A 46-year-old man with average risk for colorectal cancer presents for a routine health maintenance examination. He expresses a preference for noninvasive testing options. Assuming abnormal findings at each stage of evaluation, arrange the following clinical steps in the most appropriate chronological order for his screening and subsequent management.
- 1Prescribe a high-sensitivity fecal immunochemical test (FIT) for initial screening.
- 2Receive a positive FIT result indicating the presence of occult lower gastrointestinal bleeding.
- 3Perform a diagnostic colonoscopy to directly visualize the colonic mucosa.
- 4Detect and completely resect a 15-mm tubular adenoma during the endoscopic procedure.
- 5Recommend a repeat surveillance colonoscopy in 3 years based on high-risk adenoma criteria.
Answer
The correct sequence is: prescribe a high-sensitivity FIT, receive a positive FIT result, perform a diagnostic colonoscopy, completely resect a 15-mm tubular adenoma, and recommend a surveillance colonoscopy in 3 years.
The management cascade for colorectal cancer screening begins with initiating age-appropriate screening. At age 46, average-risk patients are eligible for screening. Given the patient's preference for noninvasive options, prescribing a high-sensitivity FIT is the correct initial step. A subsequent positive FIT result indicates lower gastrointestinal bleeding and mandates a direct diagnostic colonoscopy to locate the source. During the endoscopic procedure, suspicious lesions such as a 15-mm tubular adenoma are identified and safely resected. Finally, the histopathology and size of the resected polyp dictate future surveillance. A tubular adenoma measuring ≥ 10 mm is classified as an advanced adenoma, which necessitates a follow-up surveillance colonoscopy in exactly 3 years according to the US Multi-Society Task Force on Colorectal Cancer guidelines.
Step-by-Step Solution
Key Concept
Colorectal cancer screening cascade and adenoma surveillance guidelines
Estimated Time:1m 0s