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Hard lump in rectum: The request could not be satisfied


If You Have Anal Cancer


What is anal cancer?

Cancer that starts in the anus is called anal cancer. It starts when cells in the anus grow out of control and crowd out normal cells.

Cancer cells can spread to other parts of the body. Cancer cells in the anus can sometimes travel to the liver and grow there. When cancer cells do this, it’s called metastasis. To doctors, the cancer cells in the new place look just like the ones from the anus.

Cancer is always named for the place where it starts. So when anus cancer spreads to the liver (or any other place), it’s still called anal cancer. It’s not called liver cancer unless it starts from cells in the liver.

Ask your doctor to use this picture to show you where the cancer is.

The anus

The anus is the end of the digestive tract – the channel that food moves through as it’s used by the body. Solid waste (poop) comes out of the anus.

Are there different kinds of anal cancer?

There are many types of anal cancer. Most are rare. Your doctor can tell you more about the type you have.

The most common type is called squamous cell cancer. This type of tumor starts in the cells that line the inside of the anus and have grown into the deeper layers of the anus.

Anal cancer is also often put into 2 groups depending on where it starts in the anus – the anal canal or the perianal area. They are sometimes treated differently.

Questions to ask the doctor

  • Why do you think I have anal cancer?
  • Is there a chance I don’t have cancer?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How does the doctor know I have anal cancer?

Some anal cancers cause no symptoms at all. But symptoms of anal cancer can include changes in your poop, bleeding, itching, and pain or a lump at the anal opening. The doctor will ask you questions about your health and do a physical exam. The doctor will also look at your anus and may put a gloved finger inside to check for lumps. (This is called a rectal exam. The rectum is the part of the large intestine that connects to the anus.)

If signs are pointing to anal cancer, more tests will be done. Here are some of the tests you may need:

Anoscopy: For this test, a hollow firm tube about 3 to 4 inches long (called an anoscope) is covered with a gel and gently put into the anus. A light at the end of this tube lets the doctor see the inside of the lower rectum and anus. A sample of tissue (a biopsy) can be taken and then tested in the lab. You will be awake for this test, but it should not hurt.

Endoscopy: For this test, a flexible (not firm) tube with a tiny video camera and light on the end (called an endoscope) is put into the anus, rectum, and sometimes the entire colon to look inside. This flexible tube is much longer than the anoscope and might be used to make sure that an anal cancer symptom, such as bleeding, is not coming from another area like the rectum or colon. It can also be used to take out cells (a biopsy) from inside these areas. You will be given medicine to stay drowsy or asleep during this test.

Ultrasound: For this test, a small thin probe is put into the anus and rectum. This can be uncomfortable, but should not hurt. The probe gives off sound waves to make pictures of the inside of the body. This test can be used to see how deep the cancer has grown into the tissues around the anus.

CT scan or CAT scan: A CT scan is like an x-ray, but the pictures of your insides are more detailed. CT scans can also be used to help do a biopsy and can show if the cancer has spread.

MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures. This test may be used to check the nearby lymph nodes or the liver for cancer spread.

Chest x-ray: X-rays may be done to see if the cancer has spread to the lungs.

PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera. If there is a cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the cancer has spread. Sometimes, a PET scan is done with a CT scan to see areas of cancer better.  

Anal biopsy

In a biopsy, the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells. A biopsy is the only way to know for sure if you have cancer. For anal cancer, a biopsy is most often done during an endoscopy. If the tumor is very small and is only on the lining of the anus, the doctor may be able to take out all of the tumor during the biopsy.

There are many types of biopsies. Ask your doctor what kind you will need. Each type has reasons for and against doing them. The choice of which type to use depends on your own case.

Questions to ask the doctor

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • Who can explain them to me?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?

If you have anal cancer, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer through the anus. It also tells if the cancer has spread to nearby organs or to organs farther away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the anus. Be sure to ask the doctor about the cancer stage and what it means.

Questions to ask the doctor

  • Do you know the stage of the cancer?
  • If not, how and when will you find out the stage of the cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of the cancer, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?

There are many ways to treat anal cancer, including surgery, radiation, chemotherapy, and immunotherapy.

Surgery and radiation are used to treat only the cancer. They do not affect the rest of the body. Chemo drugs and immunotherapy go through the whole body. They can reach cancer cells almost anywhere in the body. The treatment plan that’s best for you will depend on:

  • The stage of the cancer and where it started in the anus (anal canal or perianal area)
  • The chance that a type of treatment will help
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that might come with it

Surgery for anal cancer

Most people with anal cancer do not need surgery. If surgery is needed, the kind of surgery depends on the type of tumor and where it is.

Local resection

A local resection may be done if the cancer is small and has not spread. Only the tumor and a small rim of tissue around it are taken out. In most cases, the muscle that opens and closes the anus is not damaged. If so, you’ll be able to control your poop and have it come out the anus.

Abdominoperineal resection (APR)

Abdominoperineal resection is not used a lot, but it may be an option if other treatments don’t get rid of the cancer.

For this surgery, the doctor makes 2 cuts: 1 through the belly and 1 around the anus. Then the anus and part of the rectum are taken out, and sometimes nearby lymph nodes are taken out, too. After an APR you’ll have an opening on your lower belly where poop will come out. (This is called a colostomy.)

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. Ask how you will poop after surgery. If you have problems, let your doctors know. They should be able to help you with any problems you might have.

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. In anal cancer, it’s most often given along with chemotherapy. Radiation can also be used to relieve symptoms such as pain, bleeding or other problems that happen when the anal cancer has grown very large or has spread to other areas like the bones. It’s often given in small doses every day for many weeks.

There are 2 main ways radiation can be given. It’s most often aimed at the anus from a machine outside the body. This is called external beam radiation. In some cases, a tube of radioactive seeds might be put right into the anus near the cancer. This is called brachytherapy.

Side effects of radiation treatments

If your doctor suggests radiation treatment, ask about what side effects might happen. The most common side effects of radiation are:

  • Skin changes where the radiation is given
  • Feeling very tired (fatigue)
  • Bowel movements may hurt
  • Nausea
  • Diarrhea
  • In women, radiation can irritate the vagina. This may hurt and can cause vaginal discharge.

Most side effects get better after treatment ends and many can be treated. Some might last longer. Talk to your cancer care team about what you can expect.


Chemo is the short word for chemotherapy – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body.

Chemo is given in cycles or rounds. Each round of treatment is followed by a break to give the body time to recover. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Chemo given along with radiation therapy is often the first treatment for most anal cancers. This is called chemoradiation. It may cure the cancer without surgery.

Side effects of chemo

Chemo might make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.


Immunotherapy is treatment that boosts your own immune system to attack the anal cancer cells. These drugs may be given into a vein.

Side effects of immunotherapy

Immunotherapy can cause different side effects depending on which drug is used. These drugs may make you feel tired, sick to your stomach, or cause a rash. Most of these problems go away after treatment ends.

There are ways to treat most of the side effects caused by immunotherapy. If you have side effects, talk to your cancer care team so they can help.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

What about other treatments that I hear about?

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, who will do the surgery?
  • What will the surgery be like? How will I poop after surgery?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • What can I do about side effects that I might have?
  • Is there a clinical trial that might be right for me?
  • What about special vitamins or diets that friends tell me about? How will I know if they are safe?
  • How soon do I need to start treatment?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

If you need more information about possible side effects of treatment, visit Managing Cancer-related Side Effects.

What will happen after treatment?

You’ll be glad when treatment is over. For years after treatment ends, you will still need to see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.

Follow-up doctor visits after treatment may be needed as often as every 3 to 6 months for at least 3 years. They will be less often after 3 years or so. During these visits, your doctor will ask about any symptoms you’re having and will do a physical exam. Blood tests, rectal exams, anoscopy, and imaging tests (like CT scans) might be done.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.



Hemorrhoids, also called piles, are protrusions, folds, or irregularities of anal tissue, both inside the anus (internal), and outside (external). They are formed by the stress of bowel movements, straining and local irritation. They are comprised of epithelial lining (skin or mucus membrane), connective tissue and blood vessels, in varying proportions. The symptoms they produce include itching, bleeding, discharge, swelling, discomfort, and pain.

Hemorrhoids may suddenly become acutely swollen and painful. This occurs when blood clots within the hemorrhoidal veins. This condition is referred to as “thrombosed hemorrhoids.” Commonly a pea or marble sized painful lump will appear externally. Sometimes the entire anus swells, inside and out, producing severe pain.

Conservative treatments for hemorrhoids include creams and ointments, sitz baths, and measures to maintain soft bulky stools. Such stools are the least traumatic to anal tissue and are achieved by consuming a diet high in fiber with sufficient fluid intake. Fiber supplements and stool softeners may also be helpful.

Because hemorrhoids vary in structure and location, the methods to treat them also vary. In general, only hemorrhoids that produce symptoms are treated, although occasionally external hemorrhoids are removed for cosmetic reasons.

Small thrombosed external hemorrhoids usually resolve on their own within a couple of weeks. However, if seen early in their course, they may be surgically treated in order to hasten resolution and pain relief. The colon and rectal surgeon might excise the swelling containing the blood vessels and clots or “lance” the hemorrhoid to extrude a clot.

When non-thrombosed internal hemorrhoids cause symptoms, rubber band ligation is often the treatment of choice. Quick and effective, this is the most commonly performed procedure to eliminate internal hemorrhoids. Using a specially designed instrument, tiny elastic rings are applied to strangulate an internal hemorrhoid. This is usually done in the office, and no anesthesia is required. The hemorrhoid withers and disappears within days. The band is discharged, usually unnoticed, with a bowel movement.

When internal or external hemorrhoids are large, or cause symptoms that do not respond to conservative management, surgery may be considered. A well performed hemorrhoidectomy will usually provide permanent relief. An operation called Procedure for Prolapse and Hemorrhoids (PPH) may be a less painful and better option for selected patients. Dr. Leiboff was the first to perform PPH in Suffolk County and is highly experienced with this operation. Another approach, Transanal Hemorrhoidal Dearterialization (THD), controls symptoms by reducing the blood flow to the hemorrhoids. Dr. Leiboff has performed this procedure many times, but now considers THD to be inferior to other surgical techniques for treating hemorrhoids.

Dr. Leiboff makes all efforts to reduce the pain associated with hemorrhoid surgery and routinely uses Exparel®, a long acting local anesthetic, to make the patient comfortable for many hours after surgery. Exparel® is available at John T. Mather Memorial Hospital, but is not available everywhere.

Other methods exist to treat hemorrhoids. Infrared photocoagulation (IRC) can be helpful in treating low profile bleeding internal hemorrhoids. IRC is commonly confused with “laser” treatment. Injection sclerotherapy was a common technique employed in the last century and still is valuable in certain circumstances, such as to control bleeding in patients who are on blood thinners and cannot be safely taken off. Cryotherapy (freezing) and laser surgery, while once popular and heavily promoted, did not improve results, and are rarely used by colon and rectal surgeons today.

Dr. Leiboff is an expert in the treatment of hemorrhoids and is familiar with all the above techniques. He will help you select the treatment best for you.

For more information, click on hemorrhoids.

Colon and Rectal Cancers | Cedars-Sinai

Not what you’re looking for?


Colon cancer is a cancer that forms in the tissues of the colon (the longest part of the large intestine). Rectal cancer is a cancer that forms in the tissues of the rectum (the last several inches of the large intestine closes to the anus. Colorectal cancer affects the digestive system. This includes the large and small intestines. The large intestine is also called the colon.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States among both men and women. For men, only lung and prostate cancers show higher numbers. In women, only lung and breast cancers outrank colorectal cancer.

