Hemorrhoids and rectal cancer are both diseases that occur at the end of the rectum, but they are very different in the degree of damage they cause to human health. However, both diseases are mostly manifested as blood in the stool, which is why rectal cancer is often misdiagnosed as hemorrhoids in clinical practice, thus delaying the favorable treatment time for rectal cancer patients and leading to incurable painful lessons. According to statistics, more than 90% of rectal cancers are misdiagnosed as hemorrhoids in the early stage. So as ordinary people, how should we distinguish rectal cancer and hemorrhoids? I. Hemorrhoids and rectal cancer are two very different diseases Hemorrhoids and rectal cancer are two very different diseases in terms of pathogenesis and mechanism, and the harm to human body is also very different. The anus is the end of the human digestive tract, and hemorrhoids are one of the common benign diseases in this area, which can be divided into internal and external hemorrhoids depending on where they occur. So what exactly is a hemorrhoid? They are caused by a variety of reasons that lead to venous congestion, blood accumulation, and increased pressure in the veins of the lower rectum and anal canal, or by weakness in the walls of the veins, resulting in the enlargement and varicosity of the veins and the formation of a venous mass called a “hemorrhoid”. The most common term for hemorrhoids is external hemorrhoids, because they can be seen directly around the anus by the naked eye or can be touched by yourself. Internal hemorrhoids, on the other hand, occur within the anus and cannot be seen from the surface of the body, and can only be examined by a doctor during an anal examination. Blood in the stool is the most common symptom of hemorrhoids. Most asymptomatic hemorrhoids do not require any treatment and do not have much effect on a person’s health. The rectum is a section of the digestive tract about 12-15 cm long within the anus, which is directly connected to the anus at the end. Don’t underestimate this 12-15cm long digestive tract, cancer occurring here is a common malignant tumor in the gastrointestinal tract, second only to stomach cancer and esophageal cancer in terms of incidence. Rectal cancer can be completely cured by early detection and timely treatment; however, if not diagnosed and treated early, it can be life-threatening. The majority of rectal cancer patients are above 40 years old, about 15% are under 30 years old, and men are more common than women, and Chinese rectal cancer mostly occurs in the middle and lower rectum. In recent years, with the improvement of people’s living standard and the increase of high protein and high fat food intake, the incidence of colorectal cancer is gradually increasing. Blood in stool, increased frequency of stool and thinning of stool are the common symptoms of rectal cancer. Why hemorrhoids and rectal cancer are easy to be confused Because of the similarity of the sites of hemorrhoids and rectal cancer, the most common symptom of both of them is blood in stool, so when some symptoms are crossed or atypical, the clinical diagnosis is often confused. And wrong diagnosis is not uncommon, especially when two diseases coexist, after the examination and discovery of hemorrhoids, it is limited to the treatment of hemorrhoids, without comprehensive examination, and cannot come up with a comprehensive and correct diagnosis, which may delay the diagnosis of rectal cancer and miss the best time for treatment. How to distinguish rectal cancer from hemorrhoids 1. Blood in the stool This symptom is common to both diseases, especially internal hemorrhoids, where the hemorrhoids themselves cannot be seen on the body surface, thus becoming the main reason for distinguishing between the two diseases. However, if you look carefully at the characteristics of the blood in the stool of these two diseases, you can initially distinguish them if you are careful. Patients with hemorrhoids have blood in their stools, usually “passive” bleeding. This is because when defecating, the stool grazes the affected area of the hemorrhoid (varicose veins), and most of the blood is dripping down with the stool, so it does not mix with the stool, and there is no mucus present, so it is usually blood on the surface of the stool, and blood on the hand paper after the stool. The color of blood in stool is mostly bright red. The bleeding of rectal cancer is “active” bleeding, because the surface of the tumor itself breaks down and bleeds or oozes blood continuously. In addition, because rectal cancer is often located higher than internal hemorrhoids, when stool is stored in the rectum, it will mix with rectal cancer bleeding, resulting in blood mixed in the stool. It can be seen that the blood in the stool of rectal cancer is old bleeding, so the color of blood is mostly dark red or jam color, and even the blood in the stool turns black after a long time. At the same time, because rectal cancer destroys the rectal mucosa and produces mucus secretion, as well as secondary local infection and pus, the stool itself also carries mucus and pus, the latter is also known as pus and blood stool. 