rectal cancer symptoms. rectal bleeding. dr. anton titov, md: hello! today we are with dr. thorbjorn holm. he is professor of surgery at the department of surgery and molecular medicine at karolinska institute in stockholm, sweden. professor holm has made significant advancements in the surgical treatment of rectal cancer. dr. holm advanced rectal cancer treatment methods in difficult situations with recurrent cancer. professor holm published over 280 scientific articles on colorectal cancer and in on rectal cancer symtpms and treatment. he wrote several textbooks on treatment of rectal cancer. dr. holm, hello and welcome! dr. anton titov, md: let's start the conversation about rectal cancer with a general question. how do people present with rectal cancer? what are the symptoms of rectal cancer? when somebody should be concerned about rectal cancer symptoms? because a big problem for cancer diagnosis in general and for rectal cancer in particular is late diagnosis. so the earlier rectal cancer symptoms are recognized and correct diagnosis is made, the better it is for patient. you have forty years of surgical experience treating rectal cancer. you are an international authority on rectal cancer symptoms, diagnosis and treatment. what are common presenting symptoms of rectal cancer? dr. torbjorn holm, md (rectal cancer surgeon, karolinska institute, stockholm): the most important symptoms of rectal cancer are a combination of rectal bleeding and altered bowel habits. so if you have only a slight red bleeding on the toilet paper or in the toilet, it may not be rectal cancer. it could be the hemorrhoid or it could be anal fissure. but if you have a bleeding from the anus, you should always have an examination. because even a slight bleeding from anus could mean a symptom of rectal cancer. so my advice is this. if you have a rectal bleeding always have an examination by the doctor. examination by the doctor on suspicion of rectal cancer symptoms has to include digital examination of the rectum. proctoscopy - visual examination of the rectum - should also be done. if you don't find any rectal tumor there and the patient is young and there is an explanation for the bleeding, like hemorrhoids, then we can stop further investigation of rectal cancer symptoms.
for the patient it's extremely important not to go for several weeks with rectal bleeding without the medical examination. rectal bleeding is a very important symptom of rectal cancer. also a change in bowel habits is an important symptom of rectal cancer. if you had regular bowel habits and then suddenly you start to have some loose stools and some hard stools. and if you feel urgency and you have to go to the toilet very often. that could be a rectal cancer symptom. and if sometimes you empty only a little bit of stool and then maybe in 15 minutes of 20 minutes you have to go to the toilet again and you again empty a little bit of stool. then there could be something filling out the rectum. you may feel that it's stool (feces) but it could be a rectal tumor filling out your rectum. so tumor filling rectum is also leading to change in the bowel habits and frequent urgency to defecate. rectal bleeding and change in bowel habits, urgency to defecate - these are serious symptoms of rectal cancer. if you have them, you have to seek medical attention. dr. anton titov, md: colonoscopy has been recommended for people over 50 years of age to check for bowel cancer. what is recommended for rectal cancer as a screening tool? dr. torbjorn holm, md (rectal cancer surgeon, karolinska institute, stockholm): we have screening for colorectal cancer in sweden by fecal occult blood test. we do not have colonoscopy requirement for colon cancer screening. but if fecal occult blood test is positive, then colonoscopy is required. there is no specific screening for rectal cancer. screening is the same as for colorectal cancer. you have to remember that the median age for rectal cancer is about 68 to 70 years of age. but that means 50% of the rectal cancer patients are younger than medial age. so even people are in their 40s or 50s and if they have symptoms of bleeding from the rectum - we should have the digital rectal examination because it may be a symptom of rectal cancer. we have seen people as young as 20 years with rectal cancer symptoms. the youngest person we ever operated for rectal cancer in my own hospital was a girl of 13 years old with rectal cancer. so age is not definite excluding criterion for rectal cancer symptoms. you have to remember this.
dr. anton titov, md: i had a patient rectal cancer, a female physician of 50 years of age. she presented with very late stage rectal cancer. her symptoms of rectal cancer were bleeding and change in bowel habits. at that time her rectal cancer has already invaded the uterus, urinary bladder and even pubic bone. so it was very difficult to treat this patient with rectal cancer at very specialized medical center. rectal cancer treatment required complete removal of all pelvic organs (evisceration). late presentation of rectal cancer is a big problem. dr. torbjorn holm, md (rectal cancer surgeon, karolinska institute, stockholm): one of the big problem is that the patient seeks medical attention and usually they go to the primary care doctor. and not all primary care doctors have this knowledge [that all patients with rectal bleeding or change in bowel habits have to have digital rectal examination]. so even if a patient goes to see primary care doctor. and patient says: "i have a problem with bleeding from my anus when go to the toilet." this can be a rectal cancer symptom. doctors often say "it's hemorrhoids" and they prescribe suppositories and doctors don't even examine patient's rectum with a finger to feel if there is a tumor there. we have several such patients. they have been to the primary doctor maybe three or four or five times with rectal cancer symptoms [without correct diagnosis] eventually these patients are examined and have a rectoscopy or colonoscopy. we have to educate our primary care doctors. they always have to examine the patient [do rectal examination by finger]. if there is a symptom of rectal bleeding. this is very important. dr. anton titov, md: hemorrhoids are also very common. you can have hemorrhoids and something more serious cause of rectal bleeding, like rectal cancer, at the same time. hemorrhoids and rectal cancer symptoms can co-exist. dr. torbjorn holm, md (rectal cancer surgeon, karolinska institute, stockholm): absolutely correct. if you examine the patient, and you find hemorrhoids and the patient has no sign of rectal cancer and he's young and has no hereditary form of rectal cancer predisposition. then you can just leave the patient be. but a doctor should always examine [patient's rectum by finger] - this is very important.
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