The intestines break down and absorb food and water. They also carry away the body’s digestive waste products. Genetic screening can help determine if patients may be at risk for getting the disease.

Stage of Colorectal Cancer

Rectal cancer begins in the innermost lining of the bowel called the mucosa. As the tumor grows, it invades into the rectal wall and extends outward. The second place the cancer spreads is to the lymph nodes and blood vessels that surround the rectum. The last place rectal cancer spreads is to distant organs such as the liver.

Blood tests, chest X-rays, and CT scans of the abodmen and pelvis are commonly performed to help determine the stage. A transrectal ultrasound is one of the most important tests to evaluate the stage of the rectal tumor. This is the best test to determine the depth of growth of the tumor in the layers of the bowel wall, as well as determining if lymph nodes are involved.

  • Stage I. The cancer is contained only in the inner layers of the rectal wall. There is no spread to adjacent lymph nodes or other organs.
  • Stage II. The cancer has grown through all the layers of the bowel wall, but not to lymph nodes or other organs.
  • Stage III. The cancer has spread to adjacent lymph nodes, but not to other organs.
  • Stage IV. The cancer has spread to other organs such as the liver or the lungs.

Stages of Colon Cancer

The first area colon cancer grows is from the innermost layers of the bowel wall to the outer layers. The second place the cancer spreads is to the lymph nodes and blood vessels that surround the colon. The last place colon cancer spreads is to distant organs such as the liver.

Blood tests, chest X-rays, and CT scans of the abdomen are commonly performed to help determine the stage.

  • Stage I. The cancer is contained only in the inner layers of the colon wall. There is no spread to adjacent lymph nodes or other organs.
  • Stage II. The cancer has grown through all the layers of the bowel wall, but not to lymph nodes or other organs.
  • Stage III. The cancer has spread to adjacent lymph nodes, but not to other organs.
  • Stage IV. The cancer has spread to other organs such as the liver or the lungs.


Adenocarcinoma of the colon and rectum grows slowly. A long time may pass before it becomes large enough to cause symptoms.

Routine exams are important for early diagnosis.

When symptoms do occur, they vary depending on the location of the tumor, its type, how far it has spread and complications it may have caused.

On the right-hand side of the colon, blockage usually doesn’t occur until later stages. This is because the space inside the colon is large, the colon wall is fairly thin and the material passing through is mostly liquid. Some tumors may grow big enough to be felt from the outside of the body. If there is bleeding inside, it usually isn’t obvious. However, a person may feel weak or tired because of severe anemia caused by loss of blood.

On the left-hand side of the colon, the space inside the colon is smaller and the material that passes through it is semi-solid. Colon cancer can cause both constipation and diarrhea. A person may feel cramp-like pain in the stomach. The stool may be streaked or mixed with blood.

In rectal cancer, the most common symptom is usually bleeding when going to the bathroom.

Cancer of the rectum should be considered whenever there is rectal bleeding, even if other causes such as hemorrhoids are present. A person may feel as if there is incomplete evacuation. There usually is no pain until later stages of the condition.

Symptoms of advanced disease include:

  • A feeling of being full very quickly while eating
  • Weakness and pain in the abdominal area

Causes and Risk Factors

There is no single cause of intestinal cancer. Several risk factors may play a role in its development.

Persons between the ages of 40 and 75 are at greater risk of getting colorectal cancer than younger people. More women get colon cancer. More men get rectal cancer.

Conditions such as familial polyposis, Lynch syndrome, Crohn’s disease or ulcerative colitis (ulcers in the lining of the large intestines) tend to increase the risk for the disease. Brothers, sisters and children of those already diagnosed with colorectal cancer have a greater chance of getting the disease later in life.

Population groups who have a high rate of colorectal cancer tend to eat low-fiber diets high in animal protein, fat and refined carbohydrates. The exact way the condition occurs is not yet known.


Screening is very effective for detecting early stages of colorectal cancer. Starting at age 40, even people who have no risk factors and no symptoms should have a digital rectal exam and a test for blood in the stool every year. At age 50, everyone should have a sigmoidoscopy or a similar test.

Screening tests include:

  • Digital rectal exam – The doctor inserts a gloved finger into the rectum to feel for lumps and to check for blood in the stool.
  • Sigmoidoscopy – An instrument called a sigmoidoscope is inserted to look inside the rectum and part of the colon.
  • Colonoscopy – An instrument called colonoscope is used to examine the rectum and the entire colon.
  • Computed tomography scan – A special X-ray creates a computerized picture of the colon and rectum.
  • Barium enema – A liquid is inserted into the rectum, and a series of X-rays are taken. This allows doctors to look for abnormal growths in the colon and rectum.
  • Biopsy – If test results are abnormal, the doctor may examine a small piece of the tumor under the microscope.
  • Genetic risk assessment – This is a method of identifying genes that may increase the chance of getting certain diseases.


The main treatment for colon cancer is surgery. The part of the large bowel with cancer is removed, along with surrounding lymph nodes. The remaining bowel is joined together. Surgery is a cure for 70% of patients with colon cancer. Persons who have cancer that is limited to the mucous lining of the colon have the best chance of survival. Persons who have cancer in the lymph nodes have a less optimistic outlook.

Treatment of rectal cancer depends on how far the tumor has spread and how close it is to the rectum.

If there is not enough healthy colon to reconnect after the tumor is removed, the person may need a colostomy. This is rarely permanent. For this procedure, a surgical opening is made in the abdomen and the end of the bowel is placed through the hole. A bag is placed over the opening to collect the stool.

A combination of radiation therapy and chemotherapy may be helpful for rectal cancer patients, especially if one to four lymph nodes are affected. Careful planning and attention is given to avoid injury to the small intestine.

Follow-up care with the surgeon, gastroenterologist and oncologist is important. The most common time a cancer recurs is within the first two years following diagnosis and treatment. Periodic checkups may include a physical exam, blood tests, colonoscopy, CT scan or PET scan.

The frequency of follow-up after surgery varies. Most experts recommend two annual inspections of the remaining bowel with colonoscopy or X-rays. If results are negative, repeat evaluations may be done at two- to three-year intervals.

When it is not possible to remove the cancer entirely, surgery may be helpful in managing symptoms. Chemotherapy can be used for advanced colon cancer to slow progression of the disease.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Bump on side of anus: Hemorrhoids or something else?

Dear Bumpy peas and Pea-Boy,

Sounds like you have a situation that you won’t want to sit on. All kidding aside, there are a number of conditions that may fit your descriptions, which range from common and benign (hemorrhoids) to more uncommon and serious (cancer). However, before you let your imagination get away from you, consulting a health care provider — who can see you in person — is the only way to diagnose the issue and prescribe any necessary treatment.

To answer your question, Pea-Boy, yes, the bump you’ve found could indeed be a common hemmorhoid,which are swollen veins in the lower rectum and anus (this goes for you, too, Bumpy peas). They tend to be followed by pain, swelling, or itching near the area, fecal leakage, and bloody bowel movements. A number of behaviors and conditions are associated with these particular bum bumps, including straining to have a bowel movement, constipation or diarrhea, heavy lifting, prolonged sitting, anal intercourse, pregnancy, obesity, and liver disease. Discomfort and swelling may come and go, usually lasting between three to five days. Hemorrhoids can either form internally (inside the anal canal) or externally with the potential to thrombus (form a clot), causing pain and additional swelling. The good news is that when it comes to these types of bumps, there are a number of options for treatment and prevention.

Other than hemorrhoids, there are several conditions that can cause similar small bumps to sprout near the anus:

  • Perianal hematomas are very similar to hemorrhoids and often misdiagnosed as such. They are actually a burst blood vessel near the anus, causing a pool of blood to form underneath the skin. These bumps are usually caused by straining or trauma to the area and can be very painful. If caught within the first 48 hours or before they begin to heal on their own, they can be treated by a health care provider. Although the lump may take three months to clear up, the pain usually subsides in seven to ten days.
  • Molluscum contagiosum is another type of bump that can occur anywhere on the body including near the anus. Despite being harmless, they can swell up and last between 6 to12 months. Mollusca can very easily spread to other parts of the body through contact. These small bumps have the tendency to heal on their own, but there are some additional treatment options available to remove them sooner.
  • Anal warts, commonly seen as a single bump or in a cluster resembling a cauliflower, is also another possibility. They are not usually painful, but can spread and multiply. They are caused by the human papillomavirus (HPV) and can be treated by topical medication, surgery, freezing, and laser treatment (all of which are administered by a health care provider).
  • Anal cancer is uncommon, but can also appear as a small lump in the anal canal. Other symptoms include anal bleeding, itching, or pain. The majority of anal cancers are caused by HPV. Risk factors include older age, smoking, engaging in anal sex, immunosuppressant drugs or conditions (including HIV). Anal cancer can be treated by chemotherapy, radiation, or several different surgical procedures.

Before you get all bummed out or try to treat symptoms, it’s best to get help identifying the real culprit for your pea-sized bumps. Though it may feel awkward, know that health care providers are trained professionals can properly diagnose and treat these types of conditions — which will hopefully also relieve your worry!

Anorectal Abscess | Johns Hopkins Medicine

Many glands are found within the body’s anus. If one of these glands becomes clogged, it can get infected, and an abscess can develop. An anorectal abscess is a collection of pus under the skin in the area of the anus and rectum.


These are possible signs of an anorectal abscess:

  • Pain or discomfort near the anus or buttocks
  • Fatigue
  • Fever
  • Night sweats
  • Constipation or painful bowel movements
  • Swelling or redness near the anus
  • Lump or painful hardened tissue near the anus
  • Pain in the lower abdomen
  • Pus drainage near the anus or buttocks

What are the risk factors?

These conditions may increase your chance of developing an anorectal abscess:

  • Pregnancy
  • Diabetes
  • Crohn’s disease, which is an inflammatory bowel condition
  • Certain medicines, such as chemotherapy drugs for cancer treatment
  • Drugs that suppress the immune system after an organ transplant
  • Foreign objects placed in the rectum (usually during sex)
  • Anal fissures, or cracks, related to constipation that continues for a long time
  • Sexually transmitted disease (STD)


In most cases, your healthcare provider can diagnose an anorectal abscess by looking externally at the anus and through a digital rectal exam. This test involves the healthcare provider inserting a gloved, lubricated finger into your anus. A speculum can be inserted to allow the whole anal area to be seen. In some instances, a healthcare provider will need to do a proctosigmoidoscopy. This is a test in which a flexible tube with a light and a camera is placed in the anus to see the area. In other instances, an MRI, CT scan, or ultrasound might be needed to find out where the location of the abscess.


The healthcare provider will probably treat your anorectal abscess by making a hole in the skin near the anus so the pus can drain. This relieves the uncomfortable pressure and lets the tissues heal. Often the procedure can be done in a healthcare provider’s office. If you have a large or deep abscess, you might need to be in the hospital, In addition, in some instances a full anorectal exam must be done under anesthesia in the operating room before deciding on the best course of treatment. Healthcare providers can more carefully watch your condition in the hospital as the abscess is drained. You may also need to be in the hospital if your immune system is weak and you are prone to infection. In these cases, you might be given local anesthesia to help ease pain. In some cases, your healthcare provider may prescribe antibiotics. 


About half of people with an anorectal abscess develop an anal fistula. This is an abnormal opening in the skin near the anus. Pus bursts from the abscess and seeps out. A fistula usually needs surgery to repair it. Pain, infections, and recurrence are other possible complications of anorectal abscess.


You can reduce your chances of developing this condition by managing diabetes, STDs, and other risk factors. If you have inflammatory bowel disease, such as Crohn’s, medicines are usually needed to help avoid anorectal problems like abscess. 

