For the past nine months, my stools have been rather small and thin. I have felt a fleshy growth about two inches into my rectum, which seems to be blocking things. There's no blood in my stool. I had a blood test, and it showed nothing (no anemia). Could this be a tumor? A skin tag or inflammation? I have no family history of any type of cancer, and nobody thinks I could have cancer at my age (19). Should I worry?

H.

Your complaint of small, thin stools is somewhat concerning. When gastroenterologists hear this symptom, we suspect that something may be obstructing the colon, impeding the flow of stool. Obviously, the most worrisome source of an obstruction would be cancer.

The presence of bleeding, weight loss, anemia, a history of polyps or a family history of colon cancer would all increase the suspicion of cancer, but you have none of these factors. You are also very young for colon cancer, which generally occurs after age 50. Also, the presence of your symptoms for nine months would argue against a diagnosis of cancer. Keep in mind that exceptions to the rule do occur, and it is impossible to rule out cancer without a proper examination.

Other processes can lead to rectal obstruction. The fleshy growth you feel could be a skin tag, as you mentioned. It could also be a large hemorrhoid which has thrombosed (clotted). These are generally painful, but not in all cases. You could also have a benign polyp (known as a hyperplastic or juvenile polyp) in the rectum, which can cause obstruction.

In any case, it is important for you to be examined by a doctor. He will be able to see any external abnormalities, and to feel internal ones when he performs a digital rectal examination. You may also need a proctoscopy or flexible sigmoidoscopy, both of which involve visual examination of the rectum. The therapy for your problem will depend on what is found.