Diarrhea with blood, pus and mucus may simply indicate the presence of an ulcer. The blood indicates the effect of the disease generally upon the system in the form of anemia There is a decrease in hemoglobin and the leukocytes is more marked in sarcoma than in carcinoma. The urine in these subjects does not reveal any pathological chemical, or morphological elements which are of any practical value in the diagnosis.

Sarcoma almost invariably is found within the lower two and a half inches of the anal orifice and is very rarely found higher up. The disease is of much more rapid growth than cancer and has a distinct tendency to ganglionic infection in the rectum. The lymphatic glands are involved early and when the disease is located in the anal orifice the inguinal glands will be the first to become enlarged. When the sarcoma involves the rectum higher up the presenter or the hypo gastric lymphatics will be attacked first. The growth in the rectum may itself be a metastatic deposit, due to the great tendency of this disease to their formation.

The liver, as it is in a direct line of infection through the portal circulation, is frequently the seat of secondary infection. The disease may be either primary or secondary, the latter due to metastases from growths in some other portion of the body. When hemorrhage occurs into one of these tumors the dark appearance may cause one to mistake it for the melanoma type. The melanoma change may occur in any of the different types of carcinoma by the deposit of melanin in the tumor, giving it color and causing one to mistake it for a sarcomas neoplasm in which a hemorrhage has taken place.Syphilitic lesions of the rectum in the form of stricture or gamma may resemble sarcoma. Syphilitic stricture is generally preceded by a long period of ulceration, while sarcoma develops within a year or two and is a hard, inaugurated, rapid growth which does not ulcerate until late in the disease. Summat are flat masses which are not tumor-like nor so extensive as sarcoma; and they do not involve the adjacent organs or produce metastases. A history of syphilis obtained from the patient may clear up the diagnosis. In doubtful cases microscopic examination of a specimen of the tissue for the spirochete or the sarcomas elements should be made.

Syphilis is usually manifested in some other portion of the body and usually the entire rectum is involved in the form of a proliferating inflammation uniformly distributed throughout the rectum. There is diarrhea from the beginning, profuse discharge of pus, mucus, little pain, the protruding mass is without in durations and is soft to the touch. Cancer more than sarcoma somewhat resembles syphilis.

Tuberculosis of the rectum, in the form of glandular swellings, are sometimes confused with lymph-sarcoma A history of tuberculosis at some other portion of the body, or the family history of the patient, will aid in the diagnosis. Tubercular glands are slower in development than sarcoma and are more sensitive and irregular in shape.

The examination of the feces in cases of sarcoma reveals nothing beyond the peculiar shape of the fecal mass due to compression by the growth, excepting when ulceration exists.

Treatment. The treatment of sarcoma should be a radical operation, as the metastatic tendency of the growth makes it certain that by the time the diagnosis has been made, an involvement of some of the surrounding tissue has taken place. These tumors cannot be benefited by a removal of the mass by ligature, but require the same radical surgical procedures laid down for extirpation as recommended for cancer of the rectum.