When to call the healthcare provider 

An anorectal abscess needs immediate medical attention before other complications happen. If you have any pain, discomfort, or swelling in the anus or rectum, see your healthcare provider to find out the cause.

Lumps and swellings | nidirect

Most lumps and swellings under the skin are harmless and can be left alone. However, see your GP if you develop a new lump or swelling so that the cause can be identified.

When to see your GP 

You should see your GP if you develop any growth or swelling on your body. They can examine it and confirm what it is and what’s causing it.

If your GP is uncertain, they may recommend that you have an ultrasound scan or a biopsy. Surgery may be needed to remove certain types of lump.

You should also see your GP urgently if you have a lump that:

  • is getting bigger
  • is painful
  • feels hard
  • grows back after it’s been removed

This is usually the type of lump that needs treatment or investigation due to infection or to rule out cancer.

Common reasons for an unexplained lump or swelling 

A painful lump or swelling that appears suddenly over a day or two may be caused by an injury or infection. It’s likely to be an infection if the skin around the lump is red and warm. Your GP can advise you about how to care for this.

Below are some of the most common reasons for an unexplained lump or swelling under the skin in the following areas of the body:

This information may help give you an idea about what your lump or swelling might be. However, don’t use it to diagnose yourself with a condition. Always leave that to your doctor. 

Facial swelling or lump 

A lump or swelling on the face that wasn’t caused by an injury is most likely to be one of the following:

  • mumps – a viral infection that usually affects children and causes swelling of the glands on the side of the face
  • an allergic reaction – for example to peanuts, which causes swelling in the deeper layers of the skin (angioedema) 
  • a dental abscess – that causes the side of the mouth to swell
  • a salivary gland stone – this forms when the chemicals in saliva crystallise and block the flow of saliva from a salivary gland near the jaw, causing pain and swelling around the jaw

See your GP for advice if you have a lump or swelling on your face.

Lump in the neck or throat 

A lump in the neck or throat is most likely to be one of the following (although, there are also several other causes):

  • swollen glands (lymph nodes) – usually a sign of infection, such as a cold or glandular fever (the glands tend to go down when you recover)
  • a cyst – a harmless fluid-filled lump that may disappear on its own without treatment
  • a skin tag – a harmless, knobbly wart-like growth that hangs off the skin and can be left alone
  • a goitre – an abnormal swelling of the thyroid gland in the neck that causes a lump to form in the throat  

See your GP for advice if you have a lump in the neck or throat.

Lump in the breast 

Breast lumps are common and have several different causes. While most breast lumps aren’t breast cancer, any unusual changes to the breasts should be checked by a GP as soon as possible.

Common causes of breast lumps include:

  • mastitis – painful, swollen breast tissue that is sometimes caused by an infection 
  • enlarged milk ducts
  • a non-cancerous growth (fibroadenoma)
  • a cyst – a harmless fluid-filled lump
  • a lipoma – a harmless fatty lump 
  • a skin tag – a harmless, wart-like growth often found underneath the breast

Lump around the groin area 

Common causes of a lump or lumps in the groin area include:

  • a cyst – a harmless fluid-filled lump
  • swollen glands – usually a sign of infection, such as a cold or glandular fever; the glands tend to go down when you recover
  • a hernia – where an internal part of the body, such as part of the bowel, pushes through a weakness in the muscle or surrounding tissue wall
  • an enlarged vein – known as a saphena varix, which is caused by a faulty valve inside the vein (the lump often disappears when you lie down)
  • genital warts – small, fleshy growths caused by a sexually transmitted infection (STI)

See your GP for advice if you have a lump or lumps in the groin area.

Lump or swelling in the testicle 

Most testicular lumps are harmless and aren’t cancerous. Less than 4 in 100 of testicular lumps turn out to be testicular cancer. 

A lump or swelling in the testicle is most likely to be one of the following:

  • swollen and enlarged veins inside the scrotum (varicoceles)
  • swellings caused by a build-up of fluid around the testicle (hydrocele)
  • a cyst in the epididymis (the long, coiled tube behind the testicles)

See your GP for advice if you have a lump or swelling in the testicle.

Lump around the anus (bottom) 

Anal swellings or lumps are usually one of the following:

  • a haemorrhoid (pile) –a swollen blood vessel that can hang outside the anus 
  • a skin tag – a harmless growth that hangs off the skin and looks similar to a wart
  • an abscess – a painful collection of pus
  • a rectal prolapse – where part of the rectum (the end of the bowel) sticks out of the anus
  • genital warts – small, fleshy growths caused by a sexually transmitted infection (STI)

See your GP for advice if you have anal swellings or lumps.

Lump on the hand, wrist or finger 

A lump on the hand, wrist or finger is probably a ganglion cyst. This is a type of cyst that forms around the joints or tendons.

A ganglion cyst usually appears on the back of the wrist. It’s made up of a thick jelly-like fluid and feels like a smooth, soft lump under the skin.

It’s not clear why ganglions form. However, they can be related to ageing or to injury to the joint or tendon.

If the ganglion doesn’t cause any pain or discomfort, it can be left and may disappear without treatment. If it does cause pain or discomfort you may need to have it removed.

Sometimes, small rough lumps called warts develop on the hands. Warts are caused by an infection with the human papilloma virus (HPV) and are very contagious. However, they’re usually harmless and clear up without treatment. 

See your GP for advice if you have a lump on the hand, wrist or finger.

Lump on the shoulder, back, chest or arm 

A lump on the shoulder, back, chest or arm is most likely to be a lipoma or a cyst.

A lipoma is a soft, fatty lump that grows under the skin. It’s fairly common, harmless and can usually be left alone. When you press a lipoma, it should feel soft and ’doughy’ to touch. It can range from the size of a pea to a few centimetres across.

A cyst is a sac under the skin that contains fluid, usually pus. It can look a bit like a lipoma but is close to the surface of the skin (lipomas are deeper under the skin).

Cysts can be soft or firm to the touch. Pressing on it you may get a sense of being able to squash it, and it then returning to its original shape once you remove your finger. A cyst may disappear without treatment or you may need to have it drained.

See your GP for advice if you have a lump on the shoulder, back, chest or arm.

Lump in the armpit 

A lump in the armpit is likely to be a swollen lymph gland, particularly if you also feel unwell and have other signs of an infection.

The glands in the armpit can swell to more than a few centimetres in response to infection or illness. Swollen glands usually go down when you recover.

It’s uncommon for a lump in the armpit to be a lymphoma (cancer of the lymph glands), but you should see your GP if the lump doesn’t go down.

A small, knobbly lump in your armpit that hangs off the skin like a wart is probably a skin tag. 

Skin tags grow where skin rubs against skin or clothing, which is why they’re often seen under the arm. They’re very common and harmless, and can be left alone.

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The information on this page has been adapted from original content from the NHS website.

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Rectal Tumors | BluePearl Pet Hospital

Rectal Tumors: Signs, Diagnosis and Treatment

There are many types of rectal tumors. The most common is rectal carcinoma. Less common types are plasmacytoma, adenomatous polyps, lymphoma, and mast cell tumor.

Rectal Carcinomas

Rectal carcinomas usually have one of three structural types: circumferential, cobblestone, and polypoid. The circumferential tumors, also known as a napkin ring tumor extend around the circumference of the rectum. When a digital rectal examination is performed a marked narrowing of the rectum (stricture) is usually felt.

This type of tumor tends to be located in the mid rectum. The cobblestone type of rectal tumor is a wide-based tumor and literally looks like a patch of cobblestones (bumps). This type of tumor tends to be located in the mid rectum but can also be located close to the anus. The polypoid type of tumor usually is a carcinoma in situ, which is a type of cancer that grows in one place on the surface of the colon and is attached by a narrow stalk.

Signs and Diagnosis

The most common clinical signs of rectal tumors include straining to have bowel movements and blood in the stools. In some cases the bleeding can be fairly extensive. If the tumor is polypoid and located near the anus, it may intermittently protrude through the anal opening.

Weight loss is not a common finding but may be associated with spread of cancer to other regions of the body.

Your veterinarian will often be able to make the diagnosis of a rectal mass upon digital rectal palpation. For masses further into the colon, colonoscopy will be needed to identify the mass. A complete blood count, chemistry profile and urine testing are completed to evaluate your pet’s internal organ health in preparation for general anesthesia.

Chest radiographs (X-rays) and abdominal ultrasound are used to identify visible spread (metastasis) of cancer to the lungs or other internal organs; however, neither of these tests can show microscopic spread of cancer from the primary tumor. Colonoscopy may be recommended in some cases prior to surgery to evaluate the extent of the tumor.


A surgical plan will be discussed with you based on the type of tumor that your pet has. Most polypoid tumors can be removed from within the rectum; therefore, your dog will not have any external incisions. The tumor is usually exposed at the time of surgery by pulling a section of the rectum through the anus to the outside. The tumor and a portion of normal bowel are removed and the incision is stitched together using dissolvable sutures.

Removal of a cobblestone adenocarcinoma frequently can be performed by prolapsing the affected bowel through the anus, thus not requiring an external incision. If the tumor is further up the rectum a horseshoe-shaped incision is made around the anus to assist removal of the tumor.

The circumferential (napkin ring) carcinoma needs to be removed via a more extensive approach. In some cases, an abdominal incision is required along with prolapsing of the tumor through the rectum. If the tumor is quite extensive, a pelviotomy may be required, which entails making four cuts in the pelvic bone.


The prognosis is dependent on the type of tumor present. The polypoid adenocarcinomas have low tendency to spread and usually can be cured with surgery alone. The cobblestone adenocarcinomas have a reasonably good prognosis with a median survival time of 12 months. The circumferential adenocarcinoma carries a guarded prognosis with a median survival time of seven weeks.

90,000 symptoms in men and women

Pathological processes diagnosed in the colon, such as polyps and inflammatory diseases, can lead to the formation of a malignant tumor. In this case, the patient may not be aware of the development of a dangerous disease for a long time. How to keep the situation under control and what symptoms to look for?

Colon cancer: what does the diagnosis mean?

The large intestine, or large intestine, includes the cecum with the appendix (appendix), the ascending, transverse and descending colon, sigmoid colon, rectum and anus.A malignant tumor growing from the lining of any part of the colon is called colon cancer or colorectal cancer.

About 600,000 cases of this disease are diagnosed annually in the world [1]. In the UK, colon cancer ranks second among all cancers [2]. In the United States, about 145,000 patients with this diagnosis are registered annually, one third of them die [3]. As for Russia, colon cancer in terms of prevalence occupies one of the leading places among all oncological diseases.Medical statistics report that more than 70,000 new cases of this type of cancer are detected in our country every year. In terms of mortality from cancer, colorectal cancer in Russia came in second. In about 48% of cases, the disease is detected at stage III – IV. During the first year after the diagnosis of colon cancer, about 24% of patients die [4]. However, this diagnosis is not a verdict, and the earlier colon cancer is detected, the more chances the patient has to get rid of the disease.

Causes of colon cancer

Paradoxically, the disease is most common in developed countries with stable economies. The latter fact is due to the fact that with the development of technologies and an improvement in the quality of life, the physical activity of the population decreases and the likelihood of obesity increases. These are all risk factors for developing colon cancer.

