When physicians exam the rectum with a gloved finger, they are unlikely to find a real tumor and more likely to refer patients unnecessarily for further tests. Digital rectal exams are a poor way to accurately identify rectal cancer according to a recently published study from the United Kingdom.
Doctors reviewed all referrals made to the the urgent colorectal cancer system at University Hospital of North Staffordshire because of a palpable rectal tumor between May and December of 2006. Of 1,069 referrals to the system, 108 were for rectal tumors that general practitioners reported they felt during a digital rectal examination.
However after further testing, only 32 or those 108 exams actually was a rectal tumor.
And 10 tumors, potentially within reach of the examination, were missed by referring general practitioners.
Considering those referrals that actually were not tumors and the missed tumors, accuracy for digital rectal exam in finding very low rectal cancer was 29 percent.
The research team, led by C. W. Ang concluded,
Digital rectal examination in primary care for palpable rectal tumour has a sensitivity of 0.762, specificity of 0.917, positive predictive value of 0.296 and negative predictive value of 0.988. It is an inaccurate procedure and a poor predictor for palpable rectal tumour.
In the Guidelines for Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps published in the US in March, 2008, the panel warned,
Screening for colorectal cancer with guaiac-based FOBT in the office following digital rectal exam or as part of a pelvic examination is not recommended and should not be done.
SOURCE: Ang et al., Colorectal Disease, Volume 10, Number 8, October 2008.
September 30, 2008 at 8:31 am, Deborah Kanter said:
“Accurate digital rectal examination (DRE) enables the early diagnosis of palpable rectal tumour.”
The first sentence of the abstract is key here. Perhaps the digital rectal exam needs to be reevaluated as part of the traditional annual physical.
What might replace it? Will increased blood tests be a part of an exam?
Let’s hope that when oncologists perform the often dreaded “finger exam,” it is a helpful and accurate predictor; especially in longer term survivors.
October 01, 2008 at 1:08 pm, Ruthie Pfueller said:
My cancer was discovered “accidently” when i went to my docotr for an aggreviated tailbone. He inserted his finger to adjust the joint to recieve a cortizone shot and I nearly came off the table screaming from the pain. AT this point he questioned me anout my bowl habitis ande made the decision to do a scope.
I went in for scope on Wednesday, had surgery on Friday and started my chemo and radation a few weeks later. BTW, I am 5 years post with clean bill of health, from my stage 2 colon rectal cancer, and if not for that accidental discovery, I may have died from it because I DID NOT KNOW the syptoms of colon rectal cancer.
I don’t remeber ever seeing a commercial listing the symptoms of colon rectal cancer. All I can remember knowing before my diagnosis is that you should eat lots of fiber. So awareness IS crucial.
October 01, 2008 at 1:38 pm, Kate Murphy said:
I think the point of the research is that digital rectal exam is just not a good test for detecting rectal cancer and is rarely an accurate predictor of whether someone has rectal or colon cancer.
As to what will replace it — it has already been replaced by the recommended screening tests for colorectal cancer: FOBT, DNA stool test, flexible sigmoidoscopy, barium enema, CT colonography, or colonoscopy.
People without symptoms of colorectal cancer should discuss the sensitivity and risks of each of those tests with their doctors and how often to do them. DRE should not be considered a screening test.
Patients with any symptoms of colorectal cancer should have them evaluated by colonoscopy, no matter their age.
Colorectal cancer can be prevented with screening.
November 27, 2008 at 5:28 pm, Oluokun Olutayo said:
i ve been having bowel symptoms.An episode of faecal impaction being the very 1st suggestion then abnormal faeces- Smell,color-brownish yellow to deep brown. Progressive constipation ,Now straining to pass even very loose soft stools.No longer passing had stools since i inreased my water intake.My doctor performed a digital rectal and told me there was nothing to fear.But i think i felt a mass when i used my middle finger-which is longer to perform d rectal exam on myself. I have low back pain and once had an episode of associated severe scrotal pain. No gross appearance of blood,no weight loss,No anorexia. My Doctor prescribed Mebeverine, but i can’t find it. I am 27YEARS OLD with no family history.Could i have a rectal tumor not witin reach of the examining finger.Would i need a scope ?How sensitive is the CEA test?
November 28, 2008 at 8:49 am, Kate Murphy said:
A digital rectal exam is not enough to discover rectal tumors. You need a colonoscopy to rule out tumors higher up in your colon.
Please don’t try to feel for masses yourself. You can’t feel them and might scratch delicate rectal tissue.
There are many reasons for constipation, most of them not due to colon or rectal cancer. Colorectal cancer is rare in young people, but it does exist. So a diagnostic examination is necessary to find out what is going on.
Mebeverine is sold under the brand name Colofac which may help you find it. It reduces intestinal spasms and can be prescribed for irritable bowel syndrome (IBS).
Talk to a gastroenterologist — a specialist in intestinal disorders — about your symptoms and to perform a colonoscopy.
The gastroenterologist can also help with diet and medicine to help with constipation once colorectal cancer has been ruled out.
March 22, 2009 at 3:15 pm, Suzanne said:
In my particular case, diagnoses were assumed, not developed through a thoughtful process of compiling data from history/examination/diagnostics.
I found my own anal canal carcinoma by digitally doing my own rectal examination. I discovered an olive size mass just inside of the anal sphincter.
A recent colonoscopy didn’t discover the cancer. A 2nd opinion thought it was a thrombosed hemmorhoid. Only on insistance of it’s removeal did they find out it was cancer. I had a gut feeling all along. Seek out 2nd/3rd opinions. Advocate for yourself!