What tests are used to check for rectal cancer?

Written by Liu Liang
Oncology
Updated on September 25, 2024
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When clinical symptoms such as diarrhea or constipation, changes in bowel habits, bloody stools, and abdominal pain occur, we should be vigilant about the possibility of rectal cancer. The examination for rectal cancer can start with a digital rectal exam, especially for low-lying rectal cancer, which is closer to the anus; these tumors can be detected through this method. Then, a colonoscopy should be performed to take a biopsy to confirm the diagnosis, which is the gold standard for confirmation. Additionally, blood tests for tumor markers can be conducted. Generally, carcinoembryonic antigen (CEA) and CA199 levels may be elevated, but this is not absolute as their specificity and sensitivity are not very high. An enhanced CT scan of the abdomen can also be done. In such scans, we can see thickening of the intestinal wall where the tumor is located, and the enhancement can show the intensified thickening of the intestinal wall. Combining all these methods can confirm the diagnosis of rectal cancer.

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Is anal pain and rectal bleeding indicative of rectal cancer?

Pain in the anal area, accompanied by blood in the stool, does not necessarily indicate rectal cancer. There are many causes of pain and bloody stools, which require identification and diagnosis through the color of the bloody stools, digital rectal examination, and colonoscopy. Common causes of bright red bloody stools or pain are mainly due to hemorrhoids and anal fissures. During the onset of rectal cancer, early stages generally do not involve pain in the anal area. It is mainly characterized by changes in bowel habits, or dark red blood in the stool in the middle to late stages. The tumor may grow larger, causing difficulty in defecation, and may even induce systemic symptoms such as weight loss, anemia, and intestinal obstruction.

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What are the early symptoms of rectal cancer in women?

The early symptoms of female rectal cancer are primarily localized to the rectum. Most patients exhibit symptoms such as bloody stools, recurrent constipation, or alternating occurrences of diarrhea and constipation. Some patients may experience a change in stool characteristics, an increase in the frequency of daily bowel movements, and narrower stools. Additionally, some early-stage patients may exhibit symptoms similar to bacterial dysentery, such as the discharge of mucus and bloody pus in stools, and a feeling of incomplete evacuation after a bowel movement. Some female rectal cancer patients may mistake bloody stools for hemorrhoids and consequently avoid seeking medical attention. Early symptoms are not distinctive, and many patients may overlook them, leading to a delay in the early detection of rectal cancer.

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What are the symptoms of rectal cancer?

Symptoms of rectal cancer include changes in bowel habits, such as a feeling of heaviness around the anus, a constant need to defecate, or diarrhea. Some patients may experience constipation, or alternating episodes of diarrhea and constipation. Another common symptom is a change in the shape of the stool, with the stool becoming narrower. Additionally, abdominal pain and rectal bleeding are also common symptoms. Some patients with rectal cancer may exhibit clinical signs of intestinal obstruction, which includes constipation, inability to pass stool or gas, which means no flatulence. This is accompanied by nausea and vomiting. Other common symptoms include significant abdominal pain and bloating.

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Can a colonoscopy detect colon and rectal cancer?

Colonoscopy can detect colon and rectal cancers. By conducting a colonoscopy, it can be determined whether a space-occupying lesion is in the colon or the rectum. In the workplace, it can also confirm the distance from the anus in centimeters, to guide the next steps of surgical treatment. If a colon or rectal tumor is found during colonoscopy, a pathological biopsy may be needed. Combined with the pathological biopsy, a diagnosis can be made whether the patient has colon cancer or rectal cancer. At the same time, colonoscopy can also detect other diseases, such as colon polyps, ulcerative colitis, Crohn's disease of the colon, and so on.

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Stage IV rectal cancer

In the staging of rectal cancer, we generally use the TNM staging system clinically. "T" refers to the primary tumor, "N" indicates whether there is lymph node metastasis, and staging is based on the status of the lymph nodes. "M" indicates whether there is distant metastasis. Stage IV refers to any stage of "T" and any stage of "N", as long as there is distant metastasis, such as rectal cancer metastasizing to the liver, lungs, or bones. When these distant organ metastases occur, the staging is M1, any "T", any "N", M1. This scenario is stage IV, indicating the presence of distant organ metastasis and represents advanced stage rectal cancer patients.