There are several major causes of colon cancer. Let’s consider them in detail:

  • Diseases of the colon – chronic inflammatory bowel diseases (ulcerative colitis, Crohn’s disease).Patients with such diagnoses should undergo regular diagnostic examinations.
  • Heredity. In 5% of patients, the disease is associated with a hereditary predisposition and is transmitted from parents to children [5]. Familial colon adenomatosis, Lynch syndrome, and MutYH-associated polyposis deserve special attention. In these conditions, from 10 to several hundred polyps are formed in the large intestine. These neoplasms have a great potential for malignancy, which increases the risk of developing cancer.Hereditary cancer can develop during adolescence and even childhood. If a close relative is diagnosed with colon cancer, ovarian cancer, breast cancer or cancer of the uterine body, it is advisable to be screened for hereditary syndromes and be sure to undergo regular preventive examinations, since a genetic predisposition significantly increases the risk of tumor formation.
  • Age. Colorectal cancer in most cases is diagnosed in people over 55 years old, but the current trend is the “rejuvenation” of cancer: the disease is increasingly being detected in patients 40–50 years old [6].
  • Type of food. The abundance of red meat, animal fats and flour dishes in food with a lack of plant foods rich in fiber, can negatively affect the state of the intestines and lead to the occurrence of pathological processes. Physical inactivity, obesity and diabetes mellitus are also serious risk factors for the development of the disease.
  • Bad habits. Smoking along with alcohol abuse is one of the serious factors in the development of not only lung and stomach cancer, but also intestinal cancer.
Classification of colon cancer

By the nature of their growth, tumors are divided into exophytic and endophytic . An exophytic tumor grows into the intestinal lumen and looks like a polyp, node, or “cauliflower”. An endophytic tumor grows in the thickness of the intestinal wall, covers it circularly, which causes a gradual narrowing of the intestinal lumen. If we consider intestinal cancer from the point of view of its cellular composition, then it is dominated by carcinomas – adenocarcinomas occur in 75–80% of cases [7].The remaining 20-25% are carcinoids (neuroendocrine tumors), mixed carcinoid-adenocarcinomas and other types of cancer.

Stages of development of the disease

There are four stages in the development of colon cancer.

  • At the first stage the tumor is very small, it is located within the mucous and submucosal layers of the intestinal wall. At this stage of the disease, treatment is most effective. In 90% of cases, patients recover [8].
  • At the second stage of cancer , the tumor grows into the muscle layer, but does not grow through the intestinal wall.The effectiveness at this stage of treatment is slightly lower – up to 85% of patients are cured [9].
  • The third stage is characterized by the spread of the tumor throughout the entire thickness of the intestinal wall (it grows through and through), metastases appear in regional (closely located) lymph nodes. The five-year survival rate is up to 60%, and the disease recurrence rate is high.
  • The fourth stage is characterized by the spread of the tumor to adjacent organs and tissues. Distant metastases appear: as a rule, they are found in the liver, lungs and ovaries.The survival rate is low.

Symptoms and signs of colon cancer in men and women

The risk of developing colon cancer is equally high in both men and women. There are differences only in the localization of the tumor in the intestine: rectal cancer prevails in men, and colon cancer in women.

Colorectal cancer is insidious in that in the early stages it does not manifest itself in any way – this is the main reason for the late appeal of patients for help. It is necessary to take very seriously the occurrence of dull or pulling abdominal pain, nausea, vomiting, alternating constipation and diarrhea, the appearance of blood and mucus in the stool.Alarming signals are a decrease in appetite, causeless weight loss, the occurrence of anemia of unknown origin.

An increase in the size of the tumor narrows the intestinal lumen, this can lead at first to the development of partial, and later on to complete intestinal obstruction: abdominal pain of low intensity turns into severe prolonged cramping pains with no discharge of independent stools and gases.

In advanced stages, there is a deterioration in the general condition: weakness appears, severe weight loss, body temperature rises.

Diagnosis of the disease

Given the long asymptomatic period of colon cancer, screening has been introduced for early diagnosis – a study that should be taken by healthy people over 40 years of age and patients at risk. The main method is the determination of occult blood in the feces: for this, the Colon View Hb and Hb / Hp test for occult blood in the feces is used.

For the early diagnosis of colon cancer, information about the presence of cancer in close relatives is important.At the same time, it is important to know that, according to statistics, in Russia, 25–30% of patients with genetically confirmed Lynch syndrome did not have relatives with malignant tumors in their families [10].

You can find out if there is a hereditary predisposition to the development of colon cancer by passing genetic testing and passing an analysis. If Lynch syndrome is suspected – a study for non-polyposis colon cancer , if an attenuated form of familial adenomatosis is suspected – a study for adenomatous colon polyposis APC , if MutYH-associated polyposis is suspected – a study for colon and stomach cancer .Detection of a genetic predisposition to cancer should alert the doctor: the patient must be more closely monitored and examined in time.

It is necessary to undergo preventive examinations by a gastroenterologist or proctologist annually. If, after a detailed survey, examination and palpation of the patient’s abdominal cavity, the doctor suspects the formation of a tumor in the rectal area, then he prescribes an additional examination: in addition to examining feces for occult blood, it is necessary to pass a detailed clinical blood test and undergo a colonoscopy.

Colonoscopy – the gold standard in the diagnosis of colorectal cancer. This is a partial examination of the intestines using a special flexible endoscope. The method allows you to directly see the tumor, determine its location and size, as well as obtain a piece of tissue (biopsy material) for examination under a microscope and determine the type of tumor. Computer and magnetic resonance imaging are considered auxiliary research methods, such studies also include irrigoscopy and ultrasound .

The chances of recovery are significantly higher if therapy is started on time. Therefore, at the slightest alarming symptoms, it is worth visiting a doctor.

All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

Article “Rectocele – symptoms, diagnosis, treatment”

Says by the surgeon-coloproctologist Ekaterina Borodina

Rectocele “(rectocele: lat.rectum – rectum; Greek kele – protrusion, hernia, swelling) is a protrusion of the anterior rectal wall towards the vagina (anterior rectocele), and / or, extremely rarely, along the posterior semicircle of the rectum.

Rectocele is affected in the overwhelming majority of women. Weakness of the ligaments and muscles of the pelvic floor, which develops throughout life, their damage during difficult and complicated labor leads to a weakening of the rectovaginal septum – the wall between the intestine and the vagina. At the same time, it becomes thinner, and the posterior wall of the vagina, closely connected with the rectum, acquires pathological mobility.With an increase in intra-abdominal pressure (chronic constipation and severe straining during bowel movements), the anterior rectal wall bulges towards the thinned posterior wall of the vagina. Instead of straining to “work” on emptying the intestine, the septum protrudes into the vagina, the resulting pocket prevents normal bowel movements.

Rectocele, most often, is the tip of the iceberg of pelvic floor problems in women over 50 and the cause of the so-called obstructive bowel syndrome.The failure of the pelvic floor muscles also leads to urinary incontinence during stress (when coughing, sneezing), to problems in the sexual sphere in women. That is why rectocele and prolapse of the female genital organs are diseases with a single developmental mechanism and clinical picture, the adequate treatment of which requires the combined efforts of a coloproctologist and a urogynecologist.

Symptoms of rectocele

The main complaint in rectocele is constipation. Defecation is difficult, there is a feeling of incomplete emptying of the rectum.As the disease progresses, it becomes necessary to use a manual aid during a chair, prolonged straining. The result of incomplete emptying of the rectum is frequent, ineffective urge to defecate, there is a need for a two-stage defecation. A characteristic sign of the accumulation of feces in the “reservoir”: the intestine “works” if you support or press your fingers on the back wall of the vagina or from the sides of the anus.

In the future, prolonged straining leads to injury to the mucous membrane of the anal canal and the emergence of a number of concomitant proctological diseases (chronic hemorrhoids, anal fissure, rectal fistulas, chronic cryptitis, etc.).NS.).

Diagnosis of rectocele

The characteristic complaints of a difficult act of defecation, the need for manual assistance by pressing on the back wall of the vagina to release the rectum are sufficient grounds to suggest that the patient has rectocele. The main method for diagnosing rectocele is a proctological examination performed on a gynecological chair in a supine position with legs bent at the knee joints and brought to the abdomen.When carrying out a digital examination of the rectum and vaginal examination with straining, the protrusion of the anterior wall of the rectum towards the vagina is revealed. Anoscopy / rectoscopy / colonoscopy is mandatory for all diseases of the rectum and anal canal. At the same time, the condition of the rectum is determined and concomitant proctological diseases are identified. A transrectal ultrasound examination is performed to determine the condition of the pelvic floor muscles, the size of the rectocele.

In specialized clinics dealing with pelvic floor problems, including the EMC Coloproctology Clinic, complex studies of the function of the act of defecation and pelvic anatomy are carried out using X-rays (defecography), MRI (MRI defecography), anal manometry. It is imperative to study the passage (passage) of a radio-opaque substance through the colon to exclude slow-transit constipation.

Drug treatment

In all patients with rectocele, treatment should begin with conservative measures, consisting in the selection of a diet with the inclusion of high-fiber foods and a large amount of liquid in the diet.This is a diet high in dietary fiber, drugs with dietary fiber to soften and increase stool volume; eubiotics, stimulating the development of “useful” intestinal flora.

It has been proven that drinking up to 1.5-2 liters of fluids per day increases stool frequency and reduces the need for laxatives in patients on a high toxoid diet. Such therapy is aimed at normalizing the evacuation function of the colon, and it should be prescribed for 1.5-2 months.before surgery. In cases where bowel function cannot be improved with the help of a diet, osmotic laxatives and prokinetics should be used – drugs that normalize the motor activity of the gastrointestinal tract.

At the initial stage, it is useful to carry out a set of gymnastic exercises that strengthen the muscles of the pelvic floor (Kegel exercises).

Surgical treatment

If, despite all the measures taken to improve the emptying of the rectum, the symptoms of rectocele persist, the doctor considers the issue of surgical intervention in order to remove the protruding part of the rectum and strengthen the rectovaginal septum.This decision is made by the joint consilumurogynecologist and coloproctologist. Combined operations are possible. The choice of the method of surgical treatment is carried out taking into account the patient’s history and concomitant pathology. So, with pronounced pathological changes in the position of the pelvic organs or the presence of concomitant diseases, for example, cystocele, hemorrhoids, polyps or anal fissure, surgery for rectocele is performed using a combined access with simultaneous correction of concomitant diseases, since in women suffering from rectocele, often various injuries of the anus are observed, in particular, its anterior semicircle, inflammation of the sigmoid and rectum.

Before the advent of modern technologies and the latest materials, the main type of surgery was the plastic of the pelvic floor muscles. Modern technologies allow an operation to eliminate rectocele and rectal prolapse laparoscopically and involve the installation of a mesh implant. Biologically inert implants are fixed on the pelvic ligaments and reliably strengthen the rectovaginal septum, rectovaginal region and pelvic floor. The number of complications and relapses is minimized.A woman is allowed to get up the very next day after the operation and move actively for 2-3 days. The operation is low-traumatic, it allows to heal older women who have had genital prolapse (vaginal prolapse and prolapse) and / or with a large number of concomitant diseases. In patients, normal functions of the pelvic floor muscles are restored and the process of bowel movement returns to normal.

The method of plastic surgery with mesh implants is not suitable for women who are planning a pregnancy, since it becomes impossible to adequately stretch the rectovaginal region, which is necessary for a successful natural childbirth.

In cases where there are contraindications for surgical intervention, urogynecologists decide on the appointment of special therapeutic exercises and recommend wearing a pessary – a rubber or plastic ring that prevents the prolapse of the pelvic organs, including the uterus. The pessary supports the internal genital organs of the woman. It is installed in the vagina by a doctor and requires periodic replacement, since with prolonged wear it causes the formation of pressure sores.

