Clinical features

Clinical features

Carcinoma of the rectum can occur early in life, but the age of presentation is usually above 55 years, when the incidence rises rapidly . Often, the early symptoms are so insignificant that the patient does not seek advice for 6 months or more, and the diagnosis is often delayed in younger patients as the symptoms are attributed to benign causes. Initial rectal examination and a low threshold for investigating persistent symptoms are essential. Summary box 79.8 Early symptoms of rectal cancer /uni25CF /uni25CF /uni25CF Bleeding Bleeding is the earliest and most common symptom. Typically , the bleeding is bright red in colour and painless. It can be mixed with the motions or separate in the toilet bowel. It can be indistinguishable from haemorrhoidal bleeding, which is the most common di ff erential diagnosis, particularly in younger patients. Tenesmus The patient experiences a sensation of needing to evacuate the rectum but is unable to pass a motion. This is an important early symptom and is almost invariably present in patients with tumours of the lower half of the rectum. The patient may endeavour to empty the rectum several times a day (spurious diarrhoea), often with the passage of flatus and a little bloodstained mucus (‘bloody slime’). β Alteration in bowel habit There is frequently a change in bowel habit, with a tendency to more frequent defecation and the passage of looser stool. A patient who has to get up early in order to defecate, or one who passes blood and mucus in addition to faeces (‘early morning bloody diarrhoea’), is usually found to have carcinoma of the rectum. Although a change to looser stools is more common,

Bleeding per rectum Tenesmus Early morning diarrhoea

tion may complain of increasing constipation. Pain Pain is a late symptom, but pain of a colicky character may accompany advanced tumours of the rectosigmoid, owing to a degree of obstruction. Advanced cancers invading outside the mesorectum may infiltrate the prostate or bladder anteriorly or the sacral plexus posteriorly , giving rise to severe, intractable pain. Weight loss Weight loss is also a late symptom and is almost always associ ated with metastatic disease.