Can rectal cancer present as wall thickening of the distal rectum on ct?

Possibly: But so can non-specific inflammation cause the same thickening. Needs a physical exam, sigmoidoscopy and maybe a biopsy to tell. Ct scan findings of the rectum can be non-specific and needs the physical examination to tell more.

Certainly: While thickening is a non-specific sign, it could represent a malignant tumor (cancer) of the upper rectum. A colonoscopy should be recommended to evaluate this.