuloma venereum, and condyloma acuminatum.
- People having receptive anal intercourse are at increased risk.
Whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out.
- Typically, colonoscopy is done, but skin biopsy by a dermatologist or surgeon might be needed for lesions near the squamocolumnar junction (Z line). Staging by CT, MRI, or PET is advisable.
Treated with wide local surgical excision, radiation with chemotherapy for large tumors with mets.
0.3% of rectal cancer
0.4% of rectal cancer
1.3% of rectal cancer
The remaining 33% are divided among the many other locations where secondary carcinomatous deposits tend to lodge, including the brain.
Bleeding is the earliest and most common symptom.
Fecal occult blood test is a screening method
The overall 5-year survival rate for Stage III rectal cancer is 60-85%.
Pain is a late symptom.
Does not provide cure on its own. It can be given preoperatively, postoperatively, and palliatively
Does not provide cure on its own.
None of the above
See A for explanation
Is good for initial visualization of hemorrhoids but is not appropriate to rule out cancer
MRI with contrast
Staging by CT, MRI, or PET is advisable.
See D for explanation