Diseases » Anal Cancer » Diagnosis

Diagnosis of Anal Cancer

Anal Cancer Diagnosis: Book Excerpts

• Ask the Following Questions - RECTAL BLEEDING
• Ask the Following Questions - RECTAL PAIN
• Differential Diagnosis - Rectal Pain
• Approach to the Diagnosis - RECTAL BLEEDING
• Approach to the Diagnosis - RECTAL PAIN
• History and physical examination - Rectal pain
• Diagnosis - Colorectal cancer
• Diagnostic methods - Introduction Malignant Neoplasms
• Diagnosis - Malignant spinal neoplasms
• History and physical examination - Rectal pain
• History and physical examination - Hematochezia [Rectal bleeding]
• History - Rectal Bleeding
• Differential Overview - Rectal Pain
• Diagnosis - Colorectal cancer
• History - Rectal pain
• History and physical examination - Rectal pain
• History and physical examination - Hematochezia [Rectal bleeding]
• Approach to the Diagnosis - RECTAL BLEEDING
• Approach to the Diagnosis - RECTAL PAIN

Diagnostic Tests for Anal Cancer: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Anal Cancer.

RECTAL BLEEDING: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is it severe? The presence of severe rectal bleeding would suggest ulcerative colitis, amebic dysentery, bacillary dysentery, intussusception, mesenteric thrombosis or embolism, diverticulitis, ischemic colitis, and coagulation disorders.
2. Is there diarrhea and/or mucus? The presence of diarrhea with or without mucus would suggest ulcerative colitis, amebic dysentery, or bacillary dysentery.
3. Are there signs of intestinal obstruction? The presence of signs of intestinal obstruction would suggest intussusception, mesenteric thrombosis, or embolism.
4. If the bleeding is mild, is the bleeding mixed well with the stools? Rectal bleeding that is mixed well with the stools suggests carcinoma of the colon, ulcerative colitis, Crohn's disease, Meckel's diverticulum, diverticulitis, and coagulation disorder.
5. Are there painful bowel movements? The presence of painful bowel movements, especially with bright red bleeding, would suggest anal fissure or thrombosed hemorrhoid.
6. Is there a rectal mass? The presence of a rectal mass would suggest a polyp, carcinoma, or internal hemorrhoids.

DIAGNOSTIC WORKUP

Most cases can be diagnosed by anoscopy, sigmoidoscopy, and a barium enema. A stool culture and examination for ovum and parasites should also be done. If the diagnosis is uncertain after these studies, referral to a gastroenterologist should be done for colonoscopy and other diagnostic studies. The gastroenterologist may order angiography or small intestinal enteroscopy as well as radioisotope studies.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

RECTAL PAIN: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is there bleeding? The presence of bleeding with pain suggests an anal fissure, hemorrhoids, carcinoma, rectal prolapse, and intussusception.
2. Is there a mass? The presence of rectal pain along with a mass would suggest internal and external hemorrhoids, rectal carcinoma, and perirectal or ischiorectal abscesses. However, in females, masses in the cul-de-sac, such as an acute salpingitis, ectopic pregnancy, or endometriosis, will cause rectal pain. In males, prostatic abscess, foreign bodies, and seminal vesiculitis may cause rectal pain.
3. Is there a purulent discharge? Fistula in ano, perirectal abscess, ischiorectal abscess, and submucous abscess may cause a purulent discharge.

DIAGNOSTIC WORKUP

Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, anoscopy, sigmoidoscopy, and barium enema. In females, a pregnancy test and vaginal smear and culture should be done. Ultimately, culdocentesis, pelvic ultrasound, and laparoscopy may be necessary, but a gynecologist should be consulted before considering these tests. In males, prostatic massage may yield a urethral discharge for smear and culture. An intravenous pyelogram or cystoscopy with retrograde pyelography may also be helpful.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Rectal Pain: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Anal fissure
  –Acute fissure presents with pain and bleeding (noticed on toilet paper) immediately following defecation
  –Chronic fissure presents with long-standing itching and mild pain, with or without bleeding

