This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 54-year-old woman with a very firm palpable nodule at the upper end of the anal canal on digital examination. It has some vascular changes that are similar to what we talked about in an earlier quiz, the SUTAB quiz for condyloma, but very firm to palpate. This is a small squamous cell cancer of the anus and anal cancer. Lesions like this, when they're small, have an excellent prognosis with treatment. The keys in the history were the firm palpable mass at the upper end of the anal canal. Condyloma can be bulky like this on occasion. Usually they're much flatter, but they usually don't have a firm, hard feeling to palpation. External thrombosed hemorrhoids are visible on perianal examination and wouldn't typically be palpated at the proximal end of the anal canal. Always important to keep in mind the opportunity, the potential to diagnose squamous cell cancer. So examining on the forward view, all the way back into the anal canal, and then performing retroflexion. Any unusual fullness or sense of mass should be carefully examined for the potential of squamous cell cancer. I think the greatest value of retroflexion in the rectum is the opportunity to diagnose benign pathology like hemorrhoids, hypertrophied, anal papillae, but also the very occasional squamous cell cancer of the anus.

54-year-old woman

firm palpable nodule

squamous cell cancer

early detection

retroflexion