Rectal examination
A sixty-something year old man had history of change in bowel habit since Ramadan last year. He had put up with the difficulty in passing motion and passage of mucus with the stools for some time, thinking that it would go away. Everyday, he went to toilet with the hope that it would be normal stool today. But the stool was just as difficult to pass. All he could manage was mucus and a small amount of blood. Once in every few days, he passed some liquid stools. Now that he was having abdominal pain, he came to see a doctor.
Upon hearing the history, the doctor feared the worst. The diagnosis was half-made even before examining the patient. He probed for other medical history before setting the patient on the examination couch. He went through the preliminary general examination looking for signs of anaemia and jaundice; fortunately neither was present. The abdominal examination was unremarkable. The liver was not enlarged; and there was no sign of abdominal distension or bloating.
At last he came to the crunch. This he could not, no, must not miss. Gently he turned the patient over to the left and exposed the anus. Gloving up, he reassured the patient and applied a blob of lubrication gel on the right index finger. Pressing the tip of the finger against the edge of the anus, he waited while the anus relaxed and allowed the finger to slip into the opening. His worst fear was confirmed.
The examining finger encountered a solid lump in the rectum. It was huge and it was attached to the rectal wall by a broad base. The base was at the “6 o’clock” position, he noted, meaning that it was at the back wall of the rectum. “12 o’clock” meant the front wall of the rectum. The tip of the finger couldn’t feel the upper border of the lump. It was extending too high up. He nudged the base of the lump… at least it was able to move. “Good, not stuck to the structures beyond the layers of the rectum”, he thought.
With the finger still in the rectum, “Teran sikit”. The patient contracted the anal sphincter muscle. He felt them squeeze his finger. OK, they were working well. Satisfied that he had found out all that he wanted to know, he slipped the finger out and de-gloved. Some laxatives were prescribed to induce diarrhoea (bowel preparation) so that the colon would be ready for colonoscopy the next day.
What he found was worse than expected:
The rectal tumour. Looking angry.
Bernard, so what will happen to this patient now? Pretty scary stuff.
All very grisly. I look through my fingers.
A yearly Colonoscopy is encouraged to all over 50 here in sg. Colon cancer is on the rise. What will happen to this patient?
Judy, what happens to patients once diagnosed with rectal cancer depends on the way it presents. Usually a CT scan is performed, the patient is worked-up for general medical fitness and an operation is planned.
The treatment methods for rectal cancer include:
Capt Picard, boldly go where no man has gone before.
liling, the recommended screening for average-risk individuals is every TEN years starting from the age of 50 years.
You are right… colorectal cancer is rising. Colonoscopy not only detects early cancer, it also prevents cancer by removal of polyps.
What’s the survival rate once the tumour is removed? A fren of mine’s dad was diagnosed with colorectal ca n the ca removed a couple of years back. He’s fine now but has difficulty controlling his defecation.
Hmm… it’s so embarassing to go for a rectal checkup.
SK, it depends on the stage of the disease. The stage means the extent to which the cancer has spread.
As a general rule:
Therefore, early diagnosis means better survival.
Note about cancer survival statistics: 5-year-survival is an objective way to quantify the prognosis of patients, i.e. what is the future outcome of the disease. So a higher percentage of patients live for 5 years after the diagnosis means the prognosis is better.
Generally, colorectal cancer has a better prognosis (if detected early) than most other cancers in the gastro-intestinal tract. Therefore, early detection is something definitely worth trying to achieve.
jonzz, it the body that God created for us. Everyone has the same manufacturer. Sometimes the model is a bit different but there’s nothing so be ashamed about our body.
Wah so scary, wanna faint already…
i dont want the patient to die…
Colonoscopy is no fun but it truly is worse in your imagination than it is in real life. The one that one really has to be “afraid” of is barium enema, dat one is worse.
The pathological diagnosis has come. It’s confirmed to be an adenocarcinoma.