• Perianal abscess (with or without associated fistula formation
• Thrombosed hemorrhoid
• Levator ani syndrome
• Proctalgia fugax (rectal muscle spasm)
• Coccyodynia/coccygodynia
• Fecal impaction
• Neoplasm (rectal, pelvic, or cauda equina)
• Idiopathic
• Inflammatory bowel disease (ulcerative proctitis, Crohn's disease)
• Solitary rectal ulcer syndrome
  –Misnomer: May be multiple, not restricted to rectum, and lesion may be polypoid
  –Neoplasm is a concern
• Pruritus ani
• Trauma
• Anal sex
• Constipation
• Diarrhea
• Less common causes (“zebras”) include familial rectal pain, endometriosis, pelvic inflammatory disease, prostatitis, myopathies, foreign bodies, and compression or inflammation of sacral nerves

Workup and Diagnosis

• A careful history and physical exam are crucial and often diagnostic for many conditions
  –Acute anal fissure presents as an anal tear (typically posterior) with a tender perineum; no further workup is necessary if the classic history and exam are found
  –Chronic anal fissure presents as an open ulcer with drainage and sentinel pile
  –Levator ani symptoms can be elicited by digital rectal examination
  –Proctalgia fugax symptoms cannot be elicited by exam
  –Coccyodynia: Palpation of coccyx reproduces symptoms

• In cases of perianal abscess, must rule out the presence of an anal fistula and inflammatory bowel disease
• Anoscopy may be indicated to rule out inflammatory bowel disease
• If an underlying disease process is suspected, consider stool cultures, viral titers, serologies, and/or biopsy

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

RECTAL BLEEDING: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

Armed with a more comprehensive list of causes of rectal bleeding, the clinician is ready to eliminate some of them as he or she asks appropriate questions during the history and performs the examination with all the causes in mind. The diagnosis may be pinned down by the presence or absence of other symptoms and signs. The principal diagnostic procedures are stool cultures, stool examination for ova and parasites, proctoscopy, barium enema, and colonoscopy.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

RECTAL PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The cause of rectal pain is usually obvious on examination with an anoscope or proctoscope. Careful palpation may be necessary to discover a perirectal abscess, coccydynia, or an ectopic pregnancy. Anal fissures may be missed unless all quadrants of the anus are examined with the slitanoscope.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Rectal pain: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient reports rectal pain, inspect the area for bleeding; abnormal drainage, such as pus; or protrusions, such as skin tags or thrombosed hemorrhoids. Also, check for inflammation and other lesions. A rectal examination may be necessary.

After the examination, proceed with your evaluation by taking the patient’s history. Ask him to describe the pain. Is it sharp or dull, burning or knifelike? How often does it occur? Ask if the pain is worse during or immediately after defecation. Does the patient avoid having bowel movements because of anticipated pain? Find out what alleviates the pain.

Make sure to ask appropriate questions about the development of associated signs and symptoms. For example, does the patient experience bleeding along with rectal pain? If so, find out how frequently this occurs and whether the blood appears on the toilet tissue, on the surface of the stool, or in the toilet bowl. Is the blood bright or dark red? Also, ask whether the patient has noticed other drainage, such as mucus or pus, and whether he’s experiencing constipation or diarrhea. Ask when he last had a bowel movement. Obtain a dietary history.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Colorectal cancer: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Only a tumor biopsy can verify colorectal cancer, but other tests help detect it:

❑Digital rectal examination can detect almost 15% of colorectal cancers.

❑Fecal occult blood test can detect blood in stools. However, it's commonly negative in patients with colon cancer.

❑ Proctoscopy or sigmoidoscopy can detect up to 66% of colorectal cancers.

❑ Colonoscopy permits visual inspection (and photographs) of the colon up to the ileocecal valve, and gives access for poly-pectomies and biopsies of suspected lesions.

❑ Computed tomography scan helps to detect areas affected by metastasis.

❑ Barium X-ray, using a dual contrast with air, can locate lesions that are undetectable manually or visually. Barium examination should follow endoscopy or excretory urography because the barium sulfate interferes with these tests.

❑Carcinoembryonic antigen, though not specific or sensitive enough for early diagnosis, is helpful in monitoring patients before and after treatment to detect metastasis or recurrence.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Introduction: Malignant Neoplasms: Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))

A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).

An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:

❑as a baseline during chemotherapy to evaluate the extent of tumor spread

❑to regulate drug dosage

❑to prognosticate after surgery or radiation

❑to detect tumor recurrence.

Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Malignant spinal neoplasms: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.

❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.

❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)

❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.

❑ Computed tomography scan shows cord compression and tumor location.

❑ Frozen section biopsy at surgery identifies the tissue type.

❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Rectal pain: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If your patient reports rectal pain, inspect the area for bleeding; abnormal drainage such as pus; or protrusions, such as skin tags or thrombosed hemorrhoids. Check for inflammation and other lesions. A rectal examination may be necessary.

After examination, proceed with your evaluation by taking the patient’s history. Ask the patient to describe the pain. Is it sharp or dull, burning or knifelike? How often does it occur? Ask if the pain is worse during or immediately after defecation. Does the patient avoid having bowel movements because of anticipated pain? Find out what alleviates the pain.

Be sure to ask appropriate questions about the development of any associated signs and symptoms. For example, does the patient experience bleeding along with rectal pain? If so, find out how frequently this occurs and whether the blood appears on the toilet tissue, on the surface of the stool, or in the toilet bowl. Is the blood bright or dark red? Ask whether the patient has noticed other drainage, such as mucus or pus, and whether he’s experiencing constipation or diarrhea. Ask when he last had a bowel movement. Obtain a dietary history.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Hematochezia [Rectal bleeding]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the hematochezia isn’t immediately life-threatening, ask the patient to fully describe the amount, color, and consistency of his bloody stools. (If possible, also inspect and characterize the stools yourself.) How long have the stools been bloody? Do they always look the same, or does the amount of blood seem to vary? Ask about associated signs and symptoms.

Next, explore the patient’s medical history, focusing on GI and coagulation disorders. Ask about the use of GI irritants, such as alcohol, aspirin, and other nonsteroidal anti-inflammatory drugs.

Begin the physical examination by checking for orthostatic hypotension, an early sign of shock. Take the patient’s blood pressure and pulse while he’s lying down, sitting, and standing. If systolic pressure decreases by 10 mm Hg or more, or pulse rate increases by 10 beats/minute or more when he changes position, suspect volume depletion and impending shock.

Examine the skin for petechiae or spider angiomas. Palpate the abdomen for tenderness, pain, or masses. Also, note lymphadenopathy. Finally, a digital rectal examination must be done to rule out rectal masses or hemorrhoids.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Rectal Bleeding: History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

A. Initial history. The history is an important tool for risk stratification. Important questions to ask: What is the color of blood passed? Is the bowel movement associated with pain? How long has the bleeding occurred? Is there blood on toilet tissue versus mixed with stool, or dripping into the toilet bowel? Have there been prior episodes? Is abdominal pain, constipation, diarrhea, medication use, or weight loss present? What medications do you take? The only historical questions that have evidence-based data to support benign versus serious pathology are the presence of constipation, diarrhea, age less than 50 years, and bleeding longer than 2 months (1,2) (Chapters 9.3 and 9.4). These findings are associated with more benign causes. An exception to this is in the pediatric age group where bleeding in children can represent hereditary and anatomic anomalies (4).

B. Other questions that can help discriminate serious from benign causes are a change in bowel habit to persistent loose stools for more than 1 month, absence of perianal symptoms in the presence of rectal bleedings, first time rectal bleeding, and the appearance of dark red blood (3). These are especially likely to be associated with more serious causes.

Physical examination

 Assess the patient’s weight, general condition, and vital signs. Orthostatic blood pressure changes with a drop of 10 mm Hg or an increase in heart rate of 10 beats/minute indicates a blood loss of at least 1,000 ml (20% of circulating blood volume) (5). It is important to perform an external anal inspection, (checking for external hemorrhoids, fissures), digital rectal examination (checking for a rectal mass, polyp or anal pain), abdominal examination (checking for tenderness or mass), and nasopharyngeal examination (checking for a bleeding source).

» READ BOOK EXCERPT ONLINE »

Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000

Rectal Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Hemorrhoid

❑ Rectal fissure

❑ Prostatitis

❑ Anal fistula

❑ Pruritus ani

❑ Fecal impaction

❑ Coccydynia

❑ Perirectal abscess

❑ Infected pilonidal cyst

❑ Ulcerative proctitis

❑ Infective proctitis

❑ Proctalgia fugax

❑ Anal carcinoma

Diagnostic Approach

Tenesmus is a painful urge to defecate with little result.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Colorectal cancer: Diagnosis
(Handbook of Diseases)

Only a tumor biopsy can verify colorectal cancer, but the following tests help detect it:

❑ Digital examination can help detect almost 15% of colorectal cancers.

❑ Hemoccult test (guaiac) may show blood in the stool.

