Rectal masses

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Rectal masses
Colonoscopy: Rectum villous adenoma.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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. [1] [2]


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


  • 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


  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X


The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

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