How to distinguish between anal fissure and rectal cancer causing rectal bleeding

Written by Yan Chun
Oncology
Updated on March 01, 2025
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In clinical practice, to differentiate between rectal bleeding caused by anal fissures and that caused by rectal cancer, we can consider the following aspects. Firstly, rectal bleeding caused by anal fissures is generally accompanied by pain in the anal area, and the bleeding is especially severe after defecation, with blood attached to the surface of the stool. In contrast, rectal bleeding caused by rectal cancer rarely accompanies pain in the anal area, and the blood is generally mixed with the stool. Secondly, rectal bleeding from anal fissures is usually due to hard stools, and improving the condition of hard stools, along with providing local anti-inflammatory treatment, usually relieves the symptoms of bleeding. However, in the case of rectal cancer, besides hard stools, patients may also experience an increase in the frequency of defecation and signs of diarrhea, and typical anti-inflammatory treatments are not notably effective.

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The late-stage symptoms of rectal cancer patients in clinical practice mainly include the following types. The first type is abdominal symptoms caused locally by rectal cancer. For example: bloody stools, pass stools with mucous and pus, anal pain, bloating, abdominal pain, and other manifestations. The second category of symptoms is those from metastases in various locations. For example, bone metastases cause bone pain and limb movement disorders. Lung metastases cause chest tightness, shortness of breath after activity, chest pain, breathing difficulties, coughing and coughing up blood, etc. Brain metastases cause headaches, dizziness, and seizures. The third category of symptoms is mainly systemic symptoms caused by rectal cancer lesions, such as: weight loss, fatigue, and high fever.

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In clinical practice, to detect colorectal cancer early, screening should be prioritized for individuals with a family history of colorectal cancer. This generally involves tests for tumor markers and colonoscopy examinations. The tumor markers include carcinoembryonic antigen, carbohydrate antigen 724, carbohydrate antigen 199, and carbohydrate antigen 125, among others. Colonoscopy examinations should be conducted annually. Furthermore, for individuals with colorectal polyps, yearly colonoscopy is especially recommended to detect early stages of colon cancer. Similarly, for individuals suffering from chronic inflammatory diseases of the colon and rectum such as ulcerative colitis or Crohn's disease, colonoscopy examinations should also be performed to facilitate early detection of colorectal cancer.

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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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Is a severely blocked anus a symptom of rectal cancer?

Is anal blockage a manifestation of rectal cancer? The answer could be yes, but it could also be due to hemorrhoids, or other diseases. The main common symptoms of rectal cancer include changes in bowel habits and the characteristics of the stool. There may be frequent bowel movements, diarrhea, or constipation, or alternating constipation and diarrhea, a sensation of anal heaviness, or associated with vague abdominal pain. Symptoms of abdominal pain, intestinal obstruction, and abdominal masses might also appear. When the tumor grows to a certain extent, an abdominal mass can be palpated, which might cause some compressive symptoms, possibly leading to anal blockage as one of the symptoms.

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Can a colonoscopy detect rectal cancer?

Colonoscopy can detect colon and rectal cancer. It is the most important and primary method for examining colonic mucosal lesions. The large intestine includes the cecum, colon, and rectum. Colonoscopy allows direct visual inspection of lesions, including the size and color of the lesions, and whether there are ulcers and erosion, the nature of any attachments, etc. It also allows for direct biopsy. Firstly, it can assess the texture of the lesion, such as whether it is soft, hard, or brittle. Moreover, the biopsied sample can be analyzed histologically to determine the benign or malignant nature, depth of infiltration, etc. Different pathological characteristics have different prognoses and treatment methods, suitable for early cancers treatable under endoscopy, or those that can be removed during the process of the colonoscopy.