❑ Proctoscopy or sigmoidoscopy can help detect up to 66% of colorectal cancers.

❑ Colonoscopy permits visual inspection (and photographs) of the colon up to the ileocecal valve and gives access for polypectomies and biopsies of suspected lesions.

❑ Computed tomography scan helps detect areas affected by metastasis.

❑ Barium X-ray, using a dual contrast with air, can locate lesions that are undetectable manually or visually. Barium examination should follow endoscopy or excretory urography because the barium sulfate interferes with these tests.

❑ Carcinoembryonic antigen, although not specific or sensitive enough for an early diagnosis, is helpful in monitoring patients before and after treatment to detect metastasis or recurrence.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Rectal pain: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Ask the patient to describe the pain. Is it sharp or dull, burning or knifelike? How often does it occur? Ask if the pain is worse during or immediately after defecation. Does the patient avoid having bowel movements because of anticipated pain? Find out what alleviates the pain.

Be sure to ask appropriate questions about the development of any associated signs and symptoms. For example, does the patient experience bleeding along with rectal pain? If so, find out how frequently this occurs and whether the blood appears on the toilet tissue, on the surface of the stool, or in the toilet bowl. Is the blood bright or dark red? Also, ask whether the patient has noticed other drainage, such as mucus or pus, and whether he’s experiencing constipation or diarrhea. Ask when he last had a bowel movement. Obtain a dietary history.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Rectal pain: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

Begin by taking the patient's history. Ask him to describe the pain. Is it sharp or dull, burning or knifelike? How often does it occur? Ask if the pain is worse during or immediately after defecation. Does the patient avoid having bowel movements because of anticipated pain? Find out what alleviates the pain.

Be sure to ask appropriate questions about the development of associated signs and symptoms. For example, does the patient experience bleeding along with rectal pain? If so, find out how frequently this occurs and whether the blood appears on the toilet tissue, on the surface of the stools, or in the toilet bowl. Is the blood bright or dark red? Also, ask whether the patient has noticed other drainage, such as mucus or pus, and whether he's experiencing constipation or diarrhea. Ask when he last had a bowel movement. Obtain a dietary and drug history.

Then inspect the rectal area for bleeding; abnormal drainage, such as pus; or protrusions, such as skin tags or thrombosed hemorrhoids. Also, check for inflammation and other lesions. A rectal examination may be necessary.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Hematochezia [Rectal bleeding]: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If hematochezia isn't immediately life-threatening, ask the patient to fully describe the amount, color, and consistency of his bloody stools. (If possible, also inspect and characterize the stools yourself.) How long have the stools been bloody? Do they always look the same, or does the amount of blood seem to vary? Ask about associated signs and symptoms.

Next, explore the patient's medical history, focusing on GI and coagulation disorders. Ask about the use of GI irritants, such as alcohol, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Begin the physical examination by checking for orthostatic hypotension, an early sign of shock. Take the patient's blood pressure and pulse while he's lying down, sitting, and standing. If systolic pressure decreases by 10 mm Hg or more or if the pulse rate increases by 10 beats/minute or more when he changes position, suspect volume depletion and impending shock.

Examine the skin for petechiae or spider angiomas. Palpate the abdomen for tenderness, pain, or masses. Also note lymphadenopathy. Finally, a digital rectal examination must be done to rule out rectal masses or hemorrhoids.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

RECTAL BLEEDING: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

Armed with a more comprehensive list of causes of rectal bleeding, the clinician is ready to eliminate some of them as he or she asks appropriate questions during the history and performs the examination with all the causes in mind. The diagnosis may be pinned down by the presence or absence of other symptoms and signs. The principal diagnostic procedures are stool cultures, stool examination for ova and parasites, proctoscopy, barium enema, and colonoscopy.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

RECTAL PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The cause of rectal pain is usually obvious on examination with an anoscope or proctoscope. Careful palpation may be necessary to discover a perirectal abscess, coccydynia, or an ectopic pregnancy. Anal fissures may be missed unless all quadrants of the anus are examined with the slit anoscope.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

 » Next page: Signs of Anal Cancer

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Signs of Anal Cancer
• Complications of Anal Cancer
• Misdiagnosis of Anal Cancer
• Undiagnosed Anal Cancer
• Misdiagnosis of Underlying Causes of Anal Cancer

Tools & Services:

• Bookmark this page
• Take a survey relating to Anal Cancer
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES