During a rectal examination, the doctor will check the abdominal cavity for signs and symptoms that are indicative of cancer. The exam will also look for any anal fissures, hemorrhoids, and other issues that need to be addressed. If the exam indicates a problem, the doctor will refer the patient to another medical professional.
Anal fissures
During a rectal examination, the provider may examine the anus for anal fissures. A small, gloved finger is placed into the anus and a speculum is inserted. The speculum allows for the provider to see the area around the anus more clearly.
During a rectal exam, the provider may also observe bright red blood on toilet paper or on the surface of the feces. This is a sign of an anal fissure. A fissure is a tearing pain during bowel movements. Anal fissures can occur as a primary or secondary condition.
In primary anal fissures, medical management is generally successful. Treatments aim to stop the cycle of pain and tearing. This can be done by reducing risk factors. In addition, adequate analgesia is usually necessary to alleviate symptoms.
In cases of chronic or subchronic anal fissures, surgery is sometimes recommended. This can include lateral internal sphincterotomy, a procedure where a small cut is made in the muscle. This allows more blood to flow through the anus, promoting healing.
Botulinum toxin injections may be used to treat anal fissures. In combination with other conservative measures, these injections can be effective in healing anal fissures.
Some patients with anal fissures experience rectal bleeding. If bleeding is present, a colonoscopy is usually recommended. This will allow the surgeon to exclude other causes of bleeding. If bleeding does not stop after a few days, surgical intervention may be advised.
Some people find relief from their anal fissures by soaking in warm baths or applying topical anal lubricants. In addition, a diet rich in fiber can help prevent anal fissures.
A common cause of anal fissures is constipation. To avoid anal fissures, avoid hard, dry stools. In infants, frequent diaper changes can also help prevent anal fissures.
Other conditions that can cause rectal bleeding are ulcerative colitis, tuberculosis, and herpes. Some patients report that their anal fissures are related to anal tumors. A complete diagnosis of an anal fissure requires additional evaluation of these other conditions.
Anal fissures can be caused by trauma or anal intercourse. If left untreated, they may lead to anal cancer.
Prostate cancer
Several studies have evaluated the effects of prostate cancer screening without rectal examination. These trials aimed to determine whether routine annual screening would reduce mortality rates. They did not provide conclusive data on the effect of the test on prostate cancer mortality but did show that there is a trend toward lower rates in some countries. In addition to the effects on mortality, the studies also evaluated the performance of the screening tests.
The Swedish noninferiority trial randomly assigned 1,532 men with serum PSA of 3 ng/mL or higher to one of two groups: a standard biopsy group or an MRI-guided biopsy group. All patients in the standard group received a DRE, while the men in the MRI arm received an MRI-guided biopsy if the MRI indicated a suspicious area. Detection rates were 18% in the standard group and 21% in the MRI group.
The FinRSPC trial, which included men with a family history of PC, evaluated the incidence rate ratios of clinically significant prostate cancer. The rate ratios were adjusted for age, residence, and PSA level. They showed a 20% to 30% reduction in prostate cancer mortality.
A pooled analysis of data was performed on six studies of 4,581 patients. The results of this study were not representative of the National Cancer Institute’s recommendations for screening. It is unclear if the results are applicable to the United States, where colonoscopy has become the primary screening test for colorectal cancer.
There are many potential biases in the study design that limit our ability to draw definitive conclusions from this evidence. The results are not intended to be used as formal guidelines or recommendations for healthcare decision-making. Rather, the summary provides information that can be used to inform clinicians.
A digital rectal exam has been recommended as a possible tool for early detection of prostate cancer. It is a relatively simple exam that is not painful, inexpensive, and can be taught to nonprofessional health workers. The exam involves pressing the patient’s finger against the wall of the rectum to feel for irregularities. The exam also detects areas that are prone to pain.
Metastatic workup
During the rectal examination, it is common to perform contrast-enhanced CT to find distant metastases. The use of PET/MRI is also encouraged when suspected metastasis. A PET scan is a special dye that detects abnormalities anywhere in the body. It is used to detect brain and spinal cord metastases. However, the results of the PET scan may not be conclusive. The National Comprehensive Cancer Network endorses the use of CT and PET/MRI as staging protocols for rectal cancer.
In addition to the traditional staging process, the use of PET/MRI is a convenient way to reduce the number of diagnostic procedures and increase convenience. It is also possible to perform this imaging procedure as a “one-stop shop” modality. It can be performed in conjunction with abdominal MRI, liver MRI, and bone scans.
This combination can be performed in patients with advanced rectal cancer to determine if there are any additional lesions that require treatment. A patient may be referred for a biopsy of a suspicious metastatic tumor. If the tumor has spread to the lung or liver, metastasectomy can improve survival.
The standard of care imaging protocol involves contrast-enhanced CT and a dedicated liver MRI. The M stage of rectal cancer is determined based on these two diagnostic tests, while a rectal MRI may detect pelvic bone metastases. These results can be compared to the results of the abdominopelvic CT and dedicated liver MRI. This can help to identify patients who are at high risk for developing metastatic disease.
This method of staging is difficult and can result in multiple hospital visits. It can also be cumbersome. The American Joint Committee on Cancer (AJCC) provided diagnostic criteria for metastasis.
These criteria can be a burden to patients, as they may have to undergo a number of diagnostic tests. Moreover, the staging process can be very time-consuming, requiring the use of contrast media, exposure to radiation, and multiple visits to the hospital. Fortunately, a new modality, PET/MRI, can replace several of these exams and can simplify the staging process for patients with rectal cancer.
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Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
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