90,000 Tumors of the gastrointestinal tract in dogs

GI tumors in dogs account for about 10% of all tumors. They include both benign formations – polyps, adenomas, and malignant tumors – adenocarcinomas, lymphomas, leiomyosarcomas. Malignant tumors provoke progressive disease and often spread throughout the body (metastasize) even before the appearance of noticeable clinical signs. Secondary or metastatic tumors can develop in the lymph nodes, on the peritoneum, in the liver, and in the lungs.Life expectancy in the presence of metastases is rarely longer than several months, however, with timely diagnosis and proper therapy, the period of remission can be several years. Unfortunately, even benign lesions can, due to their number and / or size, create serious problems, such as intestinal obstruction.

What do we know about the causes of gastrointestinal tumors?

Cancer is often the culmination of a series of circumstances that combine unfortunately for the animal.The development of a malignant neoplasm is a multi-stage process, which, most often, has several etiological factors at once. Some types of tumors never mutate beyond the initial stages, so they remain benign. Others are developing rapidly. There is a possibility that infections or certain chemicals are associated with the initiation or advancement of carcinogenesis, but it is not possible to name a specific cause.

Do some dog breeds have a higher genetic susceptibility to cancer?

Some breeds are much more likely to develop cancers than others.The more divisions a cell has, the more likely it is to mutate, so cancer is more common in cells that divide frequently, or in older animals whose cells have undergone more divisions.

Are tumors of the gastrointestinal tract common?

Colon tumors are rare in dogs, about 10% of all tumors. The average age of affected dogs is 9 years. Most (60%) tumors are found in the small and large intestines; tumors of the esophagus and stomach are less common.

How does a gastrointestinal tumor affect a pet’s condition?

The main clinical signs of bowel tumors are weight loss, loss of appetite, vomiting, diarrhea, and blood in vomit or feces. Vomiting is more common in tumors in the small intestine and in the stomach, while diarrhea occurs in animals with tumors in the large intestine. Sometimes there may be constipation instead of diarrhea.

How are gastrointestinal tumors diagnosed?

In addition to the standard initial examination, it is almost always necessary to carry out additional diagnostics – radiography, ultrasound.Blood tests are not a direct diagnosis of neoplasms, but may indicate indirect signs. The only way to identify a tumor is to get a sample of the tumor itself. There are two main types of material examination – cytological and histological. The first step in the “recognition” of a tumor, in the case of neoplasms of the gastrointestinal tract, will be a cytological examination. Taking material for such a study from a tumor located in the abdominal cavity is best controlled using ultrasound, which will reduce the risk of receiving low-quality samples.Cytological examination will make it possible to make a preliminary diagnosis and choose the most relevant tactics for further diagnosis. Next, it will be necessary to obtain tissue for histological examination. Depending on the intended location and clinical signs, the veterinarian may recommend endoscopic or open surgery to obtain appropriate specimens. The endoscopic method may be suitable for sampling from the esophagus, stomach, duodenum and rectum.Also, with complex locations of tumors, it is possible to carry out computed tomography for better visualization of the volume of the lesion and also targeted collection of material. After the tissues are sent to a specialized veterinary laboratory, the samples will be examined by a veterinary pathologist. Based on the result of the histological examination, the final diagnosis is made.

What types of treatments are available?

The main treatment is surgical removal of the tumor.Non-steroidal anti-inflammatory drugs (NSAIDs) may protect against colon cancer, possibly because they decrease the production of compounds called prostaglandins. In one study in dogs, rectal tumors were reduced in size following the administration of a suppository containing one of the NSAIDs. Also, in some cases, it is possible to carry out chemotherapy treatment.

Can cancers go away without treatment?

Oncological diseases in the vast majority of cases do not go away on their own, but since development is a multi-stage process, it can stop at a certain stage.The body’s own immune system is often not strong enough to fight the malignant process.

How to understand the forecast?

The results of the histological examination will enable the veterinarian-oncologist to predict the further behavior of the tumor with the greatest accuracy. Depending on the conclusion of the pathomorphologist, the clinical doctor will prescribe certain methods of treatment and control of the disease during the period of remission.

Are there any risks to my family or other pets?

No, these are not infectious tumors and are not spread from pets to pets or from pets to humans.

90% of successful cancer treatment depends on early diagnosis, be attentive to your pet’s health!

Differential diagnosis
of malignant tumors of the anal canal | Timofeev Yu.M.

Urgency of the problem
The anal canal and the anal zone are the final section of the digestive tract; according to the International Anatomical Classification, they are separated into an independent anatomical section. Malignant tumors of the anal area (squamous cell carcinoma, melanoma, adenocarcinoma, sarcoma) are characterized by a particularly severe course, often metastasize, have a poor prognosis [V.I. Knysh, Yu.M. Timofeev, 1997]. Other diseases of the anal area (hemorrhoids, anal fissure, paraproctitis, etc.) are very common. Thus, it is an important practical task to differentiate these diseases in the early stages, at the first visit of the patient to the doctor, in order to carry out the treatment correctly from the very beginning.

