Rectal Cancer - Signs, Symptoms and Investigations

Question 1

How might a patient present?

Answer 1

• Bleeding
• Change in normal bowel habits
• Tenesmus
• Mucous
• Weight Loss
• Mass in abdomen or rectum
• Anaemia
• Late stage disease: perforation, ascites, fistula

Question 2

What is an ascites?

Answer 2

• Peritoneum can be irritated by cancer cells
• Leads to build up of fluid
• Poor lymphatic drainage

Question 3

What is a fistula?

Answer 3

• An abnormal connection or passage between two epithelium lines organs or vessels
• Blind fistula: open on one end only
• Complete: internal and external openings
• Horseshoe: connects anus to skin surface after going round the rectum
• Incomplete: tube from skin which is closed on the inside and does not connect any internal structure

Question 4

What investigations take place if patient presents with symptoms?

Answer 4

• GP: patient history etc, DRE and FBC, palpation of abdo
• Referral pathway
• CT colonography can be used as an alternative to a colonoscopy - CT scanner reconstructs map or view of colon or rectum, less invasive.
• Flexible sigmoidoscopy - similar but shorter
• Barium enema, used much less now

Question 5

What is hepatomegaly?

Answer 5

• An enlarged liver

- May feel on palpation