Both hemorrhoids and colon cancer occur in the large bowel or below and present with bleeding per rectum. But the similarities stop there. The colon consists of the caecum, ascending colon, transverse colon, descending colon, and sigmoid colon. The sigmoid colon is continuous with the rectum. Rectum is connected to the anal canal. Colon cancers can occur at any site while hemorrhoids occur in the anal canal. This article will talk about hemorrhoids and colon cancer in detail, highlighting their clinical features, symptoms, causes, investigation and diagnosis, course of treatment, and also the differences between both.
There are three major soft tissue areas in the anal canal which bulge into the lumen of the anal canal when engorged with blood. These are called anal cushions, and they are located at 3, 7, and 11’ o clock positions when the patient is lying supine. When these anal cushions are engorged with blood they are called hemorrhoids. Hemorrhoids are classified into three degrees. First degree hemorrhoids are symptomatic and visible only during proctoscopy. Second degree hemorrhoids come out while straining, but returns inside afterwards. Third degree hemorrhoids are always outside. These may get strangulated and cause pain. Hemorrhoids present with fresh bleeding per rectum. They are normally painless unless strangulated or thrombosed. Sigmoidoscopy is indicated to exclude other associated pathologies. Sclerotherapy, banding, ligation, and hemorrhoidectomy are the available treatment options.
Colon cancers present with bleeding per rectum, feeling of incomplete evacuation, alternative constipation, and diarrhea. There may be associated systemic features such as lethargy, wasting, loss of appetite and loss of weight. When a patient presents with such symptoms, a sigmoidoscopy or a colonoscopy is indicated. Using the scope, a small piece of the growth is removed to be studied under the microscope. Cancer spread should be assessed to decide on treatment methods. Imaging studies like magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound scans help assess the local and distant spread. Other routine investigations should also be done in order to assess the fitness for surgery and other relevant factors. Full blood count may show anemia. Serum electrolytes, blood sugar levels, liver and renal function should be optimized before surgical procedures.
There are special tumor markers which can be used to detect the presence of a colon cancer. Carcinoembryonic antigen is one such investigation. Most of the colon cancers are adenocarcinomas. There are many risk factors for colorectal cancers. Inflammatory bowel diseases (IBD) lead to cancer due to a high rate of cell division and repair. Genetics play a key role in carcinogenesis because with rapid cell division the chance of cancer gene activation is high. First degree relatives with colon cancers suggest a significantly higher chance of getting colon cancers. There are genes called proto-oncogenes, which result in malignancies if a genetic abnormality transforms them into oncogenes.
Treatment plan varies according to the stage of the cancer. The classification currently used for colon cancer staging is the Duke Classification. This classification takes into consideration the presence or absence of metastasis, regional lymph node, and local invasion. For localized cancers, the curative treatment option is complete surgical resection with adequate margins to either side of the lesion. Localized resection of a large bowel segment can be done via laparoscopy and laparotomy. If the cancer has infiltrated lymph nodes, chemotherapy increases life expectancy. Fluorouracil and Oxaliplatin are two commonly used chemotherapeutic agents. Radiation is also of significant benefit in advanced disease.
What is the difference between Hemorrhoids and Colon Cancer?
• Hemorrhoids are not malignant while colon cancer is.
• Chronic constipation and low fiber diet precipitate hemorrhoids while it is not so for colon cancer.
• Hemorrhoids present with fresh bleeding per rectum while the blood is slightly old in colon cancer.
• In hemorrhoids, blood appears on the stools and the toilet pan while in colon cancer blood is mixed with stools.
• Colon cancer may cause constipation as well as diarrhea while constipation precedes hemorrhoids.
• Sigmoidoscopy is indicated in both conditions.
• Surgery is the treatment of choice for colon cancer while hemorrhoids can be managed conservatively for a while.
Difference Between Piles and Hemorrhoids