Diagnostic Tests for Anal Cancer
Anal Cancer Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Anal Cancer:
- Colon & Rectal Cancer: Home Testing
- Food Allergies & Intolerances: Home Testing:
- Cancer-Related Home Testing:
- Digestive-Related Home Testing:
Anal Cancer Diagnosis: Book Excerpts
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 the diagnostic tests for Anal Cancer.
RECTAL BLEEDING:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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:
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
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:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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).
Testing
A. Anoscopy. The anoscope allows inspection for fissures, fistulas, bleeding and nonbleeding hemorrhoids, and rectal friability.
B. Rigid proctosigmoidoscopy has given way to flexible sigmoidoscopy; it visualizes well the distal 25 cm of the proctosigmoid area for neoplasia, friability, polyps, ulcers, or hemorrhoids. Rigid sigmoidoscopy has a sensitivity of 69% and specificity of 95% in determining the presence or absence of disease (1).
C. Flexible sigmoidoscopy is much better tolerated by the patient than rigid proctosigmoidoscopy. It visualizes the distal 60 to 70 cm of the colon and detects similar findings as rigid proctosigmoidoscopy with similar sensitivity and specificity.
D. Air contrast barium enema demonstrates polyps, masses, mucosal irregularities, diverticulae and inflammatory bowel disease with a sensitivity of 52% and a specificity of 98% (1). When used in combination with sigmoidoscopy, it has a sensitivity of 96% and specificity of 76% with a positive predictive value of 55% (1).
E. Stool guaiac testing. As a test for occult bleeding in determining serious pathology, the guaiac card has a sensitivity of 44% to 75% and a specificity of 85%. As a screening tool, it has received mixed blessings, being promoted by the American Cancer Society and National Cancer Institute, but with insufficient evidence to recommend for or against by the US Preventive Services Task Force.
F. Colonoscopy. The diagnostic procedure of choice to visualize the entire colon. It allows only one bowel preparation and has identification rates of 74% to 82% of lower GI bleeding sources (5). The sensitivity of this examination approaches 98%.
G. Nuclear scintigraphy. 99mTechnetium-labeled red blood cells detects occult bleeding sources when the above-mentioned methods fail. Sensitivity ranges from 80% to 98% in the colon with specificity of 41% to 97% (5).
H. Mesenteric angiography uses a transfemoral placement to selectively evaluate the superior mesenteric, inferior mesenteric, and celiac axis. The sensitivity is 40% to 86% with a complication rate of 2% (5). Treatment interventions include arterial infusion of vasopressin and embolization with coil springs or gel foam.
I. Enteroscopy. Small bowel enteroscopy uses a special enteroscope or pediatric colonoscope. This scope is passed orally and has a diagnostic yield of 25% (5).
Diagnostic assessment
The answers provided in the patient’s history and physical examination are important to risk stratify this common problem. If a workup is believed necessary to deal with diagnostic uncertainty, then the entire colon should be visualized. This approach should consist of a digital rectal examination, anoscopy, rigid or flexible sigmoidoscopy, and the use of air contrast barium enema as deemed necessary. Alternatively, exploration by colonoscopy can be used, based on the provider’s discretion. The latter makes most sense as two bowel preparations can be reduced to one with enhanced patient comfort. Further workup, including nuclear scintigraphy, mesenteric angiography, enteroscopy, and referral to a surgeon or a gastroenterologist, depends on the clinical situation and seriousness of the bleed encountered. Serious pathology occurs in approximately 25% of rectal bleeding patients with 6.5% to 10% having cancer, 13% to 25% having polyps, and 4% to 11% having inflammatory bowel disease (1,2). Ten year follow-up of patients with benign anorectal disease or no evident cause of bleeding found no difference in the incidence of cancer compared with similarly aged cohort in the general population (1).
References
1. Helfant M, Marton KI, Zimmer-Gembeck MJ, Sax HC. History of visible rectal bleeding in a primary care population: initial assessment and 10-year follow-up. JAMA 1997;277(1):44–48.
2. Talley NJ, Jones M. Self reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol 1998;93:
2179–2183.
3. Thompson M, Prytherah D. Rectal bleeding: when is it right to refer. Practitioner 1996;240:198–200.
4. Colletti RB, Compton CC. Weekly clinicopathological exercises: case 7-1997. A 14-year-old girl with recurrent painless rectal bleeding. N Engl J Med 1997;336(9):
641–648.
5. Vernava AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum 1997;40:846–858.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Rectal Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Tenesmus is a painful urge to defecate with little result.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Rectal pain:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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: 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
Life isn't easy for people living with cancer and especially for young patients like filmmaker Jessica Wing whose illness and complications had...
Colorectal cancer affects the colon and rectum, and catching it early can save your life. Learn how you can reduce your risk of getting colorectal...
A tiny camera called laparoscope can be used to peek inside the body and diagnose disease. Learn how this minimally invasive technique is now being...
People who have been living with ulcerative colitis for a long time must be checked regularly for colon cancer. Listen to the story a patient that...
See full list of 11 related videos
» Next page: Diagnosis 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:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