Although the length of the anal canal is only 5 cm, about 80% of all proctological diseases are localized in the anal canal [A.M. Aminev, 1969].This is undoubtedly one of the reasons that when patients with malignant tumors of the anal canal first see a doctor, the most common non-oncological diseases are suspected. Errors in the diagnosis of anal cancer at the prehospital stage reach 34.9% [R.A. Melnikov et al., 1984]. For a long time, these tumors were erroneously assessed by doctors of the outpatient clinic network as one of the widespread proctological diseases (hemorrhoids, anal fissure, etc.).etc.).
The reverse error is also possible. In 4–5% of cases, anal diseases are malignant, and they can be disguised as benign lesions for a long time and in the early stages manifest themselves with minor pain, discomfort, anal itching, induration, non-healing ulcers, bleeding, etc.
Materials and methods
The clinical course of anal cancer was studied at the Russian Cancer Research Center of the Russian Academy of Medical Sciences in 159 patients. Anal cancer has vivid clinical symptoms, asymptomatic course of the disease, even in the early stages, is practically not observed.The most frequent and earliest symptom of anal cancer is an admixture of scarlet blood in the feces, this symptom is detected in 92.5% of patients. The admixture of mucus in the feces is less common (34% of cases). Another common symptom in anal cancer is pain in the anus, it is noted in 84.3% of cases. At the beginning of the disease, pain occurred during bowel movements, gradually they intensified, acquired a permanent character, sometimes radiated to the genitals, thigh, lower abdomen. In 26.4% of patients, the pain was so intense that the patients were forced to take analgesics and drugs.In 32.1% of cases, constipation was noted, they were caused not by a violation of intestinal patency, but by fear of stools due to pain in the anus, restrictive diet, and arbitrary stool retention. Diarrhea was rare – in 3.8% of cases. A significant proportion of patients (22.6%) complained of a tumor in the anus. Some of these patients self-identified a tumor by digital examination of the rectum. Less commonly, symptoms such as anal itching, discharge of pus from pararectal fistulas, bloating and rumbling in the abdomen, dysuric disorders, fever, decreased appetite, weight loss, and malaise were noted.General symptoms in the form of weight loss, decreased appetite, malaise, weakness do not always indicate the neglect of the tumor process, the presence of distant metastases. Most often, they are the body’s reaction to severe pain in the anus, as well as psychogenic trauma.
At rectoscopy, macroscopically anal cancer had the following forms: polypoid form – 18.2%, saucer-like form – 42.1%, ulcerative-infiltrative form – 32.7%, diffuse-infiltrative form – 6.9%. The polypiform form has the appearance of a polyp on a broad base, “cauliflower”, a mushroom-like formation.Most often, anal cancer is presented in the form of ulcers with roller-like edges, bleeding easily when touched, but the ulcers are covered with a dirty gray coating of fibrin and decaying tissue. There is a significant submucosal infiltration of tissues around the ulcer. The diffuse-infiltrative form has the form of submucosal infiltration of the anal canal, sometimes as a tuberous formation in the submucosal layer, with indistinct boundaries. The size of the tumor is from 1 to 15 cm. Melanomas of the anal canal are not always black. Black color was noted only in 20.6% of patients with melanoma, in 10.3% – a dark brown color, in other patients melanoma had a purple and red color, as in the mucous membrane of the anal canal.This does not always allow one to suspect anal melanoma by color.
According to the RCRC RAMS, in 32.1% of cases, the tumor was determined visually [V.I. Knysh, Yu.M. Timofeev, 1997]. All tumors of the anal canal could be detected by digital examination of the rectum. Rectoscopy made it possible to examine the tumor in detail, make a biopsy or take smears. Nevertheless, as the analysis of medical records showed, a significant part of the patients had gross diagnostic errors. The wrong diagnosis was made in 31.4% of patients at the first visit to the doctor.The most common misdiagnosis is hemorrhoids (18.2%), other erroneous diagnoses: anal fissure, paraproctitis and perrectal fistula, inguinal and femoral hernia, anal canal polyps, papilloma, perineal ulcer, prostate adenoma, dysentery, rectitis, inguinal lymphadenitis, bartholinitis, actinomycosis of the perineum, and even such very “distant” in the diagnostic sense of the disease as ectopic pregnancy, uterine sarcoma, gastric ulcer, adnexitis. For these erroneous diagnoses, the patients were examined and treated for a long time by surgeons, therapists, gynecologists, urologists, and even by proctologists and oncologists.In 6.3% of patients with anal cancer due to erroneous diagnoses, inadequate operations were performed: hemorrhoidectomy, hernia repair, opening of paraproctitis, opening of bartholinitis, excision of fistula, inguinal lymphadenectomy. The diagnosis of inguinal-femoral hernia and inguinal lymphadenitis was made in the presence of metastases in the inguinal lymph nodes, with a far-reaching tumor process.
The main reasons for diagnostic errors were: inattentive questioning of patients and neglect of digital examination of the rectum, as well as the absence of oncological alertness.The time from the first visit of a patient to a doctor to receiving specific treatment sometimes exceeded all oncological norms. Only 39% of patients were examined at a time acceptable for cancer patients – up to 1 month. from the first visit to the doctor to receiving specific treatment. In 33.3% this period was 1–3 months, in 15.7% – 3–6 months, in 9.4% – 6–12 months, and in 2.5% of patients – more than 1 year. All this happened due to diagnostic errors, prolonged examination of patients, some organizational flaws [V.I. Knysh, Yu.M. Timofeev, 1997].
Benign diseases of the anal area may precede malignant tumors of the anal canal. Anal cancers that develop in benign anal diseases are diagnosed late, which in most cases delays the initiation of specific treatment. Therefore, with a prolonged absence of the effect of conservative therapy, benign diseases of the anal area (hemorrhoids, fistula, fissure, etc.) should be excised and subjected to mandatory morphological examination (this allowed some authors to detect cancer in 2% of cases) [P.Matteucci et al., 1983].
Discussion of issue
Malignant tumors of the anal canal should be differentiated from the following diseases: hemorrhoids, anal fissure, polyps, papillitis and anal papillae (fimbria), genital warts, rectitis (proctitis), dysentery, colitis, Crohn’s disease, specific ulcers (syphilis, tuberculosis, HIV infection , actinomycosis, etc.), perrectal fistulas, solitary rectal ulcer syndrome, benign tumors of the perianal region (fibromas, lipomas, etc.), pectenosis of the anus, radiation ulcer, anal itching, etc.
Haemorrhoids. The most common proctological disease is hemorrhoids. “Hemorrhoids in adults, like measles in children,” wrote Professor M.S. Subbotin. American proctologist W.E. Miles estimated that 80% of all middle-aged people have hemorrhoids. According to A.M. Amineva (1971), hemorrhoids occur in 13.3% of all proctological patients and 1.42% of all surgical patients. According to the State Research Center of Coloproctology, hemorrhoids account for 38.2% of all proctological diseases, the prevalence of hemorrhoids is 139.6 per 1000 adults [V.L. Rivkin, L. L. Capuller, 1984]. Thus, hemorrhoids are a very common disease.
Obviously, therefore, the most frequent erroneous diagnosis in the initial visit to the doctor of patients with malignant tumors of the anal canal is hemorrhoids. Indeed, the most common symptoms of hemorrhoids are bleeding during bowel movements and pain in the anus. In anal cancer, these are also the most common symptoms. Thrombosed hemorrhoids present particular difficulties in differential diagnosis.They look like hyperemic, painful, with a cyanotic shade of formation in the anal canal area.
Differential diagnosis is based on digital examination. The absence of a digital examination if hemorrhoids are suspected leads to the fact that the doctor misses malignant tumors of the anal canal. The finger examination should be done carefully, sparingly, trying to cause less pain in the patient. With inflammation of the nodes, when the study is most painful, it is necessary to carry out preliminary anesthesia.With a digital examination, it is determined that the hemorrhoids are soft, easily fall off when pressed, while a tumor of a dense consistency does not disappear when pressed.
Anoscopy shows that the mucous membrane above the hemorrhoid in uncomplicated cases is not changed. In the later stages, with complicated forms, when thrombosis, necrosis, ulceration of hemorrhoids occur, the resulting ulcer may resemble the ulcerative form of anal cancer. In addition, in a long-standing ulcer, malignancy may occur over time.In such cases, a morphological examination of the ulcer is necessary: ​​cytological examination of smears-prints or biopsy of the edges of the ulcer.
A certain difficulty for differential diagnosis is a thrombosed hemorrhoidal node, determined by digital examination in the thickness of the intestinal wall. Usually such nodes are painless, mobile, small in size, easily displaced by finger examination. Such a node can be confused with melanoma in the initial stages. With such a suspicion, it would be advisable to make a wide excision of the node within healthy tissues and a histological study of the drug, which, unfortunately, is not always done in practical medical institutions.Undoubtedly, with any excision of hemorrhoids, their subsequent histological examination should be a mandatory rule.
Fissure of the anus. Fissure of the anus (or anal fissure) is a widespread disease of the anal area, second only in frequency to hemorrhoids and paraproctitis [A.M. Aminev, 1969]. In the structure of proctological diseases, anal fissure occupies the third place (11.7%) after colitis and hemorrhoids [V.D. Fedorov, Yu.V. Dultsev, 1984].
In the clinic of anal fissures, there are symptoms similar to malignant tumors of the anal canal: pain in the anus, aggravated by bowel movements, stool, blood in the feces, constipation, spasm of the anal sphincter.Pain with fissures in the anus is often very pronounced, forcing patients to take analgesics and drugs. In their intensity, these pains resemble pain in malignant tumors of the anal canal. Anal fissures most often affect women – more than 60% of all patients [V.D. Fedorov, Yu.I. Dultsev, 1984].
An anal fissure is most often located in the area of ​​the posterior commissure (according to A.M. Aminev, 1979, – in 91.5%), less often – on the anterior wall, and very rarely – on the lateral ones.Anal fissures usually have a characteristic macroscopic appearance. They have a longitudinal direction, their length, on average, about 10 mm, width – about 1-2 mm, depth – about 2-3 mm. As a rule, the fissure is localized in the area of ​​linea mucocutanea, crossing it and going with its distal end on the skin, and with its proximal end on the mucous membrane. Usually a crack does not gap, its edges are in a collapsed state. With the long-term existence of the cracks, its edges thicken, thicken, and turn yellow. Such a crack takes the form of a trophic ulcer, its edges do not collapse, it has a gaping appearance.At the distal, less often at the proximal edge, a dense protrusion is formed, the so-called border tubercle.
With a digital examination, a pronounced spasm of the anal sphincter is determined, and with long-term cracks, a circular, cartilaginous consistency is determined – pectenosis, which is a consequence of fibrous degeneration and compaction of the anal muscle ring.
Thus, the anal fissure has a vivid clinical picture, a characteristic macroscopic appearance and localization.
Malignant tumors of the anal canal have a number of symptoms similar to anal fissures: burning pain in the anus, bleeding from the anus, constipation, spasm of the sphincter. However, in case of sharp and short-lived cracks, their macroscopic appearance is so typical that it makes it possible to fairly accurately differentiate from cancerous ulcers. Cancer ulcers most often have a rounded shape, significant infiltration around them (ulcerative-infiltrative form), their edges, as a rule, do not close. Malignant tumors do not have a favorite localization on any wall of the anal canal; they affect all walls of the anal canal approximately equally.
With a digital examination, and with that, and with another disease, spasm of the sphincter is determined. However, pectenosis in malignant tumors, of course, does not have time to develop due to the transient nature of the disease.
With the long-term existence of cracks, when their edges acquire a dense, callous appearance, the cracks gap and do not subside, acquire the appearance of a trophic ulcer. In this case, such cracks can be difficult to macroscopically distinguish from cancerous ulcers. It cannot be excluded with the long-term existence of cracks and their malignancy.In this case, taking smears – prints for a cytological study, as well as a biopsy of the edges of the ulcer, allow you to establish the final diagnosis.
Anal papillae, anal fringes, papillitis. The anal papillae are the remnants of the embryonic anal membrane, which in the fetus separates the blindly ending primary intestine and the ectodermal funnel – the proctodeum. At the end of the 8th week of intrauterine development, the anal membrane is perforated, thus restoring the continuity of the gastrointestinal tract.At the base of the membrane, a circular wound remains, which, covered with stratified squamous epithelium, turns into a white Hilton line. And the remnants of this membrane are covered with stratified squamous epithelium and turn into anal papillae. A.M. Aminev (1973) in his works calls them carunculae cloacales. He distinguishes between the internal anal papillae, which are located above the Hilton’s line, and the external anal papillae, which are located below. In foreign literature, external anal papillae are usually called skin tags, anal tabs, anal tags, Molluscum pendulum (anal fringes) and are considered not embryonic remnants, but hypertrophic changes in the mucous membrane of the anal canal and skin as a result of, for example, chronic inflammation.
Normally, anal papillae can be detected by finger examination, they are defined as dense, rounded, painless formations, 2-4 mm in size (like a millet grain). With ano- and rectoscopy, they are defined as small cone-shaped formations on a broad base, sometimes on a narrow stem.
Unchanged anal papillae do not cause subjective sensations. However, a number of reasons (pregnancy, childbirth, maceration of the anal area, hard or sedentary work) lead to inflammation, enlargement, hypertrophy of the anal papillae.Hypertrophied anal papillae on the pedicle resemble polyps in appearance, therefore, in this case, some authors call them fibrous polyps, pseudopolyps, papillomas [S.A. Holdin, 1977]. Inflammation of the papillae is called papillitis.
Such polypoid formations are undoubtedly difficult to distinguish from polypoid forms of anal cancer, melanomas, or other malignant tumors of the anal canal. And the malignancy of such hypertrophied papillae, although rare, does occur. Obviously, hypertrophied, ulcerated anal papillae must be removed in order to prevent their malignant transformation.A thorough histological examination will help identify their malignancy in the early stages.
The identification of unchanged anal papillae should be considered the norm, they cannot be removed, their malignancy occurs no more often than the rest of the epithelium of the anal canal. Even hypertrophied anal papillae are rarely malignant [A.M. Aminev, 1973]. Unaltered anal papillae are not precancerous. Hypertrophied, often inflamed, ulcerated papillae have an increased risk of malignancy.
Genital warts. Pointed warts in the anal area are papillary growths in the form of “cauliflower”, sometimes “cock’s comb”. They have a wide base, sometimes in the form of a leg. The surface of warts during maceration of the epithelium has a white color, if it is eroded, it acquires a bright red color, bleeds easily when touched. Sometimes anal warts reach significant sizes, acquire a lobular appearance. These condylomas are soft in consistency.Often they have an unpleasant odor (especially if hygiene measures are not followed), due to the decomposition of serous-purulent exudate, which accumulates and decomposes between the lobules. Warts do not spread deep into the anal canal.
Their etiology has nothing to do with tumors, they are caused by viruses; the disease has a certain contagiousness. They should be distinguished from specific papules – wide warts, with which they have nothing to do.
The characteristic localization of genital warts: in the perianal region, at the entrance to the vagina.The peculiar macroscopic appearance of warts makes it quite easy to distinguish them from exophytic cancers localized in the anal ring. It is enough to see them several times in order not to be confused with anything. In difficult cases, with the slightest doubt about the diagnosis, it is necessary to biopsy the formation.
Warts are not a precancerous disease. Even giant condylomas of the perianal region, the so-called Buscke – Lowenstein tumors, occurring with destruction of the perianal region, are benign.However, with the prolonged existence of giant warts, chronic irritation of the skin of the perianal region, maceration, inflammation, their malignancy is possible. Therefore, it is necessary to remove genital warts, sanitize the surrounding tissues.
Specific inflammation of the anal area (tuberculosis, syphilis, HIV infection, actinomycosis, etc.). Among the rare diseases with which it is necessary to differentiate malignant tumors of the anal canal are syphilis, tuberculosis, actinomycosis. By themselves, these diseases are relatively rare, the proctologist has to meet with them even less often, however, they must be remembered and known in order to skillfully differentiate malignant tumors of the anal canal.
Syphilis. Anal syphilis was very rare in the past. Now, due to the growth of sexually transmitted diseases and the spread of anal sex, this has ceased to be casuistry. The perianal zone and anal canal can be affected by syphilis in the primary, secondary and tertiary periods. Syphilitic ulcers in this area have been described as far back as the 19th century.
a) Primary syphiloma (or hard chancre). In the anal folds, the chancre takes the form of a crack, which seems to be hidden between the enlarged edematous folds.If the folds are pulled apart, then an ulcer with even edges, sometimes saucer-shaped, with a cartilaginous bottom that looks like raw meat, sometimes with a peculiar mirror shine, will be found. Most often, the ulcer is covered with a grayish-yellow bloom (the color of “spoiled bacon”, in the words of old authors), after removing this plaque, the above picture will be revealed. The ulcer is mobile, painless, does not bleed. Its dimensions are from 2-3 mm to, rarely 6 cm, usually about 1.5-2 cm. Inguinal lymph nodes are enlarged. It should be emphasized that complaints with a hard chancre of the anus are very minor: weeping of the anus, soiling of linen, there is no pain syndrome.Thus, the hard chancre has a peculiar clinical picture that sharply differs from tumor ulcers. The macroscopic picture is different. In addition, the painlessness of the chancre and the absence of bleeding are pathognomonic in the differential diagnosis, in contrast to the cancerous ulcer, when the pain syndrome is strongly expressed and the bleeding of the tissues is expressed. Serological tests also help in differential diagnosis.
b) Vegetative papules (or wide warts). These formations can be found in the perianal region in the secondary period of syphilis.They look like bumpy, uneven vegetative papillae, covered with a grayish bloom. At their base there is a dense infiltration. A detailed history, a thorough examination of patients for the detection of other skin manifestations of secondary syphilis (so-called syphilis), serological reactions (Wasserman’s reaction, etc.) make it possible to suspect syphilis and direct the diagnosis in the right direction.
c) Gummy ulcers. In the tertiary period of syphilis, gummy ulcers of the perianal region and anal canal are rare, but they can occur.Their characteristic features are the extraordinary density of the walls, extensive perifocal infiltration. The bottom of the gummy ulcer has a dense consistency, covered with a dark brown coating; after removing this crust, the bottom of the ulcer is exposed. The bottom is shallow, the edges are even, abruptly cut off. After the ulcer heals, scars remain, leading to a progressive narrowing of the anus, if the gum was located in the anal canal area. Often, the gummy process in the anal canal proceeds in isolation, without affecting other organs, which complicates differential diagnosis.It should be emphasized that the differential diagnosis of gummy ulcers of the anal canal presents great difficulties, here anamnesis and positive results of serological reactions are very helpful.
In the conclusion of this section, it should be noted that for the differential diagnosis of syphilitic lesions of the anal canal area, a carefully collected history, a certain alertness of the doctor, and a mandatory study of the patient’s blood for serological reactions are important.
The perianal zone and the anal canal can also be affected by other sexually transmitted diseases, namely: gonorrhea, chancre (chancroid), the fourth venereal disease.All of them are extremely rare in the practice of a proctologist. Obviously, there is no need to give here their detailed clinical picture. It is only necessary to remember about the possibility of affecting this zone with venereal diseases; a carefully collected anamnesis, a careful examination of the patient allow one to suspect a venereal disease and direct the diagnosis in the right direction.
Lesion of the anal area with AIDS. The defeat of the intestine in AIDS is often, takes 3rd place after the defeat of the nervous system and bones.There are lesions of the anal canal. AIDS manifests itself in the form of Kaposi’s sarcoma and other oncological diseases, including in the form of squamous cell carcinoma of the anal canal [P.R. McNally, 1999]. The defeat of the perianal region macroscopically looks like warty formations (cancer). There is evidence that HIV is a risk factor for anal cancer. One of the favorite places for the localization of HIV infection is the mucous membrane of the rectum and anal canal, which explains the frequent incidence of AIDS among homosexuals.Considering the catastrophic growth of HIV infection in our country (the plague of the “XXI century”), the proctologist must be ready to face this disease.
Tuberculosis. Tuberculosis can cause damage to the skin of the perianal region and the epithelial lining of the anal canal, although it is very rare here. The lesions of this zone differ in the form of: lupus, ulcers and fistulas, warty lesions.
a) Lupus erythematosus is the most rare form of lesion. It is characterized by the appearance in the thickness of the skin of specific tubercles – lupus (from “lupus” – “lupus”) a few millimeters in size.The tubercles are brownish-pink in color, have a soft elastic consistency; in a later stage, they merge into a single conglomerate.
b) Tuberculous ulcers are the most common form of tuberculous lesions of the anal zone. The ulcers have uneven, scalloped edges, the bottom is covered with plaque, upon removal of which an uneven bottom that bleeds easily when touched is exposed. Fresh yellow nodules can be found at the bottom of the ulcer and around it. Ulcers are sharply painful. In smears from purulent discharge of ulcers in 70-90% of the study, M.tuberculosis.
c) The warty form of tuberculosis in the anus is less common than the defeat of other areas of the skin. It is a dense flat plaque, on the surface of which warty growths and massive horny layers of gray are visible. The surface of the formation is uneven, rough. Around the warty growth there is usually a characteristic violet-red border. Patients complain of profuse oozing in the anus.
For the differential diagnosis of tuberculosis lesions, it is necessary to carefully collect anamnesis, since these patients do not have isolated tuberculosis only in the anus.If tuberculosis is suspected, a bacterioscopic and bacteriological examination of the exudate should be performed, as well as tuberculin reactions should be performed. A careful examination of the anus will reveal specific features that are characteristic only of tuberculous lesions of the skin and mucous membranes.
In difficult cases, a morphological (cytological and histological) study of pathological formations is undoubtedly necessary.
Actinomycosis. Actinomycosis of the anus is an extremely rare disease of fungal etiology.It is characterized by the formation in the area of ​​the anus and adjacent tissues of an extremely dense (“woody”) lumpy infiltrate, on which there are several small fistulous openings, from which liquid pus is released, in which you can visually detect yellowish grains – these are druses of the fungus. The final diagnosis is made on the basis of microscopic examination and detection of actinomycetes, as well as allergic skin tests with actinolysate.
Crohn’s disease. According to recent studies, Crohn’s disease can affect any part of the gastrointestinal tract with the formation of single or multiple foci [V.D. Fedorov, Yu.V. Dultsev, 1984]. Anal lesion occurs in this case in 75-80% of patients. In some cases, only the anal form of Crohn’s disease occurs, without other localizations of the pathological process. Macroscopically, the disease looks like anal fissure ulcers. Their characteristic feature is different localization, multiple nature, slight soreness, lethargy of granulations, absence of rigid scar edges and sphincterospasm. Fistulas are often formed, surrounded by infiltrated tissue, sometimes in the form of a sluggish ulcer, localized in the anal canal and passing to the skin of the perineum.There may be various perianal abscesses. Malignancy is rare. In differential diagnosis, attention should be paid to the phenomena of ileocolitis in patients with Crohn’s disease. Taking material for histological and cytological examination will clarify the nature of the disease.
Radiation ulcer. When the pelvis is irradiated for various diseases (cervical cancer, rectal cancer, etc.), a dose exceeding the tissue tolerance can enter the anal canal and perianal region.In this case, in the irradiated area immediately after irradiation or after a certain period of time, early (in the first 3 months after irradiation) or late (later 3 months) radiation ulcers are formed [V.I. Knysh, 1997]. A radiation ulcer looks like a defect in the mucous membrane, with undermined edges, with purulent-necrotic tissue detritus at the bottom. Radiation ulcers are characterized by periodic or persistent hemorrhages. Radiation ulcers of the anal canal and rectum are located, as a rule, on the anterior wall of the intestine. For late radiation ulcers, a torpid course with a sluggish inflammatory reaction is characteristic.With the long-term existence of radiation ulcers, their malignancy cannot be ruled out. The decisive method in the diagnosis of a malignant process is a biopsy of the edges of the ulcer with subsequent morphological examination.
The syndrome of solitary rectal ulcer (SSNPU) is a chronic benign disease that is rare in the classical form. The exact etiological factors of SSNPK are unknown and need to be clarified. Many authors note the frequent combination of SSNPK with rectal prolapse, explaining the formation of ulcers by prolapse of the mucous membrane, tissue ischemia and constant trauma.However, there are obviously other etiological aspects of the onset of this syndrome. Clinical manifestations of SJAPC: the release of mucus and blood from the anus, pain in the anus, defecation disorder in different variants (constipation, diarrhea, tenesmus). The disease most often occurs at the age of 20–40 years, and most often affects women, especially with rectal prolapse. With a digital examination immediately behind the sphincter, in the anal transition zone or above it, thickening and pathological mobility of the mucous membrane and the presence of an ulcer are determined on the anterior wall.Rectoscopy reveals an ulcer with characteristic features: a superficial ulcer, “stamped”, gray-white, with a soft, “viscous” base. Around it there is an annular zone of hyperemia without clear boundaries. The ulcer is most often round or oval, rarely linear and crescent-shaped. Its dimensions are from a few millimeters to several centimeters. Sometimes not one but several small aphtoid ulcers can be seen. Ulcers are located at a height of 4–12 cm from the anal ring, on the anterior wall. The mucous membrane around the ulcer is mobile; when the patient strains, the affected area of ​​the mucous membrane can enter the rectoscope.However, with the prolonged existence of an ulcer, the development of fibrosis and intestinal stenosis is possible. Solitary ulcers are not malignant even with their prolonged existence. The histological picture of the SSYAPC does not have any pathognomonic features, although it has been studied in great detail.
Cryptitis is an inflammation of the morgan crypt. The Morgan crypts are located between the Morgan ridges, that is, in the anal canal area. At the bottom of the crypts, the mouths of the anal glands open. Inflammation of the crypt can go to the sphincter area. The main symptoms of cryptitis: pain in the anus, aggravated by bowel movements, blood in the stool, sometimes itching in the anus.When examining the anal area, there is hyperemia and edema in that part of the anal ring, on which the inflamed crypt is located. Per rectum: swelling of the anal canal, soreness on examination, on the finger – pus and fibrin, less often – blood. Rectoscopy: hyperemia and edema of the affected crypt and tissues around it, fibrin flakes, pus is released when the crypt is pressed. General manifestations: hyperthermia, malaise, weakness. Differences from malignant tumors of the anal canal: usually acute onset, pronounced local inflammation, general temperature reaction; with anoscopy – hyperemia and edema of the crypt, no ulceration and exophytic tumor component.Chronic, long-term cryptitis is more like an infiltrative form of anal cancer. In these cases, cytological examination of smears from the affected crypt will reveal the presence of a tumor process.
Benign tumors. In the perianal region, in the anal canal area, benign formations similar to malignant tumors of the anal area may occur. These include lipomas, fibromas, leiomyomas, etc. Usually, a benign tumor is a round formation, on a pedicle, covered with unchanged mucous or perianal skin, without infiltration and inflammation of the surrounding tissues.It should be emphasized that benign neoplasms in the anal area are subject to local excision followed by histological examination of the removed specimen. This will establish a definitive diagnosis.
Other diseases. Other diseases (rectitis, dysentery, anal itching, paraproctitis, etc.) are possible, in which symptoms similar to the clinical manifestations of anal cancer occur: pain in the anus, blood in the stool, etc. However, a careful examination of the anal area, digital examination of the rectum and vagina, rectoscopy, etc.allow to exclude tumor lesion of the anal canal.
These are the main diseases with which one should carry out the differential diagnosis of malignant tumors of the anal canal. The key point in the differential diagnosis of malignant tumors of the anal canal should be considered a carefully collected history, oncological alertness, mandatory thorough digital examination of the anal canal and rectum, rectoscopy, morphological examination (cytological and histological) of any suspicious pathological focus in the anal zone.

