Rectal masses

Masses in the rectum or anal canal should be considered cancer unless proven otherwise.

Epidemiology and Demographics
Colorectal cancer


 * Second leading cause of mortality from cancer in the United States
 * 40,000 death's/year

Differential Diagnosis
In alphabetical order.


 * Anal cancer
 * Endometriosis
 * Foreign body
 * Hemorrhoids
 * Presacral neurogenic tumor
 * Prostatitis
 * Rectal Cancer
 * Rectal polyp
 * Rectal intussusception

History and Symptoms

 * History should include bowel changes and complete family history (focus on colorectal cancer)
 * Bleeding is the most common symptom
 * Stool or vomit black in color implies GI tract bleeding
 * Blood on the toilet paper may indicate anal fissure or hemorrhoids
 * Blood clots indicate bleeding in the colon

Laboratory Findings

 * Labs include
 * Fecal occult blood testing

Echocardiography or Ultrasound

 * Endorectal ultrasound is essential to detecting potential rectal cancer
 * Ultrasound is used to evaluate stage tumor invasion and lymph node status

Other Diagnostic Studies

 * Endoscopy and/or colonoscopy
 * Measuring the amount of pressure exerted by the anal sphincter via manometry may be necessary in patients suffering from incontinence

Treatment

 * Rectal masses can be treated by radiation and/or chemotherapy

Indications for Surgery

 * Rectal and anal cancers are treated by surgery
 * Hemmorhoids - rubber band ligation for internal hemorrhoids
 * Large refractroy hemmorrhoids - surgery is indicated
 * Acute thrombosis of hemmorrhoid - incision and drainage

Acknowledgements
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