2. Age of onset In the age of onset, the characteristics of the two diseases are also very different. Hemorrhoids may occur in people of any age, while patients with rectal cancer are mostly middle-aged (>40 years old) or elderly. 3. Accompanying symptoms As mentioned above, hemorrhoids are varicose vein masses, so blood in the stool is mostly painless and intermittent, and sometimes there are lumps (vein masses) prolapsing from the anus. For prolapsed hemorrhoids, finger pressure is soft and, like veins in other parts of the body, can be squashed, or pushed back into the anus. If an internal hemorrhoid prolapses for a long period of time, it can become painful and hard, due to the formation of a blood clot within the varicose vein mass. As a solid tumor, rectal cancer is fixed in position and hard in texture, and usually does not appear to prolapse out of the anus. However, because of the fixed growth of rectal cancer in the rectum, it will lead to stiffness and pressure on the rectal wall, resulting in increased frequency of stool, anal swelling, urgency and heaviness, and bowel movement soon after defecation, but no or only a small amount of stool; further growth will also lead to narrowing of the rectal lumen and even partial blockage of the rectum, resulting in difficulty in defecation and thinning of stool, etc. A few patients will also experience abdominal pain and bloating due to rectal obstruction. A few patients may also experience abdominal pain and bloating due to rectal obstruction. In contrast, hemorrhoids will rarely cause these symptoms. When rectal cancer reaches the advanced stage, it will also cause frequent urination, abdominal pain and pelvic pain due to tumor invasion of surrounding tissues and organs; when tumor consumes human body for a long time, it will cause anemia, weight loss and fatigue. Examination 1. Basic examination Rectal finger examination is the most basic, simple and effective examination method to distinguish two diseases. This examination method is that the doctor will stick his finger into the anus and examine the mucous membrane around the rectum based on the finger touching it to come up with a preliminary diagnosis. If you feel a raised pellet inside, it may be a hemorrhoid. If you feel a cauliflower lump in the intestine or an ulcer with a raised edge and a sunken center, or if there is a combination of intestinal stricture; if there is blood, thick fluid and mucus on the finger sleeve after the examination, then you should highly suspect rectal cancer. This examination method is simple and easy to use in clinical practice, and generally speaking, anal finger examination can detect more than 75% of rectal cancer, which is a common screening method. However, due to the length of the doctor’s finger, it is difficult to reach the tumor in the upper rectum. 2.Important examination For rectal masses found by rectal finger examination and patients with highly suspected rectal or colon tumors, colonoscopy or examination should be performed. This examination method is to put a thin fiber optic mirror deep into the rectum and colon to transmit the internal situation of the intestine clearly to the monitor for the doctor to find the tumor with the naked eye under “direct vision” and to make a preliminary diagnosis of the nature of the tumor. In addition to the colonoscopy, a specimen of the tumor can be sampled through the colonoscope, i.e. biopsy. Simple sigmoidoscopy can detect almost all rectal cancers, so it is called the “golden eye” to detect rectal cancer. 3.Confirmation examination The tumor specimens obtained by colonoscopy or other examinations will be observed under the microscope after the necessary processing, and the shape of the obtained tissues and cells will be observed, and the pathological diagnosis will be confirmed. In fact, as long as the patient is alert, early detection of rectal cancer is entirely possible. Moreover, under the existing medical conditions, rectal cancer is not terrible, and many malignant tumors occurring in the colon or rectum have very satisfactory results if they can be diagnosed and treated early, but what is terrible is that they cannot be detected early or misdiagnosed as hemorrhoids. Therefore, for patients with blood in the stool, whether they have hemorrhoids or not, they must go to the hospital and ask their doctor to examine them. For patients who have previously been found to have hemorrhoids and who have been suffering from symptoms such as bloody stools for a long time, it is even more important to go to the hospital for regular reviews, making sure to first rule out other diseases of the intestines before treating them according to hemorrhoids. During the treatment of hemorrhoids, if the symptoms do not improve significantly for a long time or if blood in the stool occurs repeatedly, it is best to ask your doctor to perform a rectal finger examination as well as a colonoscopy. The distinction between hemorrhoids and rectal cancer can be made even in primary care institutions, and the diagnosis can be confirmed clinically with some simple tests, such as anal finger examination, sigmoidoscopy, biopsy and pathological examination, etc. The cost is not high, so don’t let a small hemorrhoid delay the diagnosis and treatment of rectal cancer and other diseases.