A healthy 48-year-old male visits his primary care physician to establish care. His medical record indicates no prior preventive screenings for gastrointestinal malignancies, and he has no family history of cancer. When counseled on available screening modalities, he explicitly requests a noninvasive stool-based test. Arrange the subsequent clinical interventions and findings in the correct chronological order, from the initial screening to the appropriate long-term surveillance interval.
- 1Perform a baseline fecal immunochemical test (FIT)
- 2Perform a diagnostic colonoscopy
- 3Perform a polypectomy of a 15-mm lesion in the descending colon
- 4Confirm the histopathologic diagnosis of a tubulovillous adenoma
- 5Recommend a surveillance colonoscopy in 3 years
Answer
The correct sequence is: 1) Fecal immunochemical test (FIT), 2) Diagnostic colonoscopy, 3) Polypectomy of the 15-mm lesion, 4) Histopathologic diagnosis of a tubulovillous adenoma, and 5) Surveillance colonoscopy in 3 years.
The clinical progression follows the standard algorithm for average-risk colorectal cancer screening. It begins with the initial age-appropriate screening test (FIT). A positive result triggers a diagnostic structural exam (colonoscopy). During the exam, therapeutic and diagnostic interventions are performed (polypectomy). The tissue must then be analyzed (histopathology) to risk-stratify the patient. Finally, the pathologic findings (a 15-mm tubulovillous adenoma, which classifies as an advanced adenoma) dictate the next step in long-term preventive care, which is a 3-year surveillance colonoscopy.
Step-by-Step Solution
Key Concept
Colorectal cancer screening modalities and post-polypectomy surveillance intervals based on adenoma characteristics.