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Clinical Summary

Rectal cancer is often asymptomatic, especially in early stages. It may also present with rectal mass, pain or bleeding, pain with passage of stool, anemia, or weight loss. More than 90% of cases occur in people over 50 years, and risk increases with age. Males are affected more commonly than females. Other risk factors include inflammatory bowel disease, family history of colorectal cancer or polyps, hereditary cancers such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch syndrome), low-fiber diet, and tobacco and alcohol use. There are multiple types of rectal cancers, with adenocarcinoma being the most common.

Management and Disposition

Management of rectal cancer is beyond the scope of this book. In the emergency department, if active bleeding is present, place two large-bore IVs and apply pressure to any visible bleeding lesions. Obtain abdominal x-rays if symptoms of bowel obstruction (vomiting, abdominal pain, obstipation) are present. Unstable patients and those with active bleeding should be admitted. For those with the incidental finding of rectal mass or less severe symptoms, consider computed tomography to further evaluate. If stable for discharge, it is imperative to ensure rapid outpatient follow-up with a gastroenterologist for colonoscopy and further evaluation.

Pearls

  1. Colorectal cancer is the 3rd most common cancer in adults in the United States. Rectal cancer accounts for one-third of all colorectal cancers.

  2. Rectal polyps are potentially precancerous. All patients with polyps identified in the emergency department should be referred for rapid outpatient gastrointestinal follow-up regardless of symptoms.

FIGURE 9.67

Rectal Cancer. Signet ring cell carcinoma of the rectum. (Photo contributor: Christopher L. Stark, DO.)

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