1. Aminev A.M. Guide to proctology. – Kuibyshev, 1965, 1971, 1973, 1979. – T. 1–4.
2. McNally P.R. Secrets of gastroenterology. – Moscow; St. Petersburg, 1999. – 1024 p.
3. Knysh V.I. Colon and rectal cancer. – M .: Medicine, 1997 – 304 p.
4. Knysh V.I., Timofeev Yu.M. Malignant tumors of the anal canal. – M., 1997. – 304 p.
5. Fedorov V.D. Rectal cancer. – M.: Medicine, 1987 .– 320 p.
6. Fedorov VD, Dultsev Yu.V. Proctology. – M.: Medicine, 1984.–384 p.


Tumors of the anus

The anus (anal canal) is the end section of the colon and digestive tract. The anal canal is distinguished as an independent section of the digestive tract, due to the peculiarities of the anatomical structure, specific functions, the most important of which is the retention of feces and gases.

The length of the anal canal varies depending on the individual characteristics and physiological state of the anal sphincters, gender, age, weight and height of patients and averages 3-4 cm.Despite the small size of the anal canal, malignant tumors that arise in it have the most diverse histological structure. Tumors of the anal canal are a relatively rare disease and their frequency is 1-6% of all malignant tumors of the rectum.

In the clinical classification of patients with tumors of the anal canal, a system is used in which the presence of a primary tumor and its size, the presence or absence of lymph node involvement and distant metastases are assessed.

Depending on the spread of the tumor process, the stage of the disease is specified – from 0 to IV, which is important for planning treatment and determining the prognosis (outcome) of the disease.

Squamous cell carcinoma

It is the most frequent and most typical tumor and accounts for almost half of all tumors of the anal canal. Squamous cell carcinoma occurs in women 4-5 times more often than in men. The reason for this predominance is chronic diseases of the anus in women, possibly, the peculiarities of sexual activity, infection with the human papillomavirus.


Squamous cell carcinoma of the anal canal has bright symptoms. It is important to note that asymptomatic patients practically never occur.

The most frequent and earliest symptom of squamous cell carcinoma of this localization is an admixture of scarlet blood in the feces (more than 90%) of patients. It should be noted that such a symptom is often present in hemorrhoids, which disorients patients and doctors. Less often, such discharge from the anus as mucus, pus is observed.

