Diagnosis of anal carcinoma--doctor's finger still the best?

Symptoms, delay in diagnosis, tumour stage and the clinical value of a follow-up programme were studied in 107 patients admitted to the Norwegian Radium Hospital for anal canal carcinoma. Sixty percent of the patients had advanced tumours (T3 or T4) at the time of diagnosis, while 1/4 presented with metastases to the pelvic lymph nodes and 5% with distant metastases. The most frequent initial symptoms were anal bleeding and pain (38 and 23%, respectively). About 3/4 of the patients experienced more than 1 month's delay of diagnosis, either because of the patient himself (1/2 of the cases), doctor (1/5 of the cases) or hospital (1/10 of the cases). About 1/3 of the patients had more than 6 months' total delay. The follow-up after treatment (chemoradiotherapy) shows that frequent digital rectal examination is the most important procedure. Some patients may benefit from serum carcino-embryonic antigen measurement, liver ultrasonography or chest X-ray.