Blood on toilet paper and mixed in extreme distal portion of stool.

I am a 25 year old caucasian male. I have no known family history of GI malignancies and no known personal medical history. Starting on 12/16/06, I noticed some bright blood stained or mixed into the last portion of the stool. There was also a decent amount of bright red blood on the toilet paper. The first episode yesterday had blood on the paper, and what appeared to be 2 blood clots that had been deposited onto the stool. Today, I noticed that the end of the bowel movement,approximately 1" worth had what appeared to be blood mixed into it. There was also a decent amount of blood on the toilet paper. I have no other symptoms GI or otherwise, stool diameter, bowel habits, appetite are all unchanged. No pain during defecation either.
1. Considering the factors that I have described above, what are some possible diagnoses, and most importantly,how likely is malignancy a possibility in my case, taking into account the history and symptoms I have described?
2. Would a colonoscopy be indicated in my setting, or would sigmoidoscopy or anoscopy suffice?
3. What proportion of people with my symptoms, age, history, and presentation actually end up having of the GI tract?

Many thanks in advance for your responses

[Kevin Pho, MD]

To answer your questions:
1) Hemorrhoids, an anal fissure, diverticulosis, a polyp, or inflammatory bowel disease can all be considered.

2) I would consider a sigmoidoscopy at the very least.  A colonoscopy can also be considered for a more thorough evaluation.

3) Colon cancer is unlikely in your age group.  However, it is possible and thus, should be evaluated with an endoscopy.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_