Advertisement

Initial Presentation, Evaluation and Management of Acute Anorectal Malignancies

  • Anjali S. Kumar
Chapter

Abstract

Anorectal malignancies, while rising in incidence, are often difficult to detect. Because surgeons may be the only providers completing the patient’s three-part anorectal exam – including external exam, digital anorectal exam (DARE), and anoscopy/sigmoidoscopy – they have a responsibility to be sensitive to the patient’s vulnerable condition and to document all pertinent details. This article highlights key aspects of each step to note in practice. An anal exam under anesthesia should also be considered for patients presenting with acute pain, uncontrolled bleeding, or obstruction. Throughout these processes, intentional positioning and language use are key to optimize patient comfort and maintain trust in the provider-patient relationship.

Keywords

Anal cancer Anorectal malignancy Anoscopy Perineum Rectal cancer Rectal exam Regional anesthesia 

Notes

Acknowledgment

The authors gratefully acknowledge Mariah Conley for editorial assistance.

Suggested Reading

  1. 1.
    Abel GA, Shelton J, Johnson S, Elliss-Brookes L, Lyratzopoulos G. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. Br J Cancer. 2015;112(s1):S129.CrossRefGoogle Scholar
  2. 2.
    Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surg Clin. 2017;97(3):529–45.CrossRefGoogle Scholar
  3. 3.
    Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J. Rural and urban differences in stage at diagnosis of colorectal and lung cancers. Br J Cancer. 2001;84(7):910.CrossRefGoogle Scholar
  4. 4.
    Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. N Engl J Med. 2017;376(11):1054–63.CrossRefGoogle Scholar
  5. 5.
    Shuja M, et al. Bleeding in locally invasive pelvic malignancies: is hypofractionated radiation therapy a safe and effective non-invasive option for securing hemostasis? A single institution perspective. Cureus. 2018;10(2):e2137.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, editors. The ASCRS textbook of colon and rectal surgery. Cham: Springer; 2016.Google Scholar
  7. 7.
    Watson AJ, Smith BB, Whitehead MR, Sykes PH, Frizelle FA. Malignant progression of anal intra-epithelial neoplasia. ANZ J Surg. 2006;76(8):715–7.CrossRefGoogle Scholar
  8. 8.
    Yellu M, Deeb A, Olowokure O. Overview of recent trends in the management of metastatic anal cancer. World J Oncol. 2015;6(1):311–5.CrossRefGoogle Scholar
  9. 9.
    Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anjali S. Kumar
    • 1
  1. 1.Elson Clinical Education, Surgery, Elson S. Floyd College of MedicineWashington State UniversityEverett/Spokane/Tri-Cities/VancouverUSA

Personalised recommendations