Is rectal bleeding an indication of rectal cancer?

Written by Si Li Li
Gastroenterology
Updated on November 24, 2024
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Rectal bleeding is not necessarily colorectal cancer; there are several reasons for rectal bleeding: First, caused by constipation, which leads to difficulty during bowel movements and tearing of the anal mucosa, resulting in bleeding. Second, ulcerative colitis, which commonly presents symptoms such as abdominal pain, diarrhea, and blood and mucus in the stool. Third, rectal or colon cancer, where the main symptoms also include abdominal pain, changes in stool characteristics, and rectal bleeding. Fourth, ischemic bowel disease, generally seen in older patients with some cardiovascular and ischemic diseases, where symptoms mainly include significant abdominal pain and rectal bleeding. Therefore, not all cases of rectal bleeding are due to rectal cancer; there are many causes, and it is essential to diagnose clearly before treatment.

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Does stage II rectal cancer require chemotherapy?

Whether a stage II colorectal cancer patient needs adjuvant chemotherapy after surgery depends on the specific circumstances. For example, stage IIA patients are classified as T3, N0, M0. The necessity of adjuvant chemotherapy for these patients should be determined based on the pathological report. If the report indicates the presence of vascular invasion, neural invasion, poor differentiation, or if microsatellite stability testing shows poor prognostic factors, then such patients should undergo postoperative adjuvant chemotherapy. If none of these conditions are present in a stage IIA patient, then postoperative adjuvant chemotherapy may not be necessary. Generally, stage IIB patients, whose tumors have penetrated the full thickness of the intestinal wall, are recommended to undergo postoperative adjuvant chemotherapy. Therefore, the specific conditions of the patient need to be considered.

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What tests are used to check for rectal cancer?

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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Postoperative Diet and Care for Rectal Cancer

Firstly, rectal cancer is a malignant tumor of the digestive tract, so after surgery, it is recommended to eat foods that are easy to digest and absorb. Secondly, do not smoke, abstain from alcohol, and avoid spicy and irritating foods. Thirdly, it is advised not to eat indigestible foods, such as bean products and foods that cause gas, and to consume them in smaller quantities. Fourthly, rectal cancer may deplete a large amount of nutrients in the body, coupled with the damage from surgery, so it is essential to ensure a nutrition-rich diet, consume nutritious foods such as soups, easily digestible congee, and high-quality proteins to increase the body's nutrients. Fifthly, attention should be paid to timely adding clothing to avoid catching a cold.

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Has rectal cancer progressed to the advanced stage with vomiting?

Patients with rectal cancer who experience vomiting do not necessarily indicate that their condition has reached an advanced stage; the situation needs to be differentiated and treated accordingly. If nausea and vomiting are due to the gastrointestinal side effects of antitumor treatments such as chemotherapy and radiotherapy, it is unrelated to the severity of rectal cancer. Appropriate antiemetic treatment can provide significant relief. If a rectal cancer patient experiences projectile vomiting due to brain metastases, which lead to an increase in intracranial pressure, it indicates that the disease has progressed to an advanced stage. Some rectal cancer patients may also experience vomiting due to gastrointestinal obstruction caused by the tumor, accompanied by cessation of bowel movements and gas, which are also signs of advanced disease.

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Early symptoms of rectal cancer

The early symptoms of rectal cancer generally include five main signs: The first early symptom is bloody stool, which is the earliest and most common symptom of rectal cancer. The second symptom is mucous bloody stool. Large cauliflower-like tumor masses generally secrete a large amount of mucus, which can cause mucous bloody stool. The third is a change in bowel habits. What does a change in bowel habits mean? It means that sometimes there can be diarrhea, sometimes constipation, or an alternation of constipation and diarrhea, indicating a change in bowel habits. There can even be changes in the shape of the stool, which is the third symptom. The fourth symptom is a feeling of heaviness or fullness in the perineum or anus. The fifth symptom can cause abdominal pain. It can cause pain in the lower abdomen, a sensation of a foreign body in the intestine, and even bloating. For instance, constipation can lead to difficulty in passing stool, which in turn can cause bloating and abdominal pain. These are primarily the five early symptoms.