Clinical Features

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Early anal canal malignancies usually cause nonspecific symptoms such as pruritus, pain, and bleeding admixed with stool. Ihe sensation and presence of a lump in the anal canal may be erroneously diagnosed as a hemorrhoid. As the neoplasm progresses, the patient experiences anorexia, weight loss, constipation, narrowing of the caliber of the stool, and eventually tenesmus with or without bowel movement. Complete obstruction may also occur.

Anal canal tumors may produce partial rectal prolapse; hemorrhoidal dilatation and prolapse may also occur. More advanced malignancies may present as perirectal abscesses or fistulas.

Villous adenomas, which arise from the rectal columnar epithelium, frequently produce diarrhea and a profuse rectal discharge, with secondary excoriation of skin and pruritus. Patients may suffer a significant loss of electrolytes, resulting in a clinically significant hypokalemia and/or hyponatremia.

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