How to rule out the possibility of rectal cancer

Written by Si Li Li
Gastroenterology
Updated on February 23, 2025
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Common symptoms of rectal cancer include abdominal pain, changes in stool characteristics, and rectal bleeding. These symptoms could suggest the possibility of rectal cancer. An initial examination can be conducted via a digital rectal exam to preliminarily exclude rectal cancer. If a mass is felt during the digital rectal exam, a high suspicion of rectal cancer should be maintained. Additionally, a colonoscopy can be performed for a definitive diagnosis. If a mass on the rectal mucosa is observed during the colonoscopy, a biopsy can be conducted for histopathological examination to determine the nature of the mass. Generally, if the surface of the mass is uneven, brittle, and bleeds easily, the likelihood of malignancy is high while a smooth surface suggests a greater possibility of benignity.

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Hemorrhoids bleeding and rectal cancer bleeding

Hemorrhoids or colorectal cancer can both cause local bleeding in the anal area, but there are clear differences between hemorrhoidal bleeding and colorectal cancer bleeding in clinical practice. Hemorrhoidal bleeding is mostly bright red and does not mix with the stool; it is separate bleeding. It may manifest as blood on the finger, or as dripping or spurting blood. Colorectal cancer bleeding, on the other hand, is generally dark red and mixes with the stool, sometimes accompanied by pus and blood. Bleeding from colorectal cancer mainly occurs in the late stages of the disease, usually caused by local mucosal ulceration or tumor rupture. During hemorrhoidal bleeding, an anal scope examination can reveal clear bleeding points above and below the dentate line, while bleeding from colorectal cancer requires examination with an electronic colonoscope to observe the local tumor area, which may show mucosal damage or ulcers.

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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?

Early symptoms of rectal cancer include a foreign body sensation in the anus, bloody stools, changes in stool shape, and more. Rectal cancer is a prevalent malignant tumor of the digestive tract in China, originating from the rectal mucosa. The most common pathological type is adenocarcinoma, with other pathological types being relatively rare. Patients exhibiting bloody stools or changes in stool shape should consider the possibility of rectal cancer. Patients suspected of having rectal cancer should undergo a rectal examination and colonoscopy as soon as possible. Abnormal masses in the rectum can be detected during the rectal examination and colonoscopy. Tissue can be taken from the mass for pathological diagnosis. Patients diagnosed with rectal cancer via pathology are primarily treated with surgery, and those who cannot undergo surgery should receive combined radiotherapy and chemotherapy treatment.

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Could having blood in the stool for five years be rectal cancer?

If there has been blood in the stool for five years, whether it's colorectal cancer or not, this can only be confirmed through a colonoscopy. Furthermore, pathological tissue analysis and biopsy are necessary to make a definitive diagnosis. Pathological examination is the gold standard for diagnosing cancer. If cancerous changes are present, surgical treatment should be undertaken promptly to prevent the spread of cancer cells. If there are no malignant changes, symptomatic treatment measures can be adopted. Conditions such as chronic colitis, ulcerative colitis, or hemorrhoids could also cause blood in the stool.

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Is rectal bleeding an indication of rectal cancer?

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.