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Carcinoma of the rectum.
A 53 year old man who presented with a one month history of rectal bleeding. The tumour was easily palpated immediately inside the anal canal. The biopsy confirmed an adenocarcinoma.
The patient decline conventional medical management and for 15 months went through various courses of coffee enemas and similar treatments. Eventually the pain from the local infiltration of the tumour into the pelvis became too much for the patient and he underwent radiotherapy followed by abdomino-pelvic excision of the rectum.
The photograph shows the ulcerating lesion which extends to immediately above the anal canal.
Peter Devitt, Adelaide, Australia

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