Another common symptom in squamous cell carcinoma of the anal canal is pain in the anus (in 85% of patients). At the onset of the disease, pain occurs during bowel movements (bowel movements), gradually intensifies, becomes permanent, becomes intense, which often (in 25%) forces patients to take painkillers.

Less common symptoms such as constipation, tenesmus (urge), foreign body sensation in the anus.

An increase in body temperature is observed in almost 20% of patients with the disintegration of the tumor and severe inflammation around it.A third of patients with a widespread process have symptoms such as weakness, weight loss, etc.

Saucer-shaped and ulcerative-infiltrative forms prevail, less often polypoid and diffuse-infiltrative forms of cancer growth.

The size of the tumor ranges from 0.5 to 15 cm and in a third of patients is more than 5 cm in diameter. It should be emphasized that in more than 30% of patients, the lower edge of the tumor is determined by eye during a routine examination of the anus. Despite the vivid clinical picture, simplicity and availability of diagnostics in a significant part of patients, there are frequent cases of diagnostic errors.During the initial visit to a doctor, in more than 30% of cases, an erroneous diagnosis is made (paraproctitis, anus fissure, inguinal or femoral hernia, polyp, papilloma, perineal ulcer, prostate adenoma).

With regard to these erroneous diagnoses, patients are examined and treated for a long time by surgeons, therapists, gynecologists, urologists and even by proctologists and oncologists. In some patients, inadequate operations are even performed. The main causes of diagnostic errors are:

  • inattentive interviewing of patients,
  • no digital rectal examination,
  • no oncological alertness,
  • untimely visit to the doctor.

Only about 30% of patients see a doctor within an acceptable time frame – in the first month after the onset of the initial symptoms of the disease. Almost 40% of patients visit a doctor six months later, and 5% – a year after the first symptoms appear.

Late referral is usually explained by prolonged self-medication for hemorrhoids, as well as a feeling of false bashfulness. In this regard, many patients are admitted to the clinic with advanced stages of the disease.

Squamous cell carcinoma of the anal canal has the properties of invading the surrounding organs and tissues and metastasizing to the lymph nodes (in 35% of cases).Most often, the inguinal and peri-rectal lymph nodes are affected. Distant metastases (to the lungs and liver) are detected in 15% of patients.

Treatment of squamous cell carcinoma

The main methods of anal cancer treatment are surgical and radiation methods. When using only the radiation method, the 5-year survival rate is about 7%, and one surgical method is almost 40%. The relapse rate in the first group is 85%, and in the second – 62%. Thus, the operation is a more radical method of treating squamous cell carcinoma of the anal canal in comparison with the radiation method.

The most promising is the method of combined treatment of anal cancer using radiomodifiers (local microwave hyperthermia). This technique allows 25% of patients to undergo organ-preserving treatment (i.e., without removing the rectum). In this case, the 5-year survival rate of patients is 75%, and relapses occur 4 times less often than after surgery and 5.5 times less often than after radiation treatment.

A more effective and gentle method of treating squamous cell carcinoma of the anal canal is the use of radiation in combination with local hyperthermia, chemotherapy (cisplatin, bleomycin) and antioxidants (retinol, vitamin E, pentoxifylline, ascorbic acid, cytochrome).In the absence of a pronounced effect (reduction of the tumor by less than 75%), the operation is performed.

This method of treatment allows to achieve complete disappearance of the tumor in 60% of patients, and the 5-year survival rate reaches more than 70%.

Thus, the most effective is the method of thermoradiochemotherapy of squamous cell carcinoma of the anal canal. It is well tolerated by patients, does not give serious complications, and allows organ-preserving treatment in a significant part of patients, i.e.e. to preserve the anal sphincter and the natural passage (passage) of feces.

Melanoma of the anal canal

They constitute about 18% of all malignant tumors of the anal canal and almost 1.5% of melanomas of all localizations.

The clinical picture and diagnosis of melanomas of the anal canal is similar to those of squamous cell carcinoma of this zone. Of the diagnostic procedures, one should especially focus on biopsy (taking a piece of the tumor for research). It is common knowledge that melanoma biopsy is strictly contraindicated! However, almost all patients undergo tumor biopsy before hospitalization, which significantly worsens the prognosis (outcome) of the disease.

Melanomas of the anal canal, as a rule, are pink, and not black, as on the skin, are not pigmented to the eye. Biopsy promotes the generalization of the tumor process and worsens the long-term results of treatment.

At the slightest suspicion of anal canal melanoma, a less traumatic, but diagnostically no less informative method should be used – cytological examination of smears taken from the tumor surface.

Locally advanced forms in melanoma of the anal canal are much less common than in squamous cell carcinoma, but melanomas of this localization are distinguished by early generalization of the process and distant metastasis.

Local recurrence after local excision of small melanomas is rare. This allows for small exophytic (outward-growing) melanomas, especially on the legs, to use a sphincter-preserving method of treatment – cryodestruction (low temperatures).

When the size of the tumor is less than 3 cm, the use of cryodestruction is an adequate, radical method of treatment. At the same time, there is no local recurrence in these patients.

Long-term results of treatment for melanomas of the anal canal are mostly unsatisfactory: 5-year survival rate is 17%.

Non-epithelial malignant tumors of the anal canal

Make up about 8% of all malignant tumors of the anal zone and have the structure of leiomyosarcoma, rhabdomyosarcoma, schwannoma, etc.

All these tumors are not very sensitive to radiation and chemotherapy.

Operation (abdominal-perineal extirpation {removal} of the rectum) is a radical method of treatment.

Local excision of such tumors is not an adequate method of treatment and leads to recurrence (re-growth) of the tumor.

The overall 5-year survival rate is about 35%.

90,000 Signs of cervical cancer

  1. Vaginal discharge containing blood. It can be pinkish or brownish inclusions that are released outside of your period. Bleeding can also occur in women who have already completed their menopause.
  2. Contact bleeding. One of the main symptoms of cervical cancer (CC) is considered to be a small amount of blood during or immediately after intercourse.This is due to the fact that such tumors bleed easily with mechanical damage.
  3. Painful intercourse. Patients often complain that intercourse has become unpleasant and even painful for them.
  4. Changes in the nature of menstruation. Many women pay attention to the fact that menstruation has become longer and more painful, at this time a little more blood is released.
  5. Discharge of pus. With the growth of the tumor, the process of decomposition of its tissues can begin, which causes a discharge containing pus, often with a strong unpleasant odor.
  6. Watery discharge. Due to the collapse of the lymphatic capillaries adjacent to the epithelial layer, a watery and rather abundant discharge may begin.
  7. Swollen lymph nodes. In the second stage, cancer spreads to nearby lymph nodes, causing them to swell and sore.
  8. Associated inflammatory diseases. Often a malignant tumor on the cervix causes inflammatory diseases: cervicitis or colpitis with all the characteristic symptoms.

If any such signs of cervical cancer (cervical cancer) appear, you should consult a doctor and diagnose. Perhaps the symptoms indicate some other disease, but, in any case, they clearly indicate problems with the female reproductive system.

Later symptoms of cervical cancer (CC)

If the disease was not diagnosed in time and adequate treatment was not started, then other symptoms may appear associated with an increase in the primary tumor, invasion into nearby tissues, as well as the spread of metastases.Let’s see what symptoms of cervical cancer (CC) appear at later stages:

  • Pain. The cervix has practically no nerve endings, so soreness appears only at later stages, when the tumor grows and affects the parametric tissue and reaches the nerve plexuses in the sacral region. Because of this, pain can be given to the lower back, rectum, perineum or thigh.
  • Swelling of the legs. Since cervical cancer (CC) manifests itself in this way not too often, this symptom is rarely paid attention to.It occurs when the lymph nodes are squeezed.
  • Problems with urination. Similar symptoms of cervical cancer (CC) are noted by most women. They appear when the bladder and ureter are damaged. It can manifest itself with a whole complex of similar symptoms, primarily difficult, and in the later stages – and impossible urination. Sometimes women also note another symptom: frequent urination. It is associated with associated inflammation of the bladder or kidneys.Blood in the urine may also appear, accompanied by painful urination.
  • Difficulty with bowel movements. Often, the primary tumor invades the rectum, causing a number of problems with bowel movements. Frequent signs of cervical cancer (CC) are constipation, sometimes intestinal atony appears. Another manifestation is the presence of blood in the stool, in the form of red veins. Fistula formation is characteristic of the later stages.
  • General characteristics. Simultaneously with the symptoms listed above, a general deterioration of the condition may appear: exhaustion, weakness, lack of appetite, asthenia.All these signs of cervical cancer (CC) are associated with the intoxication of the body with the decay products of a cancerous tumor.

90,000 How to treat hemorrhoids – blog of the ON Clinic medical center

How are hemorrhoids removed with the Surgitron radio scalpel?

A person suffering from anal bleeding, pain syndrome and prolapse of hemorrhoids is interested in the only question: how to remove hemorrhoids? Fortunately, excision of a hemorrhoid is nowadays possible without a scalpel.

Removal of hemorrhoids without surgery, using innovative minimally invasive techniques, has a number of advantages:

  • low pain;
  • minimal tissue trauma;
  • absence of rough postoperative scars;
  • outpatient treatment;
  • short recovery period.

It may seem to uninformed people that the removal of hemorrhoids and fallen out nodes by non-surgical methods is ineffective.That the cost of such treatment is unreasonable due to the high likelihood of relapse. That there is nothing better than a surgical scalpel. However, this is not at all the case. Yes, with some methods, the risk of relapse persists. But such a method as excision of the external hemorrhoid with a radio scalpel can sometimes work miracles. And most importantly, it is effective even in advanced cases.

The radio knife successfully performs excision of hemorrhoids of internal and external localization.At an individual consultation, the proctologists of the ON Clinic medical center are ready to talk about how to get rid of hemorrhoid nodes and what method to apply at one stage or another of the disease.

Radio wave excision of a hemorrhoid node

The principle of vaporization will tell you how to remove hemorrhoids using a radio scalpel. It is he who is the basis for the effect on biological tissue of high-frequency currents. Vaporization means evaporation. How is a tight outer knot removed by heat and evaporation? A targeted radio wave evaporates a piece of tissue on the leg of the knot.This is how an incision is formed, along the line of which the node is cut off from the surrounding tissues. At the same time, healthy tissues do not evaporate: they simply move apart, as if cut with a scalpel. At the same time, currents cause coagulation of small vessels, which minimizes bleeding, which usually accompanies any surgical action.

In addition to the question of the level of effectiveness, patients are interested in how much it costs to remove the hemorrhoid with Surgitron. And in general, how much does it cost to remove hemorrhoids in Ukraine?After all, any innovation is not unreasonably associated with high cost. Indeed, radiosurgery, like laser therapy, is currently an elite trend in medicine – and therefore quite expensive. But the final price for the removal of external hemorrhoids with high-frequency current is formed depending on the stage of hemorrhoids, the number of complications – and, accordingly, on the amount of work to be done. Thus, this is a rather individual value.

How to remove the nodes of hemorrhoids, the treatment is less traumatic and to achieve a stable remission? Proctologists know about it.Of course, the best way to protect yourself from hemorrhoids and its painful complications is prevention. It consists in a healthy lifestyle, positive thinking, reasonable physical activity and dietary nutrition in order to normalize the stool. But if you have let the disease to your body – do not despair, but look for a way out of the impasse. And he is always there. And the removal of the hemorrhoid with the “Surgitron” radiofrequency apparatus, like radical surgical measures, remains effective